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PubMed1990

[Peridural analgesia in the combined treatment of neurologic syndromes in lumbar osteochondrosis].

The authors relate the results of the treatment of 151 patients with the remarkable painful syndrome of long standing associated with lumbar osteochondrosis. In 74 patients of the main group, peridural administration of the synthetic opiates dipidolor and phentanyl provided effective analgesia in the lack of sympathetic denervation, arterial hypotension and tissue deafferentation. The selective action of the synthetic morphine-like opiates did not reduce the activity of the endogenous antinociceptive structures or destroyed the reflex mechanisms of sanogenesis. The economic effect obtained as a result of introduction of peridural injections of dipidolor and phentanyl into multimodality treatment of the neurological syndromes associated with lumbar osteochondrosis has been computed.

Analgesia, Epidural↗
PubMed1990

[Critical aspects of an outside evaluation of postoperative pain in infants. A placebo-controlled double-blind study of the question of the reliability and validity of the measurement system].

Postoperative analgesia in infants and young children is a topic of growing interest in pediatric anesthesia. Two systems measuring postoperative pain in this group of patients have been offered recently: CHEOPS (Childrens Hospital of Eastern Ontario Pain Scale) by McGrath et al. and OPS (Objective Pain Scale) by Hannallah et al. and Broadman et al. [3, 7, 8]. Both systems are economical and not reactive, but their validity is not satisfying. The validity of CHEOPS is based on the statements of experienced nurses, using the method of convergent validation by an expert's assertion. Hannallah and Broadman et al. judged the validity of their objective pain scale for infants and young children by statements of juveniles between 13 and 18 years of age. McGrath et al. accepted the item of spontaneous verbal communication as useful in the CHEOPS, although no such verbal comment occurred in their study on interrater and inter-item correlations. The aim of the present study was to evaluate the statistical qualification of items for measurements of the intensity of postoperative pain in young children and to investigate some aspects of their validity. MATERIAL AND METHODS. The study was performed in 54 children of ASA groups I and II aged 29.2 +/- 10.7 months. They were included in the study if they were pain-free before the operation and had no signs and symptoms of neurologic disease. The following operations were accepted: herniorrhapy, orchidopexy, circumcision, and umbilical herniorrhaphy. Premedication and general anesthesia were standardized. The patients were premedicated with midazolam 0.5 mg/kg rectally and subsequent intramuscular injections of ketamine 2.0 mg/kg with atropine 0.01 mg/kg. Anesthesia was induced and maintained by inhalation of oxygen/nitrous oxide and halothane (FiO2 0.3). All children were intubated and ventilation was controlled during the operation. After the operation and under steady-state anesthesia with 0.5 vol.% halothane and spontaneous respiration, the children received either nalbuphine 0.1 mg/kg, piritramide 0.1 mg/kg, or placebo in a randomized and double-blind manner. Respiratory and circulatory parameters were recorded for 15 min before anesthesia was discontinued. Five minutes after halothane had been discontinued the first measurement of the childrens' behavior was started with four subsequent measurements at fixed time intervals of 15 min. The measuring system was based on the six items of CHEOPS complemented by five items related to the waking state because it was assumed that the waking state generally modulates the child's ability to demonstrate pain. The design of the study was accepted by the ethic committee with the provision that neither a sedative nor an analgesic drug should be withheld from any child if indicated. Therefore, all children who seemed to feel discomfort according to the subjective impression of the anesthetist received midazolam intraveneously to a maximal dose of 2 mg. All the behavioral data were included in a factor analysis (principal components)...

Child, Preschool↗
PubMed1990

[Nalbuphine and piritramid in the postoperative phase in young children. 1. General condition].

