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Biomedical subjects

G Brodner

Publications and source records attributed to G Brodner.

34 records · Page 2Linked to original sources
PubMed1997

[A modern concept of postoperative pain therapy].

Pain relief should be considered part of a multimodal postoperative approach. Combining patient-controlled pain therapy with other measures i.e. respiratory therapy or early mobilisation improves the outcome after surgery. In many patients adequate postoperative pain relief can be achieved by an optimal use of traditional pain management strategies. Therefore different levels of therapy should be introduced. On the first level nursing staff on surgical wards should treat pain. Patients undergoing extended surgery will need the advanced techniques of a postoperative pain service including balanced analgesia with antipyretic analgetics, patient-controlled intravenous opioids and epidural drug administration. Low dose combinations of local anaesthetics and opioids administered via thoracic epidural catheters result in excellent analgesia and provide the most effective means in improving outcome after surgery. For optimal adjustment of the patient-controlled techniques and early detection of side effects and complications nursing staff must be integrated into the pain service. Such a structured pain management program requires the training of nurses in the principles and techniques of postoperative pain treatment. Dosage of patient-controlled intravenous opioids or epidural drug combinations must be adjusted to the individual needs of the patients. Best results can only be achieved if the patient remains under observation by the pain service. This requires daily or twice daily rounds including an adequate documentation of pain relief, side effects and complications.

Analgesia, Patient-Controlled↗
PubMed1997

[Patient-controlled postoperative epidural analgesia. Prospective study of 1799 patients].

UNLABELLED: Side effects of postoperative epidural analgesia can be controlled by two strategies: Insertion of catheters into the center of the affected spinal segments and coadministration of local anesthetics and opioids. Both techniques will reduce single drug dosage. Additionally synergistic effects will result in excellent analgesia and the risk of side effects and complications will be minimized. METHODS: Between september 1995 and february 1997 the pain-service of the Klinik and Poliklinik für Anästhesiologie und operative Intensivmedizin der Westfälischen Wilhelms-Universität Münster has used this regimen to treat 1799 postoperative patients with patient-controlled epidural analgesia. All patients received an infusion of bupivacaine 0.175%, which was combined with sufentanil 1 microgram/ml in adults under the age of 70 an in children with a body weight > 30 kg. The infusion was adjusted to the individual needs of the patients by a visual analogue scale (VAS-scale: 1 = no pain; 10 = worst pain possible). Analgesia was adequate if VAS-scores were < 4 during rest and < 7 during movement and coughing. The continuous drug administration was combined with additional patient-controlled bolus doses. Postoperatively a special observation period to monitor side effects of epidural sufentanil was not defined. All patients were admitted to wards as soon as they fulfilled common criteria for discharge from the recovery room. RESULTS: Mean VAS-scores during the postoperative observation-period were within the prior defined limits. On the morning after surgery, however, a reduction in pain relief was observed and analgesia on the first postoperative day could significantly be improved after a 24-h on call pain service has been introduced. Except urinary retention side effects are rare. Probability of motor-blockade is significantly lower in patients with thoracic compared to patients with lumbar catheters. Not any patient suffered from severe complications such as sedation or respiratory depression.de

Adolescent↗
PubMed1997

[Quality control in multimodal postoperative therapy].

Effects of anaesthesia and analgesia on postoperative morbidity and mortality remain controversial. Numerous studies have demonstrated that epidural anaesthesia and pain relief by epidural analgesia reduces perioperative stress responses and thus may reduce postoperative morbidity and mortality. In patients undergoing vascular surgery, epidural anaesthesia diminished postoperative hypercoagulability. These patients may benefit from less thromboembolic complications as well as a reduced risk of a re-operation. However, regional anaesthesia does not affect cardiopulmonary morbidity or overall mortality significantly in most clinical studies. One reason for this disappointing finding may be the missing integration of improved postoperative pain relief into general surgical care. A multimodal therapeutic approach, which consists of preoperative patient information, sufficient analgesia, early mobilisation and enteral feeding, may solve this discrepancy. Therefore, prospective controlled studies are needed to assess the influence of this perioperative approach on outcome.

Clinical Trials as Topic↗
PubMed1997

[Thoracic epidural anesthesia--more than an anesthesia technique].

