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E Traub

Publications and source records attributed to E Traub.

At least 19 recordsLinked to original sources
PubMed1994

[The effect of different anesthetic procedures on hormone levels in women. Studies during an in vitro fertilization-embryo transfer (IVF-ET) program].

Different anaesthetic procedures that were used during an in vitro fertilisation and embryo transfer (IVF-ET) program have been analysed in order to determine their influence on plasma levels of estradiol, progesterone, prolactin, and beta-endorphin and results of IVF-ET. METHODS. Fifty-four patients awaiting transvaginal oocyte aspiration were randomised into three groups: (1) anaesthesia with ketamine as an induction agent and analgesic (n = 20); (2) general intubation anaesthesia using thiopentone for induction and enflurane for maintenance (n = 18); and (3) no anaesthesia (n = 16). Estradiol, progesterone, prolactin, and beta-endorphin were measured from day 3 to 14 referring to follicle aspiration. Differences between preoperative hormone levels and their intra- and postoperative peaks were analysed using the Kruskal-Wallis test (P < 0.03). The results were corrected using the Holms method (alpha = 0.05). RESULTS. No differences were observed in estradiol and progesterone levels (Figs. 1, 2). Prolactin levels were 1.4 times higher (P < 0.001) when ketamine was used and 2.2 times higher (P < 0.001) after short general anaesthesia than in the control group (Fig.3). Similar results were observed with respect to beta-endorphin: in comparison with the control group we found significant elevation by a factor of 2.1 when ketamine was used (P < 0.001). The discrepancy became even more marked with general anaesthesia: beta-endorphin was 3.9 times higher compared to the controls (P < 0.001) (Fig.4). Comparing the two groups who were given anaesthetics, prolactin and beta-endorphin levels were also significantly different (P < 0.001). The IVF procedure itself did not appear to be affected by different anaesthetic procedures during oocyte aspiration (Table 2). CONCLUSIONS. The increased prolactin and beta-endorphin plasma levels associated with ketamine and general anaesthesia reflect a significant alteration of the observed hormone levels. When anaesthesia is indicated, we try to avoid general intubation anaesthesia in favor of ketamine.

Adult↗
PubMed1994

[Effect of different follicle puncture methods on hormone homeostasis in the woman. Studies within the scope of an in vitro fertilization-embryo transfer program].

Different methods for follicular puncture which were used in an in vitro fertilization-embryo transfer program have been analyzed in order to determine their influence on plasma levels of estradiol, progesterone, prolactin and beta-endorphins. Thirty-eight patients awaiting oocyte aspiration were randomized into a laparoscopic (n = 20) and an ultrasound-guided oocyte aspiration group (n = 18). No differences were observed as far as estradiol and progesterone levels and embryo transfer rates were concerned. When using the laparoscopic technique, prolactin levels were found to be elevated 1.5 times in comparison with the ultrasound-guided aspiration procedure, which is highly significant (p < 0.001). Also, beta-endorphins peaked at a significantly higher level during laparoscopy (27.8 vs. 20.7 mol/l, p < 0.001). The enhanced prolactin and beta-endorphin levels reflect an increased stress response during laparoscopy. With respect to less trauma and shorter duration of the procedure, we now perform the sonographically guided transvaginal aspiration technique in our program almost exclusively.

Adult↗
PubMed1992

General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.

Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia. Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group. Twenty-four hours and 7 days after delivery all infants of both groups were completely normal. At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group, due to higher inspired oxygen concentrations. Comparable results were obtained in umbilical PO2 venous values; lower pH values, however, were observed in the umbilical artery after general anaesthesia. There were no significant differences in the glucose levels between the groups. A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group, but not in the epidural group. Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.

Adolescent↗
PubMed1985

[Anesthesia-related maternal mortality during labor. Results of a survey in the Federal Republic of Germany 1971-1980].

In order to obtain figures on the anaesthesia related maternal mortality in the Federal Republic of Germany, 707 hospitals have been addressed via questionnaire. Hospitals where obstetric departments and anaesthetic departments as well were available, were investigated for maternal mortality, anaesthetic requirements, and the complications which led to the maternal deaths during the period of 1971-1980. 38% (259 general hospitals and 10 university hospitals) responded; the geographical distribution seemed to be representative. The average maternal mortality rate was at 0.21%, which ranged from 0.21% for general hospitals to 0.16% for university hospitals. The overall anaesthesia related maternal mortality was around 6.4%. 20 of the reported 21 maternal deaths occurred under general anaesthesia and 1 under local anaesthesia; 17 patients died during caesarean section and 4 during vaginal delivery. The main complications which led to the maternal deaths were cardiac arrest and aspiration of gastric content with 38,1% each and convulsions with 4.8%. In 19% of the total maternal deaths the causes could not be determined. The importance of obstetric centres and of controlled anaesthetic methods delivery will be discussed on the basis of these and other figures which have been reported in the literature.