The influence of piritramide and nalbuphine versus placebo on the postoperative comfort of 54 children of ASA-group I and II in the age between 1 and 4 years was tested in a randomized double blind trial using the comfort/discomfort scale according to Büttner et al. METHODS. Operations, premedication and anesthesia were standardized. The patients were premedicated with midazolam 0.5 mg/kg rectally and a subsequent i.m. injection of ketamine 2.0 mg/kg with atropine 0.01 mg/kg. Anesthesia was induced and maintained by inhalation of oxygen/nitrous oxide and halothane (FiO2 = 0.3). All children were intubated and ventilation was controlled during the operation. After the operation, while in steady-state anesthesia with 0.5 vol% halothane and during spontaneous respiration the children received either piritramide (n = 17) or nalbuphine (n = 20) at a dose of 0.1 mg/kg, or placebo (n = 17) i.v. Respiratory and circulatory parameters were recorded for 15 min before the end of anesthesia. At 5 min after halothane had been discontinued the first measurement of the children's behavior was started, with 4 subsequent measurements at fixed time intervals of 15 min. The measuring system included the following 6 scaled items: wake-up reaction, methodical defense against stimuli, crying, facial expression, posture of the torso, posture of the legs. In addition, the waking state was scored at the same time intervals as awake, arousable, or not arousable. During the 1-h observation period all children who seemed to feel uncomfortable received midazolam i.v. at a maximal dose of 2 mg. Up to 24 h the required supplemental analgesics were noted, as were episodes of psychomotor agitation and vomiting. Written consent was obtained from the ethical committee and the children's parents. The results were tested in a 2-factorial analysis of variance (treatment factor: drugs; within-subject factor; repeated measurements). RESULTS. The 3 groups were considered to be comparable in terms of age, body weight, kind and duration of operation and circulatory values. The use of supplementary analgesics showed a significant effect in the treatment factor and in the within-subject factor: during the 1-h observation period the placebo group received midazolam significantly more often (64.7%) than the piritramide group (5.9%) or the nalbuphine group (35%). During the following 7 h 29.4% of the children of the placebo group required supplementary analgesics (piritramide: 23.5%; nalbuphine: 20%). Subsequently up to the 24th postoperative hour there was no need for any analgesic in the placebo group, whereas 11.8% of the piritramide group and 15% of the nalbuphine group required analgesics.(ABSTRACT TRUNCATED AT 400 WORDS)

Child, Preschool↗
PubMed1990

[Nalbuphine and piritramid in the postoperative period in young children. 2. External respiration].

The use of opioid analgesics often seems to be necessary for postoperative analgesia in small children. There is a risk however, that interactions between anesthetics and the opioid analgesics may cause significant respiratory depression. There is no reliable information about the influence of nalbuphine and piritramide on respiration in small children. Therefore, the actions of nalbuphine and piritramide versus placebo on the respiratory patterns of 46 children in ASA groups I and II and aged between 1 and 4 years were tested in a randomized double blind trial. METHODS. Selection criteria were: no disturbed development, no signs or symptoms of neurological disease, uncomplicated operation, no pain at time of admission, no indication for urgent operation, written parental consent. Operations, premedication and anesthesia were standardized as mentioned in the comparison paper. Anesthesia was induced and maintained with oxygen in nitrous oxide and halothane (FiO2:0.3). Intubation was performed without the use of any relaxant. Postoperatively the ventilation was continued with the same FiO2 and with 0.5 vol% of halothane over a period of at least 20 min until spontaneous breathing was reestablished and stable ventilatory parameters were obtained. A single bolus injection of either nalbuphine or piritramide 0.1 mg/kg or a placebo was then given i.v.. The breathing parameters VT, VI, respiratory rate, maximal inspiratory flow and the inspiratory/expiratory time ratio were evaluated using the computer-assisted pneumotachometric device with hot wire anemometers (Büttner et al.). They were measured before and 2, 5, 10 and 15 min after the drugs were administered. Capillary blood-gas values were sampled before and 10 min after administration of the drug and again 5 min after extubation. Heart rate and blood pressure were recorded by means of a Dinamap monitor. Statistical analysis of the data was carried out by means of the chi 2-test or Fisher's exact test when appropriate. For the metric data analysis of variance was performed. A full factorial design was calculated with drugs and time after injection as factors and baseline values as a covariate. Multiple comparisons were performed using the Tukey test. The level of significance was set at P less than 0.05. Homogeneity was considered when p greater than 0.2. RESULTS. In spite of randomization the 3 groups could not be regarded as homogeneous for weight. In 4 of the 46 children apnea developed after drug administration and controlled ventilation was needed. These were all in the piritramide group. This result was significant against nalbuphine and placebo. There was no significant correlation between the apnea and any anamnestic, demographic or respiratory parameters. Since apnea and breathing constitute different qualities, a pooling of the apnea data and the non-apnea data within the piritramide group is not allowed...

