PubMed Health⌕ Search

Biomedical subjects

D Paravicini

Publications and source records attributed to D Paravicini.

At least 19 recordsLinked to original sources
PubMed1996

[Preventive pain therapy. Preventive tramadol infusion versus bolus application in the early postoperative phase].

Even today, adequate postoperative analgesia is still a great problem. Based on positive results of former studies using a continuous infusion of tramadol for postoperative pain relief, we aimed to improve this regimen. In order to investigate the effectiveness of preventive analgesia, one group of patients was given 100 mg tramadol (Tramal) at the time of extubation, followed by a maintenance infusion. The other group was treated with single boluses of tramadol on demand, thus representing common pain treatment. METHODS. 112 patients undergoing abdominal surgery were chosen at random for this double-blind study. Half of them (preventive group) received an injection of 100 mg tramadol at the time of extubation; the others (on-demand group) were given a placebo instead. A continuous infusion of 500 ml NaCl 0.9% (administered with 30 ml/h) followed, either containing 200 mg tramadol (preventive group) or a placebo (on-demand group) and was maintained until the end of the study. At the first expression of pain, patients in the preventive group received 50 mg tramadol (representing the first subsequent injection) whereas patients of the on-demand group were given 100 mg tramadol as a loading dose. For further treatment of pain, the members of both groups received 50 mg tramadol when necessary. The level of pain was assessed by means of VAS (visual analogue scale) every hour and additionally at first expression of pain, and finally by VRS (verbal rating scale) after eight hours at the end of the study. RESULTS. 112 patients were chosen at random. 18 had to be excluded--two treatment failures, twelve violations of the study protocol and four patients of the on-demand group, who did not ask for treatment for pain and therefore did not receive any tramadol. Hence only 94 patients could be statistically evaluated. 50% of the remaining 48 patients in the preventive group needed none or only one subsequent injection of tramadol, the other 50% needed two or more subsequent injections. However the patients in the on-demand group, now 46, split up into 71.7% who where administered up to one subsequent injection and 28.3% who received more than one subsequent injection. The number of patients who asked for treatment for pain twice or more during the study period totalled 50% in the preventive group and 58.7% in the on-demand group. The average interval between extubation and first expression of pain was 106.3 +/- 84.2 min in the preventive group, and 75.0 +/- 22.7 min in the on-demand group. The intensity of pain evaluated by VAS as that time was comparable: 55.6 +/- 22.7 (preventive) versus (63.4 +/- 18.3 (on demand). The pain relief obtained, shown by the VAS-differences between the first expression of pain and following assessment, came up to 27.7 +/- 22.9 in the preventive group and 30.3 +/- 23.4 in the on-demand group within a period of 46.2 +/- 17.2 min (preventive) and 43.7 +/- 17.2 min (on-demand). Retrograde assessment of pain (VRS) showed that 85.5% of the preventive group found pain relief excellent or good and 78.3% of the on-demand group were of the same opinion. Total consumption of tramadol totalled 281.4 +/- 53.6 mg in the preventive group in comparison with 150.0 +/- 53.7 mg in the on-demand group. CONCLUSIONS. Only 28.3% of patients of the on-demand group received more than one subsequent injection of tramadol in comparison with 50% of the preventive group--an unexpected result. However, it has to be considered that the injection of tramadol given at the first expression of pain in the preventive group was counted as the first subsequent injection already. The patients in the preventive group asked, on average, 30 min later for treatment for pain. The subsequent pain relief in both groups was comparable, although the amount of tramadol administered at that time was higher in the on demand group than in the preventive group (100 mg versus 50 mg+ amount given by infusion). These facts show the efficacy of the preventive infus

Analgesics, Opioid↗
PubMed1995

Comparison of tramadol with morphine for post-operative pain following abdominal surgery.