Thoracic epidural anaesthesia (TEA) faces growing interest as an adjuvant anaesthetic and postoperative analgesic regimen. The procedure allows a specific blockade of nociceptive reflex arches and may exert beneficial effects on stress-induced alterations of organ function. Myocardial blood flow to areas at risk is improved, and paradoxical reactions of atherosclerotic coronary arteries after sympathetic stimulation are suppressed. After cardiac surgery, TEA improved postoperative recovery and resulted in better haemodynamic stability and allowed earlier extubation. During vascular surgery, the graft occlusion rate was significantly decreased. The improved pulmonary function after TEA is due to superior pain relief which allows the patients to breathe and cough sufficiently. After upper abdominal surgery, TEA leads to improved recovery of gastrointestinal function which reduces the risk of bacterial translocation. Although lumbar epidural anaesthesia is preferred by many anaesthesiologists as there is no risk of traumatizing the spinal cord, many positive effects are forgone. With insufficient rostral spread of a lumbar epidural block above the fifth thoracic level, cardiac complications can occur due to reflex activation of sympathetic outflow in unblocked thoracic regions. When the contraindications are carefully observed, TEA can be safely performed in most patients.

Anesthesia, Epidural↗
PubMed1997

The effects of adding sufentanil to bupivacaine for postoperative patient-controlled epidural analgesia.

We tested the hypothesis that postoperative patient-controlled epidural analgesia was more effective with the combination of sufentanil and bupivacaine (Group 2) than with bupivacaine alone (Group 1). One hundred patients undergoing thoracic, upper abdominal, and aortic surgery were provided with an epidural catheter and randomly allocated to one of the two groups. Postoperatively, patients were monitored in a postanesthetic care unit for at least 1 day before they were transferred to a ward. Both groups had similar demographics and operations. Pain treatment was continued for 4.4 +/- 0.6 and 4.5 +/- 0.7 days for Groups 1 and 2, respectively. Although Group 2 patients needed less volume of the epidural analgesics on Postoperative Days 1 and 2, they reported lower pain intensity at rest and during activity for the first three postoperative days. The groups did not differ from each other regarding the incidence of respiratory depression. There was no late respiratory depression; however, three cases of early respiratory depression were detected and easily treated (Group 1 one event, Group 2 two events). Motor block was only seen in patients with lumbar epidural catheters. There was no difference between groups, and all patients with thoracic catheters could be mobilized beginning on the first postoperative day. We conclude that 1) the addition of sufentanil to a small-dose bupivacaine augments epidural analgesia and 2) thoracic epidural catheters should be used for postoperative analgesia after abdominal or thoracic surgery.

Aged↗
PubMed1996

Gastric tonometry: precision and reliability are improved by a phosphate buffered solution.

OBJECTIVE: To compare a phosphate buffered solution with normal saline as tonometric fluid in intramucosal PCO2 measurement in humans. DESIGN: Prospective, unblinded comparison. SETTING: Postsurgical critical care unit of a university hospital. PATIENTS: Six septic patients. INTERVENTIONS: Two tonometric probes were positioned in the gastric lumen in each patient. One tube was used for conventional tonometry (saline-filled balloon), while phosphate buffered solution was instilled into the second tube. MEASUREMENTS AND MAIN RESULTS: PCO2 was determined with three blood gas analyzers (ABL 2 [Radiometer, Copenhagen, Denmark], Corning 288 [Ciba Corning Diagnostics GmbH, Neuss, Germany], and StatProfile 9 Plus [Nova Biomedical, Waltham, MA]). Eight parallel PCO2 measurements per patient were evaluated, yielding a total of 48 measurements with each tonometric solution. Intrainstrumental comparison of the PCO2 determinations demonstrated an increase of 12.3 +/- 9.9% for ABL 2, 3.10 +/- 12.9% for Ciba Corning 288, and 101.2 +/- 31.5% for StatProfile 9 Plus with the phosphate buffered solution. The PCO2 values were decreased by the following amounts when the three instruments were compared, using the saline method: 14.2 +/- 8.2% (Ciba Corning 288 vs. ABL 2); 40.7 +/- 9.9% (StatProfile 9 Plus vs. ABL 2); and 30.9 +/- 9.35% (StatProfile 9 Plus vs. Ciba Corning 288). The difference in PCO2 determination, resulting from the different instrument designs, were significant between the three blood gas analyzers (p<.001). In addition, the variance of the intramucosal PCO2 values was significant between blood gas analyzers (p<.001) with normal saline as tonometric solution, but not with phosphate buffered solution. The coefficients of determination between PCO2 values in saline and phosphate buffered solution were r2=.85 for ABL 2, r2=.81 for Ciba Corning 288, and r2=.74 for StatProfile 9 Plus. When all 48 PCO2 values were analyzed, the interinstrumental coefficients of determination within a method for saline (and for phosphate buffered solution in parenthesis) were:r2=.83 (.92) between ABL 2 and Ciba Corning 288, r2=.72 (.92) between ABL 2 and StatProfile 9 Plus, and r2=.81 (.98) between Ciba Corning 288 and StatProfile 9 Plus. CONCLUSIONS: A considerable instrumental bias in PCO2 analysis is observed when saline is used as tonometric fluid in gastric tonometry, thus preventing a reliable determination of intramucosal pH. The present in vivo data show that the accuracy and reliability of intramucosal pH measurement can be improved by the use of phosphate buffered solution as tonometric fluid.