Child, Preschool↗
PubMed1990

[Bronchoscopy in ventilated patients: full narcosis or local anesthesia?].

In a prospective, randomised trial bronchoscopy was performed either in local anaesthesia (LA) or general anaesthesia, each on 15 ventilated patients. LA was carried out with oxybuprocain-hydrochloride 1% in repeated doses injected into the trachea and main bronchi, general anaesthesia with midazolam, piritramide and vecuronium bromide. Measurements were performed before, 3 minutes after induction of anaesthesia, immediately after bronchoscopy and 15 and 60 minutes after bronchoscopy. There was no effect on cardiocirculatory function during bronchoscopy in both groups, but we found a decrease in paO2 from 97 to 80 mmHg (median) after application of LA. Subsequent bronchoscopy did not significantly influence paO2. The present study shows that in ventilation patients undergoing fibreoptic bronchoscopy, the application of LA will usually result in a decline of arterial oxygen tension. This procedure should therefore only be performed if general anaesthesia is undesirable, as e.g. in patients being weaned from ventilation.

Adolescent↗
PubMed1990

[Clonidine supplemented analgesia and sedation in prevention of postoperative delirium].

In an open prospective study we investigated the efficacy of the supplementation of analgosedation by clonidine. 40 patients with oesophagus malignancy and definite alcohol abuse were on respiration therapy postoperatively after having been treated with oesophago-gastro anastomoses. With regard to manifestation intensity and development of withdrawal symptoms we found that during basic medication with piritramid-diazepam continuously i.v. administered clonidine can eliminate haemodynamic and psychovegetative symptoms related to alcohol withdrawal. The clonidine group required less analgosedation. The measurement of the urinary catecholamine output showed a normalised endogenous output. As a finding of importance the gastrovolume was reduced, and the haemodynamically firm, stable and less sedated patients of the clonidine group required fewer days of respiration therapy. Hence, the hazard of aspiration pneumonia and insufficienty anastomosis was lower. Risk of bradycardia of high potential danger did not occur with a median daily dosage of 1.09 mg/d clonidine. We consider clonidine to be a potent supplement to analgosedation for the surgical patient who is at high risk of alcohol withdrawal.

Adult↗
PubMedDate not supplied

[Total intravenous general anesthesia during radical correction of tetralogy of Fallot].

Three techniques of general intravenous anesthesia were compared, using mathematical parameters of the heart rhythm, hemodynamic and sympathoadrenal system responses, arterial blood Hb saturation with O2 (SaO2) and thermometry. It has been established that anesthesia with dipidolor ensures adequate protection against the operation stress both in patients with tetralogy of Fallot previously subject to interarterial anastomoses and patients with tetralogy of Fallot without anastomoses. Combined fentanyl and ketamine anesthesia ensures an adequate protection against the operation stress only in patients with tetralogy of Fallot without anastomoses. A more marked response of sympathetic autonomous nervous system and hemodynamics in patients with tetralogy of Fallot previously subject to anastomoses is, probably, mediated by a more intensive analgesic sequestration in the lungs in the presence of functioning anastomoses, which attenuates the analgetic effect. Anesthesia in patients with tetralogy of Fallot previously subject to interaortic anastomoses should be performed using higher doses of narcotic analgesics.

Anesthesia, Intravenous↗
PubMed1985

Exotic snakebite, an unusual emergency. A case report and therapeutic considerations.

