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H W Striebel

Publications and source records attributed to H W Striebel.

At least 37 records · Page 2Linked to original sources
PubMed1995

Pharmacokinetics of intranasal alfentanil.

STUDY OBJECTIVE: To determine the pharmacokinetics of intranasal and intravenous (IV) administrations of alfentanil in 10 healthy volunteers. DESIGN: Randomized, prospective, double-blind, placebo-controlled, cross-over trial with at least one week between the two modes of administration. SETTING: Healthy volunteers at a university medical center. SUBJECTS: 10 healthy, nondrug-dependent volunteers. INTERVENTIONS: Alfentanil 0.54 mg was administered either intranasally [with 12 ml of sodium chloride (NaCl) 0.9% IV] or IV (with 12 sprays of NaCl 0.9% intranasally). Each subject was assigned once to the intranasal and once to the IV group. To guarantee a complete elimination of alfentanil, there was a time period of at least one week between the different modes of administration. MEASUREMENTS AND MAIN RESULTS: Venous blood was sampled from a cubital vein at 3, 6, 9, 12, 15, 20, 30, 60, and 120 minutes after administration. Alfentanil plasma concentrations were determined by radioimmunoassay. Maximal plasma concentrations were 20.1 ng/ml +/- 7.3 ng/ml after 9 minutes in the intranasal group. At this measurement point, the intranasal alfentanil concentrations were 64.7% (18.7 ng/ml +/- 6.8 ng/ml) of the IV concentrations (28.9 ng/ml +/- 7.9 ng/ml). The calculated bioavailability after intranasal administration was 64.96% +/- 26.3%. CONCLUSIONS: This pharmacokinetic study demonstrates a rapid rise in plasma concentrations, as well as a high bioavailability, following the intranasal administration of alfentanil.

Administration, Intranasal↗
PubMed1995

Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection.

Prophylaxis of alcohol withdrawal syndrome (AWS) in alcohol-dependent patients shortens the duration of stay in the intensive care unit (ICU). The objective of this study was to assess the effect of four different prophylactic regimens on the duration of ICU stay, prevention of AWS and rate of major intercurrent complications in alcohol-dependent patients admitted to the ICU after tumour resection. A total of 197 alcohol-dependent patients, diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (third revised edition) with a daily ethanol intake of 60 g, were allocated randomly to one of the following regimens which were commenced on admission to the ICU: flunitrazepam-clonidine, chlormethiazole-haloperidol, flunitrazepam-haloperidol or ethanol. The duration of ICU stay, prevention of AWS, incidence of tracheobronchitis and major intercurrent complications such as pneumonia, sepsis, cardiac disorders, bleeding disorders and death were documented. On admission, patients did not differ significantly in age, APACHE II and multiple organ failure scores. ICU stay, incidence of AWS, severity of AWS (revised clinical institute withdrawal assessment for alcohol scale > 20) and major intercurrent complication rate did not differ significantly between groups. Although there was no advantage in any of the four regimens with respect to the primary outcome measures, pulmonary and cardiac patients were not included in the study. Patients in the chlormethiazole-haloperidol group had a significantly increased incidence of tracheobronchitis (P = 0.0023), probably because of an increased incidence of hypersecretion.

Adrenergic alpha-Agonists↗
PubMed1993

[Postoperative pain therapy following total endoprosthetic surgery on the hip using a continuous 3-in-1 blockade].

40 patients who had undergone total hip replacement were included in a randomised prospective study. Postoperative pain management was performed with a continuous 3-in-1 block combined with demand-adapted intravenous meperidine titration (3-in-1 catheter group; n = 20) or by demand-adapted intravenous meperidine titration alone (control group; n = 20). The 3-in-1 catheter was placed before the start of anesthesia, and the patients received 30 ml 0.5% bupivacaine via this catheter. A second dose of 30 ml 0.5% bupivacaine was injected 10 min after postanaesthetic recovery. In the control group intravenous meperidine titration was initiated if the patients required pain relief. Subjective pain intensity was evaluated over a 6-hour period by means of the visual analogue scale. Bupivacaine plasma concentrations were determined in 18 patients at 30, 60, 120, and 180 min after the first postoperative injection of bupivacaine. Good pain control was achieved in both groups. The patients in the control group required a mean of 80.8 +/- 49.9 mg meperidine. The 3-in-1 block group required significantly less meperidine (54.3 +/- 44.5 mg). Mean bupivacaine plasma levels ranged between 0.75 and 1.33 micrograms/ml. Placement of the 3-in-1 catheters was without complications. For the management of postoperative pain following total hip replacement a continuous 3-in-1 block alone was often insufficient but postoperative meperidine requirements were significantly reduced (p < 0.05). Toxic bupivacaine plasma concentrations were not measured.

