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Biomedical subjects

J P Haberer

Publications and source records attributed to J P Haberer.

At least 19 recordsLinked to original sources
PubMed1992

[Penile block in adults].

A block of the penile nerves provides a sensory blockade of the penis. In adults, surgery can thus be carried out on the foreskin, glans, corpus cavernosum, corpus spongiosum or penile urethra. The two dorsal nerves of the penis can be blocked by two different routes. In the median technique, only one injection is performed in the subpubic space, near the posterior inferior aspect of the symphysis. In the bilateral technique, each penile nerve is blocked separately at the level of the penile root. Whichever technique is used, additional subcutaneous infiltration of the penile root improves the quality of analgesia. Bupivacaine without adrenaline is used at a concentration of 0.25% or 0.5%. In the median technique, bilateral diffusion of the anaesthetic solution has been demonstrated in ten patients by adding contrast medium to the anaesthetic solution. On the other hand, contralateral diffusion was only found in six of ten patients after an unilateral injection. These results substantiate the value of the bilateral technique in the adult. Both techniques were used in a group of 80 patients, aged 17 to 87 years. In 47 patients no other agent was administered, while the remaining 33 had either additional sedation or a general anaesthetic. Among the latter, three had a partial failure of the block. Postoperative analgesia, which was of excellent quality, covered an average of 10 hours. Neither local nor general incident occurred. Penile block is a reliable technique for regional anaesthesia. Because it is easy to carry out, and comfortable for the patient, this technique may be suggested to adults requiring penile surgery.

Adolescent↗
PubMed1991

[Local and regional anesthesia of the upper limb in emergency hand surgery].

The very conditions of the emergency led the authors to define the indications for the various modalities of local and regional anaesthesia: intravenous regional anaesthesia, nerve trunk blocks, plexus blocks, interdigital block and local infiltration. The parallel development of anaesthetic drugs with variable systemic toxicity and a duration of action inversely proportional to the toxicity now allows precise adaptation of the anaesthesia to the type of lesion, the patient's general condition, the practical conditions of the emergency and the surgical technique selected, provided the anaesthetist is fully aware of the traps to be avoided, which can only be based on a long practice of local and regional anaesthesia in elective surgery.

Anesthesia, Conduction↗
PubMed1991

Basophil histamine release in atopic patients after in vitro provocation with thiopental, Diprivan and chlormethiazole.

The degree of histamine release induced by three different anesthetic drugs was studied in vitro using basophil leukocytes from atopic patients (n = 11) and controls (n = 14). In all, eight dilutions (1/2 to 10(-5)) of Diprivan and its solvent Intralipid, thiopental and chlormethiazole in aqueous solution, were used. Histamine was released in four controls with weak dilutions (1/2 to 10(-5)) of Diprivan (n = 2) and thiopental (n = 2). The reaction with thiopental was greater than that with Diprivan. Five of the atopic subjects released histamine with one or more drug: thiopental and Diprivan four times each, Intralipid twice, and chlormethiazole once. Histamine release was greater in these patients than in controls, and occurred with dilutions ranging from 1/2 to 10(-2), except for one case. It is concluded that atopic patients release histamine with hypnotic anesthetic drugs more easily than normal subjects. In the clinical setting, where blood concentration of the drugs studied is equivalent to a dilution of less than 10(-3), they do not release much histamine. They may be used in atopic patients if the drugs are injected slowly.

Basophils↗
PubMed1991

Effects of H2-receptor blockers on response of cerebral blood flow to normocapnic hypoxia.

Cimetidine blunts the increase in cerebral blood flow (CBF) normally observed during hypoxia. It is important, therefore, to know whether other H2-blockers also affect the cerebral circulation adaptation to hypoxia. Cerebral blood flow was measured in 24 awake dogs after an intravenous injection of either saline (control) or one of three H2-blockers: 1 mg/kg ranitidine, 0.4 mg/kg famotidine, or 1 mg/kg roxatidine. These doses are equipotent blockers of H2-gastric receptors. Each dog was studied during normoxia and after 2 and 4 h of normocapnic hypoxia (FIO2, 0.10; FICO2, 0.035). During each set of experimental conditions, a bolus of either saline or one of the anti-H2 drugs was administered, and, 15 min later, radiolabeled microspheres (ruthenium 103, scandium 46, and cerium 141) were injected into the left atrium for measurement of regional CBF. After death by an overdose of thiopental, each dog's brain was excised and fixed in 10% formaldehyde; it was then weighed and dissected by region, with the radioactivity measured in each region using a gamma counter. During hypoxia, PaO2 ranged from 45 to 50 mm Hg, and pH, PaCO2, and hematocrit were within the normal limits. In the control group CBF increased 34% above normoxic baseline levels after 2 h and 31% after 4 h of hypoxia. Ranitidine (1 mg/kg) did not prevent the increase in CBF during hypoxia, but famotidine and roxatidine prevented it. When the dose of ranitidine was doubled (2 mg/kg), it too abolished the increase of CBF induced by hypoxia. In conclusion, H2-receptor blockers could interfere with the adaptation of CBF during hypoxia.