In a multi-centre, double-blind, randomized study involving 523 patients, the analgesic efficacy of tramadol was compared to that of morphine given in repeated intravenous boluses as required to control post-operative pain following abdominal surgery over 24 h. Intravenous administration of the study analgesic started as soon as the patient reported pain. Patients received an initial dose (either tramadol 100 mg or morphine 5 mg) and, if necessary, repeat doses of tramadol 50 mg or morphine 5 mg could be given on demand over the first 90 min. Further doses up to a total of tramadol 400 mg or morphine 40 mg could then be given after 90 min up to 24 h after the first dose of study medication. The primary efficacy parameter was the responder rate (no or slight pain) within the first 90 min of treatment. Whilst responder rates reached 72.6% with tramadol and 81.2% with morphine, the treatments were statistically equivalent and the observed difference in the responder rates between the groups was within the predefined range of +/- 10%. Mean cumulative doses received by treatment responders amounted to 188.2 mg within the first 1.5 h and 157.1 mg during the subsequent 22.5 h in the tramadol group and 13.9 and 18.4 mg, respectively, in the morphine group. A high incidence of gastrointestinal adverse events were observed with both treatments mostly consisting of mild nausea, dry mouth, vomiting, dyspepsia and hiccups.

Abdomen↗
PubMed1994

[Postoperative analgesia with tramadol. Continuous infusion versus repetitive bolus administration].

Postoperative pain relief can be achieved by several methods, including the use of systemic opioids and regional anaesthesia with intrathecal or epidural opioids or local anaesthetics. On-demand analgesia using a PCA (patient-controlled analgesia) system is regarded as the ideal option for systemic opioid analgesia. While PCA devices are not yet commonly used in all recovery units, the use of repetitive boluses on demand is still the most frequent form of administration in postoperative pain therapy. The objective of the present study was to show if continuous infusion of the opioid tramadol could produce better analgesia than repetitive administration of boluses. METHOD. In a study under double-blind conditions 135 ASA I and II patients were assigned at random to group I (infusion group) or group B (bolus group) when they first requested pain treatment after abdominal surgery. The patients in group I received an initial intravenous loading dose of 100 mg tramadol, followed by an infusion of 12 mg/h tramadol for 24 h; if necessary, repeated boluses of 50 mg tramadol were given. In group B the patients received a placebo infusion instead of the tramadol infusion; otherwise, the procedure was the same. Pain relief was monitored by means of a VAS (visual analogue scale) up to 6 h after surgery. We investigated the retrograde assessment of analgesia by the patients after 6 h, how often repetitive boluses were required, and the amount of analgesics administered in 6 and 24 h. RESULTS. The pain relief was assessed as excellent or good by 76.5% of group I and 65.6% of group B; 19.1% of group I and 26.9% of group B assessed the analgesic effect as satisfactory; 4.4% of group I and 7.5% of group B complained of insufficient analgesia. In group I 69.2% requested only one or no repetitive bolus, compared with 40.3% in group B, while two or more boluses were demanded by 30.8% in group I und 59.7% in group B. The average analgesic consumption after 6 h was 223.5 +/- 53.7 mg tramadol in group I and 176.6 +/- 63.1 mg tramadol in group B, respectively. After 24 h it was 449.5 +/- 66.0 mg tramadol in group I and 201.6 +/- 83.9 mg tramadol in group B. While the consumption during the first 6 h was comparable, from then on the consumption in group I increased significantly. Side effects were reported by 25% in both groups. They were clinically irrelevant and did not necessitate termination of the clinical trial in any case. During the study period pulse and blood pressure remained within the normal range and did not show any significant changes. CONCLUSION. The fact that the patients in group I requested far fewer repetitive boluses than those in group B and the assessment by the patients led to the conclusion that treatment in the infusion group is better than that in the bolus group. Concerns that a significantly higher consumption of analgesics would cause unwanted side-effects have proven unfounded. Six hours after surgery, when analgesia was evaluated by the patients, there was no significant difference between the two groups. Not until the maintenance infusion had been administered for a further 18 h, was the tramadol consumption within the infusion group significantly higher. Thus, we should consider continuing unreduced administration of the maintenance infusion 6 h after operation.

Abdomen↗
PubMed1991

[Essential standards of mechanical autologous donation and transfusion].