Anesthesia, Conduction↗
PubMed1984

The early use of positive end expiratory pressure (PEEP) ventilation in emergency medicine, and some experiments on pigs.

The effects on near drowning of young pigs of positive end expiratory pressure and zero end expiratory pressure were studied. The arterial PO2 and blood gases were examined during recovery from near drowning and after haemorrhagic shock. The cardiovascular parameters were measured after shock. The findings were considered in relation to the use of positive and expiratory pressure in patients. It was recommended that it be only administered by experienced staff in hospitals, and should not exceed 10 mbars, while 5 mbar was adequate and avoided complications in most cases.

Animals↗
PubMed1984

[Comparative studies on general anesthesia versus peridural anesthesia in primary cesarean section].

In a prospective interdisciplinary study involving the departments of gynaecology, anaesthetics and paediatrics, the influence on both the mother and neonate of general as opposed to epidural anaesthesia was compared in 47 planned caesarean sections. Neither maternal or foetal risk factors were present in these cases, and the cardiotocogram was always normal before the anaesthetic was applied. Methods. Systolic and diastolic blood pressure were carefully monitored. Under an identical infusion regime the following parameters were estimated in maternal blood: blood gas and acid-base status, blood sugar, lactate, beta-hydroxybutyric acid, ACTH and cortisol. These same parameters were also estimated in cord blood taken at delivery. The Apgar score at 1, 5 and 10 minutes, and a complete paediatric assessment including neurostatus at 15 minutes, 24 hours and 7 days of age were used to assess neonatal status. Some of the women given a general anaesthetic initially had marked increases in blood pressure and pulse, while about a third of the epidural cases showed a blood pressure fall despite positioning in the left lateral position in order to prevent the aorto-caval syndrome. An increase in lactate, ACTH and cortisol was found in both groups up to the time of delivery, when the ACTH level of the general anaesthetic group was significantly higher. Acid-base and PCO2 values were not markedly influenced by either of the techniques used, but the maternal capillary PO2 levels were very much higher in the general anaesthetic group. The neonates born under general anaesthetic had a lower 1 min Apgar score, as a result of the relatively long induction-delivery time, of on average 17 min. The 5 and 10 min Apgar scores and the neurophysiological development of the babies revealed no differences between the two groups.

Adult↗
PubMed1983

[A comparative study on the obstetric aspects of epidural anaesthesia].

A retrospective analysis of 2,130 deliveries in 1980 was done. 42.21% of the women had epidural anaesthesia (EDA). They were compared with the 57.79% of the women, who did not have EDA. Decisive differences in both groups concerning age, fetal malposition, birth weight, umbilical artery pH and the Apgar score after one minute were not noted. There were more primiparous women in the EDA group and more women with a nationality other than German in the control group. Frequency of instrumental vaginal deliveries was extremely high in the EDA group as compared with the control group. In the EDA group a prolongation of labour especially the third stage was observed. A cesarian section due to an arrest in the process of labour was more often performed in the EDA group than in the control group. The suggestion is made that the relaxation of the pelvic floor and the diminuation of the bearing down reflex in EDA leads to a prolongation of labour and an increased instrumental delivery rate.

Adolescent↗
PubMed1983

[Peridural morphine analgesia: effects and pharmacokinetics. A double-blind study in vaginal hysterectomy patients].

In a controlled prospective double-blind-study we were able to show that the analgesic duration of epidurally applied morphine is more than four fold longer lasting than intravenous morphine. We found similar pharmacokinetics in both groups, suggesting a rapid absorption of epidurally applied morphine into the vascular system. The identical pharmacokinetics of intravenous and epidurally applied morphine suggest that only small amounts of morphine diffuse across the dura to the spinal cord, where it produces a long lasting analgesia at the opiate receptors. The comparison of serum morphine levels in patients who reported a very short lasting and very long lasting analgesia gave us no pharmacokinetic explanation for this difference.

Adult↗
PubMed1982

[The effect of fenoterol on the incidence of arrhythmias during Caesarean section (author's transl)].

Beta-sympathomimetic tocolysis is an important part of modern obstetric therapy. Severe cardio-vascular complications have been described however, when inhalational anaesthesia was given following fenoterol-verapamil therapy. Alterations in clinical; cardiovascular parameters were measured in a prospective study on healthy women who had to undergo caesarean section and who had been treated with fenoterol-verapamil until the time of anaesthesia. The patients were given either halothane or enflurane as inhalational anaesthetic, and either an atropine premedication or none at all. Severe cardiovascular disturbances such as frequent extrasystole, arrhythmias or marked falls in blood pressure were not noted either during induction, whether following atropine or not, or during the course of anaesthesia with either 0.5 vol% halothane or 1.0 vol% enflurane.