Animals↗
PubMed1991

Comparison of continuous, constant rate enteral tube feeding in supine patients to bolus food intake in ambulatory, healthy subjects regarding bioavailability of perorally administered cefroxadine.

Stabilized, bedridden, inactive trauma patients on enteral nutrition via continuous, constant rate tube feeding (2 different formulas) were given a single dose of cefroxadine p.o. There were no differences in the pharmacokinetic parameters between the groups on different enteral nutrition. These patients were compared to cefroxadine absorption in ambulatory healthy subjects after a standardized meal (bolus-fed). The mean residence time was significantly longer in the patients, and the extent of absorption was slightly reduced with one enteral nutrition formulation and significantly reduced with the other. The other pharmacokinetic parameters were not significantly different. The difference is believed to be caused by reduction in splanchnic blood flow in the immobilized patients, weakening of migrating motor complex due to tube feeding and the lower temperature (4 degrees C) of enteral nutrition.

Administration, Oral↗
PubMed1991

Peroral absorption of cefroxadine in patients within the first day after severe trauma: comparison to cefroxadine pharmacokinetics in fasted, healthy volunteers.

Peroral absorption of cefroxadine given to 7 24-h fasted trauma patients by nasogastric tube within the first day of admission was compared to that obtained in fasted healthy volunteers. The trauma patients exhibited significantly lower Cmax and reduced AUC. Even though rate and extent of bioavailability cannot be determined from these two different population groups since the total clearance must be assumed to be different in patients and healthy subjects, a reduced bioavailability is assumed based on pathophysiologic reflections.

Administration, Oral↗
PubMed1991

Accuracy and precision of fourteen pulse oximeters.

Two sets of seven pulse oximeters (Criticare CSI-502; Nellcor-N200; Datex-Satlite; Physio-Control-Lifestat 1600; Critikon-Oxyshuttle; Ohmeda-Biox 3700; Ohmeda-Biox 3740; Radiometer-Oxi; Spectramed-Pulsat; Kontron-7840; Biochem-Ox2000; Invivo-4500; Engström-EOS; Novametrix-505) were studied in two groups of eight healthy subjects, aged 26-50 yrs. The transcutaneous oxygen saturation (SpO2) was compared with arterial oxygen saturation (SaO2) measured in simultaneously with drawn blood samples (OSM2 Radiometer) at four 20 min steady-state levels of inspired oxygen fraction (FIO2) (0.21, 0.10, 0.08 and 0.07; SaO2 99-55%) in a conditioned chamber. Both the error in accuracy (mean SpO2-SaO2 difference), and the error in precision (SD of the differences) remained less than 3% for the two highest FIO2 levels (SaO2 greater than 83%) but, during deeper hypoxia, they were increased to 8% and 5%, respectively. An instrumental systematic bias affected accuracy in particular. We concluded that a good agreement between SpO2 and SaO2, as reflected by the Bartko's intraclass coefficient, was observed in nine instruments.

Adult↗
PubMed1990

[Postanoxia encephalopathies].

Ischaemic brain damage can follow global cerebral hypoxia, localized cerebral hypoxia and global cerebral anoxia as it occurs after circulatory arrest. The calcium-ion-mediated mechanism is one of the main routes to cerebral deterioration. Barbiturates are restricted for treatment of increased intracranial pressure and seizures. Calcium channel blockers cannot yet be recommended. Therapy remains mainly symptomatic. Hyperglycaemia should be avoided.

Acidosis, Lactic↗
PubMed1990

[Premedication with intranasal midazolam in pediatric anesthesia].

