Biomedical subjects
Publications and source records attributed to A Schlager.
In this review the effectiveness of the acupuncture point Pericard 6 (P 6) on postoperative nausea and vomiting (PONV) is described. Use of the acupuncture, acupressure as well as the laser stimulation of P 6 proved as efficient prophylaxis of PONV in numerous studies. These methods are free of side effects and represent therefore a good alternative to the pharmacological prophylaxis and treatment of PONV.
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This study was performed to determine the optimum dose of pancuronium (n = 30) and pipecuronium (n = 30) under continuous sedation and analgesia in the intensive care unit (ICU). This was an open clinical investigation in 60 critically ill patients with head injury, multiple trauma (in some complicated with sepsis and multi-organ failure), requiring neuromuscular block for ventilation for at least 48 h. Emphasis was placed on the neuromuscular monitoring with a peripheral nerve stimulator and adequate sedation and analgesia. Satisfactory block was achieved in all cases with an average dose of 3 mg/h with either compound. None of the patients experienced prolonged paralysis, muscle weakness, or other neuromuscular dysfunctions in the postventilatory period. We suggest that adequate use of sedative hypnotics and opioids plus neuromuscular monitoring allowed us to optimize the dose of muscle relaxants according to the need of individual patients.
Benzodiazepine agonists in combination with opioid analgesics are commonly used for combined analgesia and sedation in intensive care patients as well as for anesthesia. In animals, studies indicate either agonistic or antagonistic interactions of benzodiazepine agonists and opioids. This retrospective study of 43 patients evaluated the possible clinical relevance of benzodiazepine-opioid interactions related to pain management. We observed an increase of greater than 50% of the maximal sufentanil infusion rate in significantly more patients in group 2 (13 patients vs 6 patients; chi 2: p = 0.04) and a decrease of the sufentanil infusion rate in eight group 1 patients, but only in one patient in group 2 (chi 2: p = 0.03). We believe that an interaction between midazolam and sufentanil on nociceptive transmission and/or a rapid development of tolerance to sufentanil may be responsible for the observed difference. Contrary to the common clinical impression that midazolam potentiates opioid analgesia, these results indicate that systemic co-administration of midazolam over a period of more than three days can diminish sufentanil efficacy.
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Imidazobenzodiazepine (flumazenil) is a specific competitive benzodiazepine antagonist. It antagonizes the sedative-hypnotic, anticonvulsive, anxiolytic and the muscle-relaxant effects of benzodiazepines. Its efficacy is prompt and complete. In several studies rebound phenomena have been observed. It was the aim of this randomized double blind study to investigate the efficacy of flumazenil by psychometric tests. The psychometric parameters we used were cognition and choice reaction time of 12 young and healthy volunteers. Three medication groups (A, B and C) were formed for this investigation. In a cross over design all volunteers had to be treated in each of these three medication groups. Between the groups we set a test-free interval of 7 days for every volunteer. In medication group A (midazolam/flumazenil) we applied 15 mg midazolam. Reversion was performed after 60 min with 0.5 mg flumazenil. In medication group B (placebo/flumazenil) midazolam was replaced by a physiological solution of sodium chloride. In medication group C (placebo/placebo) midazolam and flumazenil were substituted by a physiological solution of sodium chloride. For the investigation of the psychometric parameters (cognition and choice reaction time) we used the so called syndrome kurz test (SKT) and the decision reaction time measuring instrument ("Entscheidungs-Reaktionszeit-Messgerät"; ERM). Psychometric investigations were performed in all groups at intervals of 5, 30, 60, 90, 120, 180 and 240 min. Our results show that cognitive abilities remain impaired up to 60 min after the administration of flumazenil. Decision time and choice reaction time improved 120 min after administration of the antagonist. In our investigation neither rebound phenomena nor agonistic reactions of flumazenil were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
A patient presenting with acute severe asthma associated with protracted hypoventilation (paCO2 = 90 mmHg) and impaired consciousness underwent sedation and controlled mechanical ventilation. The peak airway pressure could be reduced by constant-volume mechanical ventilation and analgosedation with midazolam and ketamine. When the gas exchange had stabilized, the first attempt at weaning was made by synchronized intermittent mechanical ventilation (SIMV). After this and two other attempts had failed, the patient was given continuous sufentanil (0.8-1.0 micrograms/kg), as well as additional bolus injections of 2 micrograms/kg and 0.35 micrograms/kg for analgosedation. Controlled mechanical ventilation was replaced by the system of biphasic positive airway pressure (BIPAP). The mechanical ventilatory support was gradually reduced, as was the dose of continuous sufentanil. Extubation was possible at a dose of 0.2 micrograms/kg per h sufentanil and CPAP. From this case, it is not possible to determine whether the BIPAP system or the analgosedation with Sufentanil was the decisive factor in the therapeutic success. It may well have been the combination of both therapeutic measures that--in our opinion--supplemented each other in an ideal way.