Adult↗
PubMed1996

Attenuation of the oculocardiac reflex after topically applied lignocaine during surgery for strabismus in children.

The effect of topical lignocaine applied to the eye muscles, on the incidence of the oculocardiac reflex during squint surgery of the medial rectus was investigated in 56 healthy children aged between 3-14 years. Three groups were studied. One (n = 16): stimulation of the reflex without lignocaine; 2 (n = 10): stimulation of the reflex after topical administration of 1 mg kg-1 lignocaine 2% to the medial part of the eye after induction of anaesthesia; 3 (n = 30): stimulation of the oculocardiac reflex without, and after a 5 min interval under the influence of lignocaine. Topical administered lignocaine significantly attenuated the OCR (105 vs. 68 bpm group II vs. group 1:82 vs. 63 bpm in group III). Severe bradycardiac rhythm disturbances, in particular cardiac stand-still, were not observed after lignocaine had been applied. Systemic side effects of lignocaine were not seen.

Administration, Topical↗
PubMed1995

[Erythropoietin therapy during frequent autologous blood donations. Dose-finding study].

Avoidance of homologous blood products and patients' demand for preoperative autologous blood donation programs are increasing. As many of these patients are older, with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs, the feasibility and benefit of autologous blood donation is often limited. Augmentation of preoperative blood donation by therapy with recombinant human erythropoietin (rHuEPO) has been described in animal models and in patients. METHODS. In a multicenter, controlled, randomized trial, 49 patients scheduled for orthopaedic or vascular surgery received 0 (control group, n = 9), 200 (n = 10), 300 (n = 11), 400 (n = 10) or 500 (n = 9) U/kg rHuEPO (Erypo, Cilag, Sulzbach, distributor Fresenius, Oberursel, Germany) subcutaneously twice a week for 3 weeks while every week 450 ml blood was collected. Iron sulphate 100 mg was prescribed orally twice a day. Patients were ineligible if they had uncontrolled hypertension, recent myocardial infarction, haematological disorders or a history of seizures. Blood donation had to be cancelled if the haematocrit was below 30%. RESULTS. There was a significant (ANOVA) drop of the haematocrit value only in the control group, and end-point values for haematocrit and haemoglobin were significantly elevated in the 400 and 500 U/kg groups compared with the control group (Table 9). DISCUSSION. The erythropoietic stimulus of phlebotomy for autologous blood donations is often not efficient enough to guarantee a constant haematocrit. Lowering of the preoperative haematocrit jeopardizes the aim of avoidance of homologous blood transfusions. rHuEPO increased the efficiency of autologous blood collections, as predonation haematocrit values could be preserved in the high-dosage groups. As a consequence, homologous transfusions could be avoided. However, there were broad interindividual differences in the erythropoietic response, possibly due to limitations in iron availability. Adverse effects of rHuEPO therapy, such as hypertension, thrombosis or neurologic disorders, are mostly reported in patients with terminal kidney failure. No such disturbances were observed in the present study. CONCLUSION. rHuEPO ameliorates the preoperative decrease of haemoglobin and haematocrit values due to autologous blood donations in a dose-related fashion. The individually adjusted dosage of rHuEPO and iron supplementation merits further investigation.

Blood Donors↗
PubMed1992

[Prophylactic administration of glucocorticoids prior to microlaryngoscopies?].