Aged↗
PubMed1993

[Single-shot spinal anesthesia versus continuous spinal anesthesia using the CoSPAN catheter].

OBJECTIVE: We compared conventional single-shot spinal anaesthesia (SS) with continuous spinal anaesthesia (CS) in a randomised prospective study. PATIENTS AND METHODS: Sixty patients undergoing urological surgery received either SS (n = 30) using an atraumatic needle or CS (n = 30) using a CoSPAN catheter. Prior to performing the spinal anesthesia, patients were prehydrated with 250 ml of hydroxyethyl starch 10%. Spinal anaesthesia was performed with the patients in the sitting position at L3-4 interspace. In the CS group CSF was aspirated via the catheter to check its correct position, and initially 0.5 ml of hyperbaric 5% lidocaine were injected. 0.25 ml boli at 5 min intervals were repeated as often as necessary to reach the desired sensory blockade up to the T10 segment. In patients undergoing the single-shot technique 1.5 to 3.5 ml of hyperbaric 0.5% bupivacaine was injected. After performing the block, haemodynamic parameters were assessed for 20 minutes at 2 min intervals, before and thereafter at 5 min intervals. The required time for recovery of motor activity of the legs was assessed postoperatively. The patients were visited on the 1st, 3rd and 5th postoperative day and asked about possible headache. RESULTS: The CoSPAN spinal catheter was easy to handle. CSF could be aspirated via this catheter within 33.1 +/- 7.6 seconds. The desired maximum cephalad spread (T10) was exceeded by a mean of 0.63 +/- 1.3 segments in the CS group and by a mean of 1.4 +/- 2.6 segments in the SS group. In the SS group a mean volume of hyperbaric 0.5% bupivacaine of 2.59 +/- 0.4 ml was used. In the CS group a mean volume of 1.08 +/- 0.4 ml of hyperbaric 5% lidocaine was necessary. In the SS group, mean arterial blood pressure was found to have significantly decreased to lower than the initial value within the first 20 min after injection at each of the 10 determinations. Maximal decrease of mean arterial pressure to 89.3 +/- 7.7% was registered 14 min after injection. In the CS group, only the measurement 14 min after injection of the initial bolus revealed a significant decrease of the mean arterial blood pressure to 94.2% of the initial value. The mean interval elapsed before motor function of the legs returned after the end of surgery was 67.7 +/- 50 min in the SS group and 26.7 +/- 15.4 min in the CS group. None of the 60 patients complained about postspinal headache. DISCUSSION: Fractionated injection of the local anesthetic via a spinal catheter was more precise in achieving the desired maximum cephalad spread than SS. The CS group revealed a significantly more stable blood pressure than the SS group. The use of a short-acting local anesthetic for CS provided an earlier postoperative return of motor function of the legs. Postspinal headache appears not to be a clinically relevant problem when 28-gauge spinal catheters are used.

Aged↗
PubMed1993

Intranasal fentanyl titration for postoperative pain management in an unselected population.

A randomized, double-blind study was undertaken to investigate the suitability of intranasally administered fentanyl for postoperative pain management under routine conditions in an unselected population. For postoperative pain relief, patients received either 0.027 mg fentanyl intranasally and sodium chloride 0.9% intravenously (intranasal group, n = 53) or sodium chloride 0.9% intranasally and 0.027 mg fentanyl intravenously (intravenous group, n = 59). These doses were repeated every 5 min until the patients were free of pain or refused further analgesia. Pain severity was evaluated before beginning opioid titration and 5, 10, 15, 20, 30, 40, 50, 60, 70 and 80 min thereafter. Adequate pain relief was achieved in 52 of 53 patients in the intranasal and in all patients in the intravenous group. Pain intensities evaluated on a 101-point numerical rating scale as well as on a verbal rating scale decreased significantly in both study groups within 5 min. At the 15 min measurement point, numerical rating scale pain intensity and at the 10 and 20 min point, verbal rating scale pain intensity was significantly lower in the intravenous group. The incidence of side effects was low in both groups and no patient complained of intranasal pain. Intranasally administered fentanyl would appear to be suitable for the management of postoperative pain.