Envenomation by exotic poisonous snakes constitutes a rare emergency in Western Europe, but which in the future may be seen more frequently due to the increasing number of captive specimens in private collections. A case report of moderate envenomation by a viper is described. Diagnostic problems and therapeutic management are discussed for viper envenomation. The importance of differentiating between local and systemic poisoning is emphasized.

Adult↗
PubMed1989

[Comparative study between pirprofen (Rengasil) and piritramid (Dipidolar) in postoperative pain in maxillofacial surgery].

In this clinical single-blind trial, the potential analgesic effect of pirprofen (Rengasil) was compared to the analgesic effect of piritramid (Dipidolor). The two compounds were tested intramuscularly in patients submitted to maxillofacial surgery. Pirprofen and piritramide seem to have an equivalent analgesic effect but pirprofen (Rengasil) seems to act a little faster and to be better tolerated than piritramid. Therefore, pirprofen may be utilized with success to treat postoperative pain in patients who undergo maxillofacial surgery: its advantage is avoiding secondary effects of the morphinomimetic compounds.

Adolescent↗
PubMed1989

[The efficacy of the benzodiazepine antagonist flumazenil (Ro 15-1788) based on the EEG of mechanically ventilated intensive care patients].

To evaluate the efficacy of flumazenil in intensive care medicine, the benzodiazepine antagonist was administered to 20 intubated and ventilated patients. In 18 cases the drug was used to interrupt long-term sedation (midazolam in combination with piritramide) for a short period of neurological examination. In two cases it was used to diagnose a coma of unknown origin. The patient's alertness was evaluated by clinical observation and electroencephalography. Blood pressure and heart rate were monitored continuously. The two patients with coma of unknown origin demonstrated no clinical response to flumazenil at a dosage of 2 mg. However, there was a change in the EEG: before administration of the antagonist, slow delta waves predominated; after administration there was an increase in theta activity. This activity shift was associated with a slight increase in the median frequency from 1.6 to 2.1 Hz. Serum level analysis confirmed a non-benzodiazepine-induced coma. The other 18 patients (average serum midazolam concentration: 0.27 microgram/ml) were awake and oriented after a dose of between 0.3 and 0.6 mg flumazenil. This clinical finding correlated with the EEG which showed an increase in the median frequency from 2 Hz to 6-7 Hz. Even after receiving the antagonist, the patients were able to tolerate intubation and ventilation without problem. No significant adverse effects were observed.

Adult↗
PubMedDate not supplied

[Effect of dipidolor on hemodynamics and respiration in rats after exposure to gamma-radiation and cytostatics].

It was shown in experiments on anesthetized rats that intramuscular administration of dipidolor (5 mg/kg) failed to exert any effect on the functioning of the cardiovascular and respiratory systems of the animals which previously had been irradiated with the dose of 50 Gy or given intravenous injections of platidyam (5 mg/kg) or cyclophosphane (50 mg/kg).

Analgesics, Opioid↗
PubMed1989

[Comparative study between pirprofen (Rengasil) and piritramid (Dipidolor) for postoperative pain in maxillofacial surgery].

In this clinical single-blind trial, the potential analgesic effect of pirprofen (Rengasil) was compared to the analgesic effect of piritramide (Dipidolor). The two compounds were tested intramuscularly in patients submitted to maxillofacial surgery. Pirprofen and piritramide seem to have an equivalent analgesic effect but pirprofen (Rengasil) seems to act a little faster and to be better tolerated than piritramide. Therefore, pirprofen may be utilized with success to treat postoperative pain in patients who undergo maxillofacial surgery: its advantage is avoiding secondary effects of the morphinomimetic compounds.

Adolescent↗
PubMedDate not supplied

[Analgosedation as an adjuvant during surgery under local anesthesia].

Twelve systemically healthy patients each (ASA risk groups 1-2) who required oral surgery under local anesthesia received the short-acting benzodiazepin Midazolam for analgosedation as well as the analgesics Pentazocin or Piritramid. Both i.v. medications are suitable as adjuvants for local anesthesia since neither clinically relevant respiratory and circular depression nor major sleepiness were observed.