Intravenous glucocorticoids before direct laryngoscopy? The necessity of a preventive injection of corticoids before direct laryngoscopy was determined in a prospective, double blind study. 51 patients, who underwent direct laryngoscopy under general anaesthesia, received either 250 mg methylprednisolone in 10 ml NaCl 0.9% (corticoid group) or 10 ml NaCl (NaCl group) intravenously one hour before laryngoscopy. Oedema formation and the degree of inflammation in the pharynx and hypopharynx were examined on the day prior to surgery and three to four hours postoperatively. Complications of the airways were noted in the immediate postoperative phase and at the time of the second examination. Direct laryngoscopy did not induce any significant change in oedema formation or degree of inflammation in both groups. However, there was a correlation between the duration of surgery and the degree of increase in oedema and inflammation in the NaCl group but not in the corticoid group. No difference between the groups was noted with regard to postoperative complications of the airways. Based on the present study, routine application of corticoids to prevent oedema after direct laryngoscopy cannot be recommended.

Adult↗
PubMed1991

Effects of halothane in low concentrations on cerebral blood flow, cerebral metabolism, and cerebrovascular autoregulation in the baboon.

Halothane in anesthetic concentrations causes cerebral vasodilatation and decreases cerebral oxygen consumption (CMRO2). The purpose of this study was to evaluate cerebral blood flow (CBF) and CMRO2 changes associated with low concentrations of halothane. In eight normoventilated baboons with background anesthesia maintained with phencyclidine and nitrous oxide, CBF and CMRO2 were studied during the administration of end-tidal concentrations of halothane (0.125, 0.25, 0.375, 0.5, 0.75, and 1.0 vol%). Arterial blood pressure was supported by an infusion of angiotension II amide at 0.75 and 1.0 vol% of halothane to maintain an adequate cerebral perfusion pressure. In addition, cerebrovascular autoregulation was tested before and during the administration of 0.375, 0.75, and 1.0 vol% of halothane. Cerebrovascular autoregulation was assessed by observing the response of CBF to an acute increase in mean arterial pressure produced by angiotensin. CMRO2 decreased as the concentration of halothane was increased. At low halothane concentrations (0.125-0.375 vol%), CBF decreased; however, at concentrations above 0.375 vol%, CBF increased with a decrease in cerebrovascular resistance. Autoregulation was intact during 0.375 vol% of halothane, but with 0.75 and 1.0 vol% of halothane, CBF was passively dependent on cerebral perfusion pressure, suggesting impaired autoregulation.

Animals↗
PubMed1983

Psychological and vocational long-term outcomes of cardiac rehabilitation with postinfarction patients under the age of forty.

70 male postinfarction patients, who were under 40 years of age at the time of transmural myocardial infarction, participated in an inpatient control examination 3.8 years following first hospitalization (mean age: 40 years, SD = 3.5 years). A multivessel disease occurred in 52% of the patients, in 80% a multilocular disease was diagnosed and in 25% coronary angiography indicated a progression in coronary sclerosis. Coronary risk factors had been considerably reduced. 78% were capable of working. Job-related stress factors of at least moderate intensity were present in about 30% of the jobs now held by the patients. Progressive morphological change occurred in patients who are older, have a multilocular disease, are subjected to more frequent and more intensive job-related stress factors, show less concern for their health and tend to leave their old living habits unchanged. In patients with multivessel disease, time pressure elicited more psychophysiological activation; furthermore, doing too many tasks at the same time and a reduced control over vocational success, together with sufficient self-confidence and an exaggerated job devotion are found in these patients. Retired patients differ from those who went back to work in cardiological, psychological and psychophysiological aspects. The importance of psychological and psychophysiological findings for a successful vocational reintegration is emphasized by these results.

Adaptation, Psychological↗
PubMed1982

Type A behavior pattern in a German sample of post-infarction patients below age 40.

While Type A is predominant in 62 coronary subjects below age 40, its specificity is to be questioned because for controls the A:B ratio is very similar. Cases display significantly more hostility and loud/explosive speech than controls. During the interview, cases belonging to different Type A categories did not differ in heart rate, skin resistance responses and blood pressure, when task values are used. Furthermore, no differences between coronary A and B subjects are found on cardiological findings, inclusive severity of coronary atherosclerosis.

Adult↗
PubMed1982

The Type - A behavior pattern applied to problems in the rehabilitation of MI - patients below age 40: associations with personality dimensions and psychophysiological parameters essential to CHD.

In a sample of 60 MI-patients below age 40 there were mainly found correlations between the component "hostility" and personality dimensions indicating job stress and problems in the patients adjustment to their new situation as chronically ill persons. Whereas self- and expert ratings do not differentiate between Type A1 and B subjects psychophysiological testing reveals a groups difference between both groups in Ps. Therefore it can be assumed, that in daily life Type A MI-patients are prone to respond with an elevated Ps.

Adaptation, Psychological↗