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J Biscoping

Publications and source records attributed to J Biscoping.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Maternal and neonatal bupivacaine plasma levels in peridural anesthesia for relief of labor pain].

Peripheral venous blood samples were drawn for bupivacaine analyses (gas chromatography) from 24 patients under epidural anaesthesia, used to reduce pain caused by contractions. The specimens were taken 10, 20, 30 and up to 45 minutes following a first injection of 11 to 13 ml bupivacaine 0.25%, before, 15 as well as 30 minutes after each repetitive dose and at childbirth. Immediately after cord clamping, blood sampling in the neonate was performed to evaluate bupivacaine concentrations in the umbilical artery and vein. Additionally, apgar scores and blood gas parameters were checked and compared with those of neonates, born without analgesic treatment of their mothers. Using bupivacaine 0.25% (average 12 ml) for epidural anaesthesia, the peak plasma levels (mean = 0.2 micrograms/ml) were found 10 minutes after application of the analgesic dose. In one patient a maximum bupivacaine plasma concentration (0.47 micrograms/ml) was determined 15 minutes after the second repetitive dose of 5 ml bupivacaine 0.25%. Apgar scores and results of blood gas analyses demonstrated no significant difference between neonates born spontaneously under regional anaesthesia or without any analgesic treatment of their mothers, respectively. Using bupivacaine 0.25% in epidural anaesthesia for pain relief in labour, we found maternal and neonatal plasma concentrations of the local anaesthetic drug far below the accepted threshold level which might produce systemic toxic reactions.

Adolescent↗
PubMed1989

[Mother and child stress parameters during cesarean section with general and peridural anesthesia].

This study compared maternal and fetal stress responses during cesarean section in either general anesthesia (GA) or epidural anesthesia (EA). Ten patients received GA with thiopental induction, intubation, and controlled ventilation with nitrous oxide and oxygen. After delivery, anesthesia was supplemented with fentanyl 0.2-0.3 mg. Ten patients received EA via catheter, using bupivacaine 0.5%, and prilocaine or lidocaine 1%. Maternal mean arterial pressure (MAP), HR, and plasma concentrations of epinephrine and norepinephrine (by HPLC/ECD), ADH, ACTH and cortisol (by RIA) were determined before and after induction, after delivery, at the end of the operation and 30 minutes postoperatively. Fetal catecholamine levels in umbilical artery blood were measured immediately after delivery. In addition, fetal blood gas analyses and Apgar scores were compared. Fetal epinephrine was slightly increased in the EA group (EA 132 pg/ml, GA 52 pg/ml). Norepinephrine was similar in both groups (EA 1.218 pg/ml, GA 1.124 pg/ml). Blood gas analyses and Apgar scores were also comparable. A negative correlation was found between norepinephrine and pH values in fetal umbilical artery blood (P = 0.01). Maternal epinephrine levels were lower under EA and below the normal range (EA 23 pg/ml, GA 77 pg/ml, P = 0.002); levels increased during GA and decreased during EA (P = 0.01). No statistical differences were seen in maternal norepinephrine (EA 206 pg/ml, GA 354 pg/ml). MAP was lower during EA (group levels EA 81 mmHg, GA 95 mmHg, P = 0.0002) and HR was higher during GA (group levels EA 89/min, GA 104/min, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed1989

[Does the development of methemoglobin in the newborn infant affect the suitability of prilocaine for pudendal anesthesia? A clinical study in the peripartum phase].

Pudendal block is a well established method of achieving analgesia during the second stage of labor. Whenever a large amount of a local anesthetic has to be injected in well vascularized tissue, local anesthetic drugs with low systemic toxicity should be used, to minimize side effects. This means that prilocaine is the drug of choice. It is well known that the metabolites of prilocaine induce methemoglobinemia, and thus the question arises as to whether the methemoglobinemia affects the fetus. PATIENTS AND METHODS. Pudendal block was achieved with 2 x 10 ml prilocaine 1% in each of 17 mothers. Plasma concentrations of the local anesthetic in the second stage of labor were determined by gas chromatography in blood samples drawn from the mother and the newborn at the moment of childbirth. In addition, the time course of methemoglobinemia was determined by capillary blood samples from the neonate up to 6 h. To evaluate methemoglobinemia in the newborn, 125 microliters heparinized capillary blood was diluted with 200 microliters 0.9% sodium chloride; methemoglobin was detected by absorbance spectrometry. RESULTS. Before the pudendal block maternal methemoglobin concentrations were about 0.2% of the total hemoglobin concentration and within the physiological range. At the moment of delivery it was increased only to a small extent, without statistical significance. In the neonates mean methemoglobin concentrations were about 1% of total hemoglobin immediately after delivery, increasing up to 1.8% in the next 2 h and then decreasing continuously in all. At the moment of childbirth maternal mean prilocaine concentrations were 0.57 micrograms/ml on an average and 0.29 micrograms/ml in the newborn. DISCUSSION. With respect to systemic toxicity, prilocaine is the drug of choice in local anesthetic procedures when a long duration of anesthesia is not required; it guarantees short latency and adequate relief of pain. Methemoglobinemia induced by its metabolites is not a contraindication for its use in humans. Formerly prilocaine was judged to be contraindicated in pregnant women during delivery because of the small redox capacity of fetal erythrocytes. Our study, however, demonstrates that 200 mg prilocaine for pudendal block does not induce methemoglobinemia in newborns to any significant extent. One explanation for this may be the increased renal elimination of local anesthetics in newborns and the low fetomaternal ratio.