Apparative autologous blood donation and transfusion can be performed by simple devices (Bentley ATS, Sorenson, Solcotrans) or by using cell separation and RBC-washing (Dideco, Haemonetics). Due to many problems in retransfusion of recovered whole blood, simple devices should no longer be used. By mechanical autotransfusion including cell separation and RBC-washing, an autologous RBC-concentrate of high quality is reached. Considering essential standards, mechanical autotransfusion is a safe method to reduce the risks of homologous blood transfusion.

Blood Component Removal↗
PubMed1988

[Intra- and postoperative autotransfusion--a quality analysis].

In clinical practice intra- and postoperative autotransfusion is well established, especially in combination with other blood saving techniques (praeoperative blood deposit, praeoperative plasmapheresis and normovolaemic haemodilution). During autotransfusion red blood cells should be separated and washed in physiological saline to remove plasma free haemoglobin, potassium, intracellular enzymes and triglycerides as well as anticoagulant, activated clotting factors and debris. After knowing the mechanism of the recently developed autotransfusion devices (Haemonetics Cell Saver or Dideco Autotrans) acceptance of this procedure is very high in anaesthesiologists and surgeons due to microelectronic equipment. Considering the contraindications (bacterial contamination of the operative field and cancer surgery) intra- and postoperative autotransfusion is a very safe procedure for the patient undergoing major operations.

Blood Transfusion, Autologous↗
PubMed1985

[Tramadol infusion anesthesia with the substitution of enflurane and various nitrous oxide concentrations].

The synthetic opioid tramadol was given to 40 patients during surgery according to a fixed, calculated infusion scheme. Anesthesia was started with thiopental and the patients were given different nitrous oxide concentrations via a semi-open system (group 1: 60%, group 2: 75%). The aim of this study was to clarify whether this anaesthetic procedure is practicable or whether it has grave disadvantages in comparison with the anesthesia models used so far. Furthermore we wanted to clarify whether under this infusion scheme the proportion of N2O in the inspiratory mixture is sufficient or whether higher concentrations are required. In 24 of 40 patients analgesia or the depth of anaesthesia was insufficient so that additional enflurane application was necessary. Postoperative respiratory depression in three patients had to be treated with naloxone. The advantages of this procedure are the safe and easy practicability, absence of significant changes in the haemodynamic parameters, good postoperative response of the patients and postoperative pain relief as well as the low incidence of postoperative side effects such as nausea, vomiting and CO2-retention.

Adolescent↗
PubMed1984

Red blood cell survival and morphology during and after intraoperative autotransfusion.

In an animal experimental model the survival of untreated red blood cells (RBC) tagged with 51Cr was compared with cells processed by an autotransfusion device separating and washing the RBC tagged with 111In. Intraoperative autotransfusion (IAT) was done by the Haemonetics Cell Saver. Additionally the morphology of human RBC was investigated in different stages of IAT by the aid of scanner electron micrographs. The survival of RBC after processing was slightly decreased in comparison to untreated cells. The morphology of autologous RBC is little affected compared with older homologous RBC in erythrocytic concentrates. Cell detritus due to haemolysis is reliably eliminated by microfiltration. Especially regarding survival and morphologic alterations of RBC IAT with a system separating and washing the cells seems to be superior to the transfusion of homologous blood.

Animals↗
PubMed1983

[Use of neomycin-bacitracin irrigating solution with intraoperative autotransfusions during orthopedic operations].

Although there is doubt about the importance of rinsing the operative field with a solution containing locally acting antibiotics, it is frequently done. In this paper we tried to answer the question, wether intraoperative autotransfusion (IAT) with the Haemonetics Cell Saver is contraindicated during rinsing the operative area with locally acting antibiotics or vice versa. The measured serum concentrations for neomycin and bacitracin (Nebacetin) were extremely low. Therefore IAT is recommended with a system separating and washing the autologous red blood cells even under circumstances of rinsing the operative field with a solution containing locally acting antibiotics.

Adult↗
PubMed1983

[Heparin elimination in intraoperative autotransfusion with the haemonetics cell saver].