Adult↗
PubMed1989

[Catheter epidural analgesia in serial rib fractures].

According to our results, permanent epidural anaesthesia was significantly superior to systemic opioid treatment in patients with serial rib fractures. The main advantages were not only continuous pain relief despite the fact that the nonepidural control group required more than twice the dosage of morphine derivatives; also, the respiratory and pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory pain and therefore on respiration as a whole. Deep breathing and expectoration were easier, so that the use of respirators and other artificial breathing aids could be avoided or at least reduced in duration in some cases. This makes the method particularly suitable for use in the management of polytraumatized patients. The standard dose was a mixture of 3.3 mg morphine and 37.5 mg bupivacaine (= 1/3 ampoule morphine + 15 ml Carbostesin 0.25%) every 12 h. When morphine was temporary contraindicated (frequently the final diagnosis in the case of an "acute abdomen" delayed the administration of morphine) the use of bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic pain relievers were only necessary when the patient was suffering from pain caused by other injuries beyond the area of effectiveness of the epidural catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg fentanyl (= 2 ml Fentanyl Janssen) and 1.2 mg flunitrazepam (Rohypnol).

Adult↗
PubMed1986

Patient-controlled analgesia with piritramid for the treatment of postoperative pain.

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (20 each having undergone abdominal or orthopedic operations). Whenever the patients required pain relief, piritramid demand doses of 2.0 mg were given via the hand-button of a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 15 mg with a pump refractory time of 1 minute between valid demands. A continuous low-dose piritramid infusion (0.24 mg/h) was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 19.7 +/- 6.5 hours (mean +/- SD). During this time, 17.1 +/- 13.8 demands per patient were recorded resulting in mean individual piritramid consumptions of 30.4 +/- 28.1 micrograms/kg/h. Self-administration was characterized by considerable intra- and interindividual variability. Following abdominal surgery, slightly more piritramid was needed compared with orthopedic patients, although less pain relief was achieved in the former group. The same proved to be true for a comparison between the sexes, males requiring significantly more piritramide for less pain relief than females (p = 0.05). Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 73% of patients when compared with previously experienced conventional postoperative analgesia. Side effects (sweating, nausea, emesis) occurred in about 20% but were usually of minor intensity. No serious circulatory or respiratory problems were observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and for clinical pain research.

Abdomen↗
PubMed1988

[Nalbuphine in comparison with piritramid and placebo in postoperative pain therapy following intubation anesthesia with halothane. Side effects and effectiveness].

UNLABELLED: The aim of the study was a comparison of the side-effects and efficacy of nalbuphine, piritramide, and placebo in patients during recovery from halothane anesthesia. METHODS: Neurosurgical (vertebral surgery) and otolaryngological patients (surgery of face and neck) were operated under halothane anesthesia. Postoperatively 20 patients received 20 mg nalbuphine, 21 patients 15 mg piritramide, and 19 patients 0.9% NaCl for pain therapy in a randomized and double-blind manner. Respiratory function was monitored by blood gas analysis, hemodynamic function by noninvasive measurements. The analgetic and sedative effects were estimated by the patients (visual analog scale) and the investigator (4-point scale). If the treatment was ineffective, the study was interrupted and a known analgesic was prescribed. RESULTS: The noninvasively measured hemodynamic parameters were unchanged. On the other hand, in the nalbuphine group mean arterial pCO2 increased significantly (max. 55.4 mmHg after 20 min), over the piritramide group (max. 51.2 mmHg before treatment) and the placebo group (max. 55.1 mmHg before treatment). Drowsiness, in 8 patients in each of the treatment groups and 3 patients in the placebo group, was the most frequent side-effect. After nalbuphine the pain threshold was significantly higher than after treatment with piritramide and placebo. The study was interrupted because of inefficacy in no patients from the nalbuphine group, 2 patients from the piritramide group, and 6 patients from the placebo group. There were no differences in the sedative effects. CONCLUSIONS: Nalbuphine seems to have better analgesic effects then piritramide. Both cause no hemodynamic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Endotracheal↗