Anesthesia, Obstetrical↗
PubMed1989

[The quantitative analysis of amide local anesthetics using high pressure liquid chromatography and ultraviolet detection (HPLC/UV)].

This study was undertaken to develop a time- and cost-effective method for the detection of lidocaine, mepivacaine, prilocaine, bupivacaine, and etidocaine by HPLC/UV. The chromatographic system consisted of a C18-column (300 x 3.9 mm) for reversed-phase chromatography and a mobile phase of 30% acetonitrile and 70% 0.05 M sodium phosphate buffer. For the analysis of lidocaine, mepivacaine, and prilocaine, the buffer was adjusted to pH 5.8. The buffer for the analysis of bupivacaine and etidocaine was adjusted to pH 3.5. The flow rate was 1 ml/min. UV detection took place at a wavelength of 210 nm. All blood samples were taken from a central venous line. After plasma separation, 1 microgram (100 microliters) of internal standard was added to 1 ml plasma. The samples were alkalized and extracted with ether, followed by the extraction of the organic phase in 250 microliters 0.05 N sulphuric acid; 50 microliters of this solution was injected into the system. The chromatographic system allowed the separation of bupivacaine and etidocaine (pH 3.5) as well as lidocaine and mepivacaine or prilocaine (pH 5.8). Separation of prilocaine and mepivacaine in one run was not satisfactory. Recovery rates for all local anesthetic substances were about 90%, standard variations below 3%, and coefficients of variation below 2%. The detection limit was about 30 ng/ml. The method is suitable for clinical practice. Only minor methodological modifications are necessary for the detection of the amide local anesthetics in current clinical use.

Anesthetics, Local↗
PubMed1989

[Initial experiences with a novel nerve stimulator for use in axillary plexus anesthesia].

The advantages of an electrical nerve stimulator for detection of the axillary neurovascular sheath have been frequently described in the literature and are now well known. In most of these techniques, stimulation is achieved by a fixed electrical voltage and variable amplification. The new nerve stimulator presented here offers the possibility of measuring the current at the site of stimulation ("test" position). PATIENTS AND METHODS. Axillary block was performed in 23 patients undergoing orthopedic surgery. Identification of the neurovascular sheath was first achieved by the "loss of resistance" technique, after which the injection cannula was connected to the new device. Stimulation was started at 1.0 mA. In case of a negative response to stimulation the actual electric current was checked by means of the test position in order to exclude an error in the circuit system. In these cases, the position of the cannula was altered so as to maintain a response at the lowest possible current (less than 0.5 mA). After removal of the inner solid steel stylet of the cannula, the local anesthetic was injected while compressing the distal part of the neurovascular sheath in order to avoid downstream diffusion. RESULTS. All 23 patients were operated upon under axillary block after nerve stimulator control without any additional drugs. Table 2 indicates the lowest stimulation current that still evoked a response. Disturbances in the circuit system were found twice, one caused by a short circuit, the other by a desiccated gel pad on the adhesive electrode. After elimination of the defect, stimulation produced a response. DISCUSSION. Since it is now well known that induction of paresthesias in locating peripheral nerves can cause irreversible lesions, the use of electrical nerve stimulators is preferred to locate the cannula as near as possible to the nerve without direct contact. The mode of operation of the stimulator presented here, which defines the chosen technical starting impulse as well as the actual current, allows much better localization of nerves during local anesthesia. Thus, disturbances in the circuit between nerve stimulator and patient, as shown in the two cases, can be detected. According to our experience, the intensity of stimulation for successful nerve blockade should be approximately 0.5 mA or lower. Consequently, universally applicable stimulating instruments with constant electrical tension should allow fine tuning of the current in 0.1-mA aliquots.