Administration, Intranasal↗
PubMed1993

[The role of clonidine in anesthesia].

For decades the adrenergic alpha2 agonist clonidine has been considered to be one of the classical, centrally acting antihypertensive agents. In addition to its antihypertensive and sympathicolytic effects, in recent studies clonidine has been demonstrated to be an effective sedative and analgesic and to reduce the amount of anaesthetic agents required. Therefore, a reconsideration of possible new indications for clonidine in clinical anaesthesiology seems to be justified. This paper presents the pharmacological basis for treatment with clonidine and reviews the extensive literature on its clinical indications in anaesthesia. Clonidine apparently produces its sedative and anaesthetic-sparing effects by stimulation of centrally located alpha2 adrenoceptors. Analgesia seems to be mediated mainly by activation of alpha2 adrenoceptors in the dorsal horn of the spinal cord. Considering its clinical indications, clonidine is often used as a supplement in the treatment of alcohol withdrawal syndromes. Future indications for clonidine may be the treatment of postoperative shivering and chronic pain management. Administration of clonidine in combination with a local anaesthetic prolongs analgesia and motor blockade. Its use in premedication and postoperative pain management may be limited by its principal effects of hypotension and bradycardia. In future, cardiovascular side effects may be minimized if all the subtypes of alpha2 adrenoceptors, their distribution within the central nervous system, and their specific action are clearly defined. This could result in a detailed therapeutic index of more selective and potent alpha2 agonists.

Analgesics↗
PubMed1992

Postoperative pain management by intranasal demand-adapted fentanyl titration.

The aim of the present study was to investigate whether intranasal administration of fentanyl allows a demand-adapted postoperative opioid titration. Forty-two patients who had undergone surgery for lumbar intervertebral disk protrusion were included in a prospective randomized double-blind study. When complaining about intense pain, 22 patients received six sprays of fentanyl (0.027 mg) intranasally and 6 ml sodium chloride 0.9% intravenously and 20 patients received six sprays of sodium chloride 0.9% intranasally and 6 ml of a diluted fentanyl solution (0.027 mg) intravenously. In both groups, these doses were repeated every 5 min until the patients were free of pain or refused further analgesic. Before the beginning of opioid titration and then every 10 min for at least 1 h, pain was evaluated with the aid of a 101-point numerical rating scale and a verbal rating scale. Blood pressure, heart rate, arterial hemoglobin oxygen saturation, respiratory rate, and side effects were recorded. All patients were satisfied with the pain reduction achieved. The total fentanyl dose was 0.073 mg (range 0.027-0.162) in the intravenous group and 0.11 mg (range 0.027-0.243) in the intranasal group. The onset of action after intranasal application was nearly as fast as after intravenous titration. The pain reduction achieved was comparable in both groups. Only at the (10-), 20- and 30-min measurement points was the pain intensity significantly lower in the intravenous than in the intranasal group. One patient of the intravenous group showed a decrease in arterial hemoglobin oxygen saturation to less than 90%. Other serious side effects were not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1992

[A comparison of a tramadol/metamizole infusion with the combination tramadol infusion plus ibuprofen suppositories for postoperative pain management following hysterectomy].

