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E Honců

Publications and source records attributed to E Honců.

6 recordsLinked to original sources
PubMed1990

[Methods of determining clinically sufficient decurarization and its evaluation].

Mechanomyoscopy as an objective method for determining the degree of decurarisation is particularly useful in the case of uncooperative patients and those who are incapable of adequate neck flexion mostly for spinal column diseases. The authors use for that purpose a Czechoslovak-made neuromuscular stimulator (LSN 110), with constant 50 Hz frequency of stimulation, 0.3 ms impulse duration, max. 50 mA and, depending on skin impedance, 5-140 V. The stimulator switch is manually controlled. The absence of muscular fatigue (fade) on single as well repeated stimulation lasting only a fraction of a second necessary to elicit muscular response does not rule out residual curarisation despite the fact that less than 70% of the cholinergic receptors are blocked. The only reliable sign of clinically sufficient decurarisation is the ability of the muscles of the hand to maintain contraction on tetanic stimulation of the motor point of the ulnar nerve in the wrist for at least 5 seconds without fatigue, and that even on a repeated exercise. This corresponds to a block of less than 60% of the cholinergic receptors. The patient's ability to raise his or her head and to keep it raised at 4 fingerbreaths for a period of 4 seconds is also a manifestation of clinically sufficient decurarisation. The value of forced expiratory volume is not conclusive evidence of sufficient decurarisation, it only gives a rough idea of its degree. The final decision is up to the an anaesthesiologist, his knowledge and experience based on objective data.

Adult↗
PubMed1990

[The positive effect of the 10 degree Trendelenburg position in patients undergoing epigastric surgery with lumbo-thoracic epidural anesthesia].

The authors administered to 60 patients, mean age 71 years, epidural anaesthesia on account of operations in the epigastrium. A solution of 0.5% bupivacaine without adrenaline in doses calculated according to Bromage for 18 segments was administered from a lateral approach in the upper part of the lumbar spine. After administration of the anaesthetic they tilted the patients to a 15-20 degrees Trendelenburg position. They adjusted the slope of the patients to ensure that the anaesthesia reached eventually the radicular zone of Th3. They made use of the finding that the anaesthetic solution in the epidural space tends to decline. After fixation of the anaesthetic to the nervous tissue, 30 patients were slowly changed to a horizontal position and the same number of patients was left throughout the operation in a Trendelenburg position. The authors made sure that the systolic blood pressure did not drop below 13.3 kPa in normotonics and beneath 60% of the initial value in hypertonic patients. There were no substantial differences in the ephedrine consumption per kg body weight within three hours after the puncture of the epidural space in the two groups. The total consumption of Hartmann solution, ketamine and diazepam was, however, significantly lower in patients who during operation were in the 10 degrees Trendelenburg position. The variations of blood pressure during traction of anatomical structures in the epigastrium were smaller in the latter patients. No serious disorders of the cardiac rhythm were recorded. None of the patients of the group died within seven days after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1990

[Catheterization of the central venous system by way of the cubital veins].

The authors elaborated and tested in 100 patients the described method and were successful in 97%. After local anaesthesia they incise the skin in the inner portion of the skinfold in the cubital fossa and, if necessary, extend it to the bicipital ridge. The best vein as regards access is the v. basilica or the strongest branch of the brachial vein, on both sides. They isolate the vein and insert a thread underneath it. The ends of the thread are grasped by a forceps and thus the vein is fixed. After compressing the arm with a rubber band with subsequent venostasis they puncture the vein on the index finger with sharp scissors. A polyvinyl catheter cut obliquely at the end with an external diameter of 1.5 mm, containing a drip infusion of saline, is inserted slowly into the vein of the sitting patient without positioning of the head, 40-60 cm centrally, with the free hand. The position of the tip of the catheter is checked by X-ray. If there is a venous spasm (the catheter cannot be inserted, its tip is beyond the thoracic cavity or it forms a loop or is bent) the arm is compressed as high as possible. At a short distance the authors insert a catheter into the vein and administer in a drop infusion 40-60 ml 0.3% Xanidil (xanthinolium nicotinicum) solution. After relaxation of the spasm they connect the infusion with the saline, release the rubber band and complete the cannulation. In case of an unintentional injury of the vein they suture it but never use ligatures.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗
PubMed1989

[Experience with the lateral lumbar approach in epidural anesthesia].

Based on a detailed analysis of X-ray pictures of the lumbo-sacral spine and experience assembled during epidural anaesthesia in 116 men, mean age 67 years, and 84 women, mean age 68 years, the authors describe in more detailed the formerly recommended method of a lateral lumbar approach. To make it as successful and as safe as possible it is essential during puncture to be aware of the typical resistance of the yellow ligament, frequently after previous contact with bone and to obtain the positive sign of the "hanging drop" after penetration of the ligament. If in exceptional instances in the depth the elastic resistance of the yellow ligament is lacking before the positive sign of the "hanging drop", it is better to perform the puncture of the epidural space in another intervertebral space. This practically rules out the false positive sign of the "hanging drop" in case of the possible presence of a tougher ligamentous septum in the paravertebral muscles in older patients. This rules out also the even rarer possible penetration of the needle to the dura mater, exactly in the middle of the yellow ligament through the opening for the blood vessel where are only individual elastic fibres, practically without resistance, with a positive "hanging drop".

Adolescent↗
PubMed1989

[Differences in patient sensitivity to currently used non-depolarized curaremimetics and factors which affect it].

A whole number of factors which affect the depth as well as duration of the block after administration of non-depolarizing myorelaxants, both positively and negatively. However, the effect in one patient can be predicted only with difficulty--as this paper showed--as neither the hydration level, age nor kalemia concentration had any effect on the depth of the neuromuscular block. Neither in patients, otherwise healthy, is it possible to predict the degree of the neuromuscular block after administering a standard dose of curaremimetic. The depth of the block can only be established by an objective method--mechano-myoscopic block monitoring. For this purpose, the authors use a Czechoslovak-made neuromuscular stimulator LSN 110. The determination of the actual block depth can help to control relaxation according to the needs of the surgeon or anaesthesiologist, and according to the individual patient's sensibility. A different sensibility response to myorelaxants was found in pipecuronium, vecuronium and even in atracurium. It corresponds approximately to gaussian curve of frequency.

Adult↗