Brachial Plexus↗
PubMed1989

[Local anesthetic level and cardiovascular changes following local anesthesia in cataract operations with 3% mepivacaine].

Are there toxic plasma levels of mepivacaine after local anesthesia for ophthalmic surgery with 3% mepivacaine? What hemodynamic changes occur during injection of the local anesthetics? Fifteen patients undergoing cataract surgery were given 10 ml of mepivacaine (3%) as a local anesthetic regardless of body weight. After inserting an arterial line, blood samples were taken before the beginning of the injection of mepivacaine and after 3, 5, 10, 15, 30, and 60 min. Concentrations of the drug were measured by gas chromatography. During the first 15 min arterial blood pressure and ECG were registered continuously on a multichannel recorder. The maximum mepivacaine plasma levels were estimated after 15 min with a range from 0.28 to 6.95 micrograms/ml (means +/- SD: 4.5 +/- 1.47 micrograms/ml). The blood pressure was elevated over the preoperative value, at the beginning of the evaluation period, but there was no change in the blood-pressure level over the whole period. In 4 patients without known cardiac arrhythmias, ventricular or supraventricular extrasystoles occurred. The mepivacaine plasma levels complied with resorption kinetics, which is an indication that there were few intravascular injections and that the injection technique war correct. On the other hand, in some patients the mepivacaine plasma levels exceeded the toxic level. Even in ophthalmic surgery, local anesthetics should be given in relation to the body weight of the patients. The high blood-pressure levels indicated non-optimal preoperative treatment of the hypertonic patients, which was followed by an intraoperative exacerbation of the blood pressure.

Aged↗
PubMed1988

Influence of dextran on the absorption of adrenaline-containing lignocaine solutions: a protective mechanism in local anaesthesia.

The effect of adding 6% dextran to a lignocaine solution containing adrenaline was studied in 27 neurosurgical patients during modified neuroleptanaesthesia. Before trepanation they received infiltration anaesthesia of the scalp at the site of the proposed operation. For a period of 1 h following injection plasma concentrations of adrenaline were measured by high pressure liquid chromatography and serum concentrations of lignocaine by gas chromatography. The addition of dextran caused a significant reduction in the absorption of both adrenaline and lignocaine from the injection site. It is concluded that the dextran adjuvant constitutes a protective mechanism against toxic systemic side effects in local anaesthesia using adrenaline-containing anaesthetic solutions. This effect is particularly significant in patients with pre-existing cardiovascular disease and when local anaesthetic solutions are used in combination with volatile anaesthetics.

Absorption↗
PubMed1988

[Sedative-analgesic medication in intensive care patients needing ventilator treatment].

UNLABELLED: It was the aim of this study to compare two regimens for sedation and analgesia during ventilator treatment in intensive care patients. Special regard was given to endocrine stress response, neuro-monitoring, hemodynamic parameters and clinical practicability. METHODS: A total number of 16 patients of an operative ICU were randomly allocated to the following groups: (1) Fentanyl-group, approximately 0.2 mg/h fentanyl, 2.5 mg/h midazolam and 2 mg/h pancuronium in intermittent doses, (2) ketamine-group, about 50 mg/h ketamine and 2.5 mg/h midazolam by syringe pump, in addition 2 mg/h pancuronium. During a period of 2 days and in intervalls of 6 h, plasma levels of epinephrine and norepinephrine (by HPLC/ECD), ADH, ACTH and cortisol (by RIA), ketamine (by GC) and stress-metabolites (glucose, lactate, free glycerol) were determined. Hemodynamic parameters were investigated in intervalls of 12 h, EEG (Compressed Spectral Array, CSA) in intervalls of 24 h. In addition, routine laboratory data, vigilance and adaptation to the respirator were observed. RESULTS: Plasma levels of adrenaline, noradrenaline, dopamine, ADH, ACTH, cortisol and stress-metabolites were comparable in both groups. Levels of ADH, ACTH, cortisol and free glycerol did not leave the normal range. In three patients, in which epinephrine- or norepinephrine-infusions were necessary to improve cardiocirculatory stability, this treatment could be finished after beginning of the ketamine application. In both groups, CSA showed a dominant delta- und theta-activity according to the clinical aspects of sufficient sedation and analgesia. Hemodynamic parameters were comparable in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Plasma concentrations of lidocaine and prilocaine following infiltration anesthesia in otorhinolaryngologic surgery].

