Biomedical subjects

G Wald-Oboussier

Publications and source records attributed to G Wald-Oboussier.

5 recordsLinked to original sources

PubMed1989

[Supraclavicular plexus blockade using prilocaine in patients with chronic anemia].

It has not yet been clarified whether prilocaine-induced methemoglobinemia is a problem in patients with chronic anemia. We therefore performed supraclavicular brachial blockade for upper limb surgery (6 mg/kg prilocaine 2% + 0.1 IU vasopressin/ml) in ten female patients with chronic renal failure (mean Hb 8.19%) requiring hemodialysis. Before the blockade, a catheter was inserted into the opposite internal jugular vein and blood samples were drawn before and 10, 15, 20, 30, 45, 60, 90, 120 and 180 min after injection. Plasma prilocaine concentrations and methemoglobin levels were within the ranges measured by other authors in healthy patients. There was no correlation between plasma prilocaine levels and methemoglobinemia. We therefore consider prilocaine to be a safe local anesthetic in patients with renal failure and chronic anemia.

Aged↗

PubMed1988

[The action of bupivacaine-HCl following supraclavicular plexus block in patients with chronic kidney insufficiency].

A reduced duration of activity of local anesthetic drugs in patients with chronic renal failure has been described by several authors. Because surgical duration is not always predictable and these patients must be classified as high-risk patients (ASA physical status III-IV), reduced effectiveness may be a significant problem in clinical practice. Various reasons have been discussed as possible explanations for this phenomenon such as: (1) uremia-induced changes in acid-base status of blood and tissue, (2) alterations in protein-binding; and (3) changes in hemodynamic parameters. However, we have not been able to find any severe changes in electrolyte or acid-base status in patients with chronic renal failure after adequate hemodialysis. We wondered, therefore, whether changes in tissue pH might be one cause of the shorter duration of action of anesthetic drugs. We also examined some other pharmacokinetic parameters after administration of the anesthetic drug in order to find differences in comparison to healthy patients. Supraclavicular brachial blockade (3 mg/kg bupivacaine 0.5% + 0.1 IU vasopressin/ml) was performed in 11 patients with chronic renal failure requiring hemodialysis who were admitted to the hospital for a shunt operation in the forearm. The control group consisted of 11 healthy patients who were admitted for minor hand surgery. Preoperative blood samples were taken for measurement of blood urea nitrogen, serum creatinine, serum electrolytes, lactate, hemoglobin and hematocrit, and an arterial blood gas duration of action was defined as the time to full recovery of sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1987

[Continuous block of the celiac plexus].

We describe a new method for the insertion of an indwelling catheter into the region of the celiac ganglion in order to achieve long-lasting pain relief. A simple nylon catheter, of the type usually used for performing epidural catheter techniques, is placed into the prevertebral space opposite the first lumbar vertebra. The applications of the catheter were tested in a prospective study. Catheter insertion was performed in five patients suffering from carcinoma or pancreatitis. The catheter remained in place for an average of 5.8 days. The new technic was found to be successful not only for pain therapy but also to be a useful supplement for anaesthesia during laparotomy.

Adult↗

PubMed1987

[Comparative study of circulatory and ECG-changes after supraclavicular plexus block with bupivacaine-HCl 0.5 per cent in patients with chronic kidney failure].

The systemic effects of local anesthetic drugs, especially bupivacaine, on myocardial conduction and the increase of cardiotoxicity by hypoxemia, acidosis, and hyperkalemia has been proven in numerous animal experiments. In our department, supraclavicular brachial block with bupivacaine is the method of choice for patients with chronic renal failure requiring operations of the upper limb. The question may be raised whether or not these patients with their concomitant disease--electrolyte and acid-base imbalances, uremic cardiomyopathy--are especially endangered by the use of this drug. Supraclavicular brachial blockade (3 mg/kg bupivacaine 0.5% + 0.1 IU vasopressin/ml) was performed in 10 patients with chronic renal failure requiring hemodialysis. The control group consisted of 10 healthy patients who were admitted for minor hand surgery. Preoperative blood samples were taken for measurements of blood urea nitrogen, serum creatinine, serum electrolytes, and arterial blood gas analysis. Long-term ECG monitoring begun 20 min before injection of the block and continued over a total of 200 min. Serum concentrations of bupivacaine were determined at 10, 20, 30, 60, 120, and 180 min after injection. Comparing the two groups, no severe changes in electrolytes or acid-base status could be found despite some statistical significances. Even though bupivacaine serum concentrations proved to be 3 times higher in the study group than in the control group, no changes in cardiac conduction could be registered. We conclude that bupivacaine is as safe in dialyzed patients with chronic renal failure with regard to possible changes in circulatory parameters and myocardial conduction as in healthy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Chemical Analysis↗

PubMed1987

["Self-taming": an alternative to the prevention of succinylcholine-induced pain].

Muscle pain associated with single-bolus administration of suxamethonium is reported to be one of the common complications of this technique. Since suxamethonium is the most commonly used relaxant in our department and priming with nondepolarizing muscle relaxants is also reported to be linked with complications, while the literature concerning this problem is very contradictory, we wondered if the so-called "self-taming" method represents an alternative to pretreatment with nondepolarizing muscle relaxants. One hundred thirty-two patients (69 male, 63 female) were randomly allocated to three groups. Anesthesia was induced with thiopentone 7 mg/kg body weight. Group 1 (n = 44) was pretreated with 2 mg pancuronium bromide 3 min prior to full relaxation with suxamethonium 1.5 mg/kg. Group 2 (n = 43) received no pretreatment. Group 3 (n = 45) received 4 mg suxamethonium i.v. after induction. One minute later the remaining dose of suxamethonium was applied ("self-taming"). Muscle fasciculation and postoperative myalgia were verified by means of a score. Neuromuscular transmission was recorded on a monitor after controlled train-of-four stimulus and time of onset of neuromuscular blockade was measured. With regard to muscle fasciculation, postoperative pain, and onset of neuromuscular blockade, "self-taming" with suxamethonium yielded results identical to pretreatment with pancuronium bromide. It may therefore be considered as an alternative to pretreatment with nondepolarizing muscle relaxants.

Adult↗