Anesthesia, General↗
PubMed1982

[Studies on the effectiveness of obstetric epidural analgesia. I. Vaginal delivery (author's transl)].

In a retrospective study 1,000 women who in 1979 had undergone a delivery either under epidural-anaesthesia or without, and instead either relation training or pethidine in small doses (20-30 mg i.v.) at the Ulm Department of Obstetrics, were followed up by questionnaire. The women of the epidural group felt that they had been adequately informed about the various possibilities of pain relief during labour, while some of the control group felt that they had been inadequately or even incorrectly informed. In the epidural group, pain relief during labour was such that 90% had hardly experienced any, or only mild discomfort, similar degree of pain relief was described by a many as 68.7% of the control group. Especially in the case of primigravida, the women of the epidural group had an insufficient urge to bear down, hence the rate of forceps delivery was relatively high, whereas this problem did not arise in the control group, where the forceps rate was markedly lower. The incidence of headache and back pain was only slightly higher in the epidural as compared to the control group, where other complaints were more frequent. 82% of the epidural group said that they would again choose this form of analgesia for future deliveries, 15% would not. In the control group 22% said that they would like an epidural for future deliveries, while 21% would not. The Apgar scoring and pH values of the newborn showed no significant differences between the groups.

Anesthesia, Epidural↗
PubMed1982

[Effectiveness of obstetric epidural analgesia. II. Caesarean section].

A questionnaire was sent to 260 women who in 1979 had undergone a caesarean section under either epidural or general anaesthesia. Those women who had an epidural for their caesarean section were on average very well informed about the procedure. In contrast, those who had been given a general anaesthetic felt that they had been badly or inadequately informed. Over 90% of the patients of both the epidural and the general anaesthetic groups described the type of anaesthesia which they had received as "very good" to "adequate". In the epidural group, 80% of the patients described the experience of the birth as very intense. Headache, back pain and other complaints such as abdominal pain and wound pain were significantly more frequent in the general anaesthetic as compared to the epidural group. 85.8% of the women given an epidural said that they would choose the same again for a future caesarean, 12.1% would not. Of the group given a general anaesthetic, 29.9% said that in the future they would choose an epidural, and 62.3% that they would prefer to have a general anaesthetic again. The Apgar score at one minute, and the umbilical artery pH values of the newborn of the epidural group were significantly better than those of the general anaesthetic group, whereas at 5 and 10 min the Apgar scores of the babies of both groups showed no differences.

Anesthesia, Epidural↗
PubMed1981

[Important metabolic parameters in the peripartum period as affected by peridural anesthesia].

In a clinical study we compared two groups of healthy patients at term: - 10 patients received no analgesics or very small doses of pethidine (control group) during the course of labour, - 17 patients were given CO2-bupivacaine via epidural catheter because they asked for it and because their obstetricians prescribed it (CEDA-group). After giving the same infusion solution of 120 ml/h 5% half-isotonic fructose to all the parturients, the following biochemical parameters were measured at the beginning and at the end of the first stage of labour, at delivery, and two hours later: Blood gases and acid-base status, blood sugar, lactate, betahydroxybutyric acid, ACTH, cortisol, hematocrit, electrolytes, and serum osmolality. The above mentioned parameters, except electrolytes and serum osmolality, were also determined in umbilical-cord blood immediately after delivery. In the labour ward, infants were observed and their capillary blood gases, acid-bases status, and blood sugar were measured 30, 60, and 120 minutes after birth. Lactate, betahydroxybutyric acid, ACTH, and cortisol levels rose significantly until delivery in both of the groups; significant differences between the two groups could be seen in blood gases, blood sugar, and ACTH levels. In the umbilical cord there were only significant differences in blood sugar. In summary it can be concluded that although labour pain can be controlled by epidural analgesia, the stress of labour is only influenced by different analgesic methods to a certain degree.

3-Hydroxybutyric Acid↗
PubMed1980

[Intensive care of acute respiratory distress syndrome in septic shock--a case report (author's transl)].

The acute respiratory distress syndrome being a critical complication of septic shock limits the patient's survival. A significant advance in treatment is the use of positive end-expiratory pressure ventilation (PEEP). As microthrombosis of the lung microcirculation seems to be one of the pathogenetic factors of RDS, fibrinolytic treatment may be tried as an additional therapeutic possibility, even in life-threatening situations. In this case we report on the treatment of shock lung resulting from septic shock occurring after diagnostic amniocentesis in the 16th week of pregnancy, this being a rare complication. By applying the principles of treatment described above --"Super PEEP" with 20 cm H2O and fibrinolysis with urokinase despite the presence of absolute contraindications--the respiratory insufficiency could be controlled.

Adult↗