UNLABELLED: Infiltration anaesthesia is still relevant for the surgical treatment of patients in otorhinolaryngology. The injection of local anaesthetics in well vascularised areas constantly causes the danger of high plasma concentrations of local anaesthetics combined with undesirable side effects. In our study we tried to determine the development of plasma concentrations of local anaesthetics in patients scheduled for routine tonsillectomies and tympanoplasty. MATERIALS AND METHODS: In 45 patients the development of plasma concentrations was measured immediately after the injection at short intervals; the samples were obtained between 1 minute and 60 minutes after the first injection. Group 1: Lidocaine 0.5% with epinephrine (1:200,000) 15-20 ml for tonsillectomy (n = 18). Group 2: Lidocaine 0.5% with epinephrine (1:200,000) 8-15 ml for tympanoplasty (n = 15). Group 3: Prilocaine 1% with epinephrine (1:200,000) 8-15 ml for tympanoplasty (n = 15). For tactical reasons infiltration anaesthesia for the patients of group 2 was - in addition to general anaesthesia - applied by the otorhinolaryngologist, whereas the patients of groups 1 and 3 were operated exclusively under local anaesthesia. RESULTS: Within the first minute after the initial injection plasma concentrations of the local anesthetic increased close to toxic threshold levels that are associated with undesirable systemic side effects. In the patients of group 1, who underwent tonsillectomy, plasma concentrations of 4-7 micrograms/ml were found during the first minute. The highest average values always appeared within the first five minutes: group 1 2.07 micrograms/ml, group 2: 0.45 micrograms/ml, and group 3: 1.15 micrograms/ml. DISCUSSION: With infiltration anaesthesia in well vascularised areas it may happen that there are--mainly in the early stage--high plasma concentrations of the applied substances, although the total dose was below the known maximum. Despite careful technique (repeated aspiration test in two levels) at least partial intravascular injections are apparently not always avoidable according to the pharmacokinetic data. Our results demonstrate that in addition to a safe peripheral venous line and prophylactic oxygen therapy, intraoperative monitoring of blood pressure, heart rate, electrocardiogram and verbal patient monitoring is of advantage in this group of patients. In our opinion the "standby function" of an anaesthesiologist can avoid severe complications.

Adolescent↗
PubMed1988

[Effect of dyshemoglobinemia (methemoglobinemia and carboxyhemoglobinemia) on accuracy of measurement in pulse oximetry in operations of long duration].

In two groups - eleven patients each - who underwent long lasting surgical procedures, arterial oxygen saturation was measured non-invasively (pulse oximeter) and invasively (CO-oximeter). In addition, total haemoglobin (THb), fractions of haemoglobin (metHb) and bloodgases were monitored. All patients of group I received an epidural anaesthesia via catheter with prilocaine combined with general anaesthesia. In group II a modified neurolept analgesia (balanced) was performed. As expepted we found a prilocaine-induced methaemoglobinaemia (metHb up to 11.6 Vol%) whereas in group II physiological values were not exceeded. Carboxyhaemoglobin up to 4 Vol% was found in the smokers of both groups, which decreased continuously - in contrast to metHb - during hyperoxic ventilation. Comparing the non-invasively and the invasively determined saturations no correlation (r = -0.002) was found in group I. However, a positive correlation (r = 0.652) was obtained in group II. After correction of SaO2 (pulse oximeter) using an adjusted formula a fair correlation (0.613) was found in group I, too. Using this equation for correction the correlation in group II increased to r = 0.824. Because of methodological facts (the pulse oximeter registers only desoxygenated haemoglobin) the arterial oxygen desaturation (O2Hb or fractional saturation) accompanying dyshaemoglobinaemia remains undetectable to the pulse oximeter. In the cases of known or expected dyshaemoglobinaemia pulse oximetry can yield only limited information; fractions of inactive haemoglobin should be measured by other means or accounted for by the given equation for correction (SaO2 corr. = SaO2 pulse oximeter - (COHb + metHb]. Pathophysiological effects of dyshaemoglobinaemia are discussed.

Abdomen↗
PubMed1988

[Behavior of plasma concentrations of prilocaine following intravenous regional anesthesia and their relation to methemoglobinemia].