Postoperative pain management is still a grossly neglected field. In most cases, antipyretic analgesics alone are insufficient during the early postoperative period. Powerful narcotics are often avoided or underdosed because they are associated with the risk of respiratory depression. Some authors recommend combined infusion of tramadol and metamizole, which is assumed to provide sufficient pain relief without the risk of respiratory depression. However, this regimen has not yet been investigated in a study that meets currently accepted scientific standards. METHODS. Sixty patients who underwent vaginal hysterectomy were included in a randomised, prospective double-blind study. Thirty women received two placebo suppositories immediately after induction of anaesthesia and a postoperative infusion of tramadol and metamizole (400 mg tramadol plus 5 g [= 10 ml] metamizole in 500 ml electrolyte solution). The 30 women of the control group received two ibuprofen suppositories (585.2 mg) preoperatively and a post-operative tramadol infusion (400 mg tramadol plus 10 ml placebo [NaCl 0.9%] in 500 mg electrolyte solution). The patients of both groups received 125 ml of the appropriate infusion solution as a loading dose over 10 min (corresponding to 1.25 mg metamizole and 100 mg tramadol in the metamizole/tramadol group or 100 mg tramadol in the ibuprofen/tramadol group) 10 min after awakening. The remaining solution was administered at an infusion rate of 12.5-25 ml/h (corresponding to 125-250 mg metamizole and 10-20 mg tramadol/h or 10-20 mg tramadol/h). On request or when complaining of stronger pain, the patients received an additional bolus infusion of 125 ml over 10 min. In case of insufficient pain reduction despite repeated infusion of 125-ml boli or consumption of the entire infusion solution, the patients discontinued the study and received demand-adapted intravenous titration of piritramide. Postoperative pain was evaluated on the visual analogue scale (VAS) and the 101-point numerical rating scale immediately before the start of the infusion. Pain evaluation was repeated 20, 30, 40, 60, 100, 120, and 240 min after awakening accompanied by registration of heart rate, respiratory rate, systolic and diastolic blood pressure, and side effects. RESULTS. About 60% of the entire infusion solution was administered within 60 min in both groups. Significant postoperative pain reduction in both groups and on both the 101-point scale and the VAS was observed only at 100, 120, and 240 min after awakening. In the tramadol/metamizole group, nausea occurred in 7 cases and vomiting in 1. Nine patients in this group additionally required intravenous piritramide because of insufficient pain relief. In the tramadol/ibuprofen group, 8 patients complained about nausea and 4 patients vomited. Six patients additionally received intravenous piritramide because of insufficient pain reduction. CONCLUSIONS. Satisfactory pain reduction occurred rather late despite high doses of both the tramadol/metamizole and the tramadol/ibuprofen. Both analgesic combination must be regarded as insufficient after inhalational anaesthesia because of the very slow onset of action and the high failure rate.

Adult↗
PubMed1991

[Fulminant malignant hyperthermia during the 6th general anesthesia using volatile anesthetics].

We report on the fulminant crisis of malignant hyperthermia occurring in a 30-year-old female during kidney transplantation. In the past, she had been anaesthetised repeatedly without complications. Anaesthesia was induced with thiopental and vecuronium and continued with isoflurane/N2O/O2. After an initially normal course of anaesthesia, the patient developed symptoms of a fulminant malignant hyperthermia (MH) including excessive increase in end expiratory CO2, hyperkalaemia, tachycardia and hyperpyrexia. The patient was saved by the timely administration of dantrolene. A surgical revision required the next day because of bleeding was done under dantrolene cover and took an uncomplicated course. The patient was extubated 7.5 hours after the second intervention and transferred to a normal ward after 4 days. A subsequently performed in vitro contracture test clearly revealed susceptibility to malignant hyperthermia.

Adult↗
PubMed1991

[Knotting of a peridural catheter].

We report a patient who was given continuous epidural anesthesia due to painful contractions during delivery of a child after intrauterine fetal death. Placement of the catheter and repeated reinjections were carried out without problems, however, during withdrawal of the catheter it could only be pulled 1-2 cm until there was enormous resistance. An X-ray film showed knotting of the catheter in the epidural space. Firm pulling finally allowed complete withdrawal of the catheter. Insertion of the catheter too far into the epidural space initially must be considered as a possible cause. As this complication rarely occurs, we consider this case worth reporting.

Anesthesia, Epidural↗
PubMed1990

[Perioperative respiratory therapy and postoperative pain therapy].

Especially patients with preexisting bronchopulmonary diseases or those undergoing operations in the upper abdomen or thoracotomies are susceptible to post-operative pulmonary complications. All patients at risk should learn the prophylactic respiratory maneuvers preoperatively. Perioperative use of incentive spirometers, breathing exercises or IPPB seems to reduce the incidence of postoperative pulmonary complications. Opioids are used usually for postoperative pain management, but unfortunately they are given mainly as i.m. injections, although an i.v. administration would be far better. If given in an equipotent dose, nearly every opioid provides sufficient postoperative analgesia. Wide interindividual variation in the needed dose requires that opioids be titrated intravenously.

Combined Modality Therapy↗