Intraoperative autotransfusion has proved useful in decreasing decisively the need of donor blood in major operations. Due to an important technical development of the equipment used including the possibility to separate red blood cells and to wash them in physiological saline, typical problems occurring during intraoperative autotransfusion seem to be overcome for the most part. One of these problems is the retransfusion of the citrate or heparin added for anticoagulation of blood. Heparin itself may be responsible for a disturbance of coagulation. The efficiency of eliminating heparin by washing it in the Haemonetics Cell Saver was tested by means of a high sensitive heparin test. Partly the samples were totally free of heparin, partly small remains of heparin could be found. Even the maximum value of 60 I.E. measured in one autologous red blood cell concentrate is of no importance for the daily clinical practice. Intraoperative autotransfusion with the Haemonetics Cell Saver is also superior to a homologous transfusion of blood with its unavoidable share of citrate.

Blood Transfusion, Autologous↗
PubMed1982

[Comparative examinations of different types of soda lime (author's transl)].

Three different types of soda lime (Dräger-Sorb 800, Sodasorb and Tricomed) were analysed both experimentally and in patients for their capability of eliminating CO2 from the anaesthetic circle system. In the experiment Sodasorb was exhausted already after 24 minutes (transmission of 0.6 vol-% CO2) while with Tricomed these data were reached only after 35 minutes and with Dräger-Sorb 800 after 40 minutes. Regarding measurements in patients the soda limes tested showed no significant difference in this field, but again Dräger-Sorb 800 was the best in eliminating CO2 (after a 2 hours application - 1.05 vol-% CO2 after the absorber, that is in the inspiratory gas flow), followed by Tricomed (1.38 vol-% CO2) nd Sodasorb (1.49 vol-% CO2). Considering its prolonged functional performance as well as its lower dust production Dräger-Sorb 800 can be regarded as the best soda lime being available especially with respect to almost equal expensiveness.

Anesthesia, General↗
PubMed1982

[Effects of tramadol on haemodynamics and blood gases in the early postoperative period].

A variety of opioids is available for treatment of acute pain. Sometimes administration is limited due to typical side effects such as respiratory depression or pressure increase in the pulmonary circulation. Tramadol, a synthetic opioid, was investigated in a dosage of 1.5 mg/kg body weight i.v. with regard to changes in haemodynamic parameters and in blood gases. The haemodynamic parameters generally remained stable; all changes were statistically non significant. There were no signs of respiratory depression. The risk of pain therapy with opioids seems to be reduced further by the introduction of this agent.

Adolescent↗
PubMed1981

[A new Draeger Anaesthetic circuit for newborns and small infants (author's transl)].

A new semi-closed anaesthetic system for newborns and small infants was developed by slightly modifying the circle system used for adults. The fact that this new system was employed with satisfactory results in anaesthetizing more than 50 children under 20 kilogram bodyweight weakens the argument that semi-closed circuits should be avoided in small children on account of high expiratory resistance, possibility of increased dead space, inefficient CO2 absorption and unpredictable inspiratory oxygen concentration. The advantages and disadvantages of the new system are reviewed.

Anesthesia, Endotracheal↗
PubMed1981

[Tramadol during the postoperative period].

The effect of tramadol, a new synthetic opioid, on respiration and circulation was examined in 42 patients during the postoperative period after upper abdominal surgery. Pulmonary disorders were present in some patients. Tramadol did not affect the haemodynamic parameters; but the tidal volume increased and the respiratory rate fell. Forced vital capacity, which was reduced after the operation, increased, possibly due to the analgesic effect of tramadol. The drug appears to be a suitable choice during the postoperative period, especially in patients with pulmonary disorders.

Abdomen↗
PubMed1980

[Anaesthesia in hypercalcaemic coma (author's transl)].

Hypercalcaemic coma leads to changes in myocardial efficiency and skeletal muscle tone. It is difficult to recommend a favourable anaesthetic agent for such a rare but acute and serious clinical condition. Our experiences are against administration of enflurane. It seems to be that neurolept anaesthesia is the most suitable method for those patients.

Adrenalectomy↗