In a previous investigation we were able to demonstrate quite different methemoglobin levels after axillary plexus blockade on one side and intravenous regional anesthesia (IVRA) on the other using prilocaine (Fig. 1). At that time we tried to explain this observation by prolonged mobilization of the local anesthetic after tourniquet release, causing only minimal stress to the erythrocyte-related reduction system. In order to study prilocaine mobilization after tourniquet release in the upper limb following IVRA, prilocaine and methemoglobin concentrations were measured in 8 patients. All patients received 400 mg prilocaine; IVRA lasted 30 min in all cases. In each patient we inserted an intra-venous line via the cubital vein with its orifice in the region of the venous outflow of the blocked upper extremity (Fig. 2). Simultaneously, blood samples were taken for measurement of plasma prilocaine concentrations in the axillary region of the blocked limb and from the contralateral upper limb. Following tourniquet release, samples were collected at short intervals for 15 min; starting with the 15th min methemoglobin concentrations were also determined for up to 5 h. The results of the outflow and systemic prilocaine concentrations are presented in Figure 3. Remarkable differences in peak prilocaine concentrations (64 micrograms/ml vs 7.9 micrograms/ml after the 1st min) were found during the 3-h study period. The course of methemoglobin formation was similar to that in a group of patients we had studied previously (Fig. 4). Our findings confirm the assumption that the low and plateau-like methemoglobin formation following intravenous regional anesthesia of the arm is the result of delayed prilocaine release.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Conduction↗
PubMed1988

[Effect of pancuronium bromide on the adherence of polymorphonuclear neutrophilic granulocytes in vitro].

Infection is still an important problem following surgery. Polymorphonuclear neutrophil granulocytes (PMN) play a vital role in host defenses against invading bacteria; thus, adverse effects on PMN caused by anesthetic agents are of general interest. In this study, we examined the influence of pancuronium bromide on PMN adherence in vitro. Heparinized venous blood samples were obtained from 18 healthy male adult donors. Each specimen was divided. One part was used to determine the adherence of untreated PMN, while pancuronium bromide was added to the other. Two concentrations (1.3 or 0.5 micrograms relaxant/ml blood) were tested. PMN adherence was studied using nylon fiber columns as described by MacGregor et al. Both concentrations of pancuronium bromide caused an inhibition of adherence, which was significant in the case of the higher dosage (p less than 0.05). There is a direct correlation between the intensity of PMN adherence and the extent of granulocyte delivery to sites of inflammation. Therefore, it seems possible that clinical concentrations of pancuronium bromide may be able to increase the risk of developing bacterial infections. Further studies concerning this problem should be conducted.

Adult↗
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↗
PubMed1988

[Tube wall herniation in an Ulmer system as a cause of an intraoperative ventilation disorder].

We report an intraoperative complication caused by nitrous oxide diffusion through the inner layer of a tube of the Ulmer breathing system, which has been developed for ventilation of small children and neonates (Fig. 2a). About 40 min after intubation and mechanical ventilation with oxygen, nitrous oxide, and halothane a sudden rise in PETCO2 was noticed (Fig. 1). Auscultation of both lungs revealed no pathological finding; suction through the endotracheal tube was possible with no indication of endotracheal tube herniation. After reconnection to the ventilator, PETCO2 values again increased. Thorough inspection of the tubes of the Ulmer breathing system revealed a herniation that nearly occluded the lumen (Fig. 2b). After changing the anesthetic system, the operation and anesthesia were continued uneventfully.

Child, Preschool↗
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

[Change in the adhesiveness of polymorphonuclear neutrophilic granulocytes by the intravenous anesthetics midazolam and ketamine].

The influence of midazolam and ketamine on polymorphonuclear neutrophil granulocyte (PMN) adherence was investigated in vitro by using nylon fiber columns. Both a concentration of 1.0 microgram midazolam/ml blood and 0.2 microgram/ml caused a reduction of adherence. This decrease was significant (p less than 0.05) in the case of the higher dosage. The two concentrations of ketamine used (1.3 micrograms/ml resp. 0.5 microgram/ml) produced a significant reduction of adherence too. Thus both anesthetic agents are able to impair PMN function in vitro dose-dependently. This feature is possibly related to increased risk of postoperative bacterial infection. Further studies concerning this problem should be conducted.

Adolescent↗
PubMed1986

[Anesthesia procedures and perioperative patient monitoring in chemonucleolysis].

Premedication with H1 and H2 blockers as well as cortisone to reduce or prevent allergic reactions should be an integral part of the overall treatment. The facilities for immediate treatment of anaphylactic reactions including cardiopulmonary resuscitation must be readily available. Our haemodynamic measurements allow us to give a negative answer to the question--so far not investigated in man--whether the use of chymopapain or of its fragments leads to constant cardiocirculatory effective reactions in the early phase. Our experiences collected so far favour catheter peridural anaesthesia as the method of choice in chemonucleolyses.

Anesthesia↗