To evaluate nasally administered midazolam 0.2 mg.kg-1 for preinduction of anaesthesia in paediatric patients the authors studied ASA 1 patients scheduled for elective surgery. Forty-five children, ages 3 to 126 months, were randomized in three groups: group D (n = 16) received diazepam 0.33 mg.kg-1 orally, group P (placebo) (n = 13) 0.04 ml.kg-1 normal saline via the nasal route; in group MDZ (n = 16) the children were given intranasal midazolam 0.3 mg.kg-1. The premedication was assessed on a 5-point sedation scale, modified to include the response to mask placement and the quality of the induction of general anaesthesia. The degree of sedation, heart rate, blood pressure, respiratory rate and oxygen saturation levels were recorded on the arrival in the operating room (0 min) and 3, 6, 9, 12 and 15 min (mask placement) after drug administration. With intranasal midazolam sedation was demonstrable at 6 min and was significant at 9 and 12 min. In this group all the children were calm or drowsy. The induction of anaesthesia was equivalent in group D and MDZ but easier than in those patients receiving normal saline. Vital signs did not change during the study period in any of the three groups. Intranasal midazolam was slightly more effective than oral diazepam. In children, it produces anxiolysis and sedation with rapid onset and is an attractive alternative to other routes for preanaesthetic medication.

Administration, Intranasal↗
PubMed1990

Pharmacokinetics of propofol infusions in patients with cirrhosis.

We have compared the pharmacokinetics of propofol as an infusion in 10 control and 10 patients with cirrhosis. Anaesthesia was induced within 3-4 min during administration of an infusion of propofol 21 mg kg-1 h-1. After 5 min, the infusion was decreased in a stepwise manner to 12 mg kg-1 h-1 and subsequently 6 mg kg-1 h-1. The mean recovery time after discontinuation of the infusion was significantly longer in the cirrhotic group; however, when patients opened their eyes, blood concentrations of propofol were similar in both groups (1 micrograms ml-1). Pharmacokinetic analysis was performed from the beginning of infusion to 8 h after termination. Total body clearance was not reduced significantly in cirrhotic (1.56 (SD 0.48) litre min-1) compared with control (1.75 (0.32) litre min-1) patients. The volume of distribution at steady state was significantly greater in patients with cirrhosis than in control patients (202 (82) litre vs 121 (49) litre). However, this difference did not change terminal elimination half-life. The pharmacokinetics of propofol given by infusion to maintain general anaesthesia were not affected markedly by moderate cirrhosis.

Adult↗
PubMed1990

[Ambulatory surgery of the hand].

After performing ambulatory surgery in hospital, then in a private clinic, without specifically distinguishing this activity, we have created an independent Hand Surgery Center in 1980. This unit was recognized by the Social Security, with whom we have signed an agreement. This 20-year experience of ambulatory surgery has enabled us to outline its advantages and disadvantages, both for the patient and for the medical staff and the health care system. Savings on medical costs cannot be the aim of this practice, which is justified only if the patient's comfort is improved while at the same time guaranteeing the quality of care. It will only be developed harmoniously if precise "specifications" are drawn up to avoid errors and mistakes that may lead to an unjustified summary "execution". We have continued the figure-based study of which we had presented the preliminary results to the Academy of Surgery as early as 1984.

Ambulatory Surgical Procedures↗
PubMed1989

[Prospective preoperative survey of 300 patients using prick tests with muscle relaxants].

It is now well established that the retrospective diagnosis of anaphylaxis to muscle relaxants may be based on skin prick testing. These tests, which use undiluted solutions of muscle relaxants, are as sensitive, specific and reproducible as intradermal tests for the diagnosis of IgE related adverse reactions to muscle relaxants. The rate of muscle relaxant anaphylaxis (1/1 500 to 1/5 000) justifies its prevention based on a possible latent sensitization. A prospective investigation was carried out in 300 surgical patients scheduled for general anaesthesia. Prick tests were carried out using the 6 available muscle relaxants: suxamethonium, gallamine, alcuronium, pancuronium, vecuronium and atracurium. The wheal the drug might produce was compared with that obtained with codeine phosphate (a histamine releasing drug). Thirty-seven patients (13%) were considered to be atopic; 262 (87%) had undergone a previous anaesthesia. Three percent (n = 11) of tests were positive for atracurium. The wheal produced by atracurium was in favour of non-specific histamine release. One test was found positive for suxamethonium. Confirmation of this probable latent sensitization was unfortunately not possible. There were no other positive skin tests. Muscle relaxants were subsequently used in 58 patients (80% vecuronium) without any problem. Skin prick testing should be used on a larger scale to detect latent sensitization. However, predictive skin tests with atracurium should be avoided, as wheal reactions with this drug are probably due to non-specific histamine release.

Adolescent↗
PubMed1989

Sufentanil pharmacokinetics in patients with cirrhosis.

The effects of cirrhosis on the elimination kinetics and plasma protein binding of sufentanil were evaluated in 12 anesthetized patients with uncomplicated cirrhosis and these findings were compared with data from age-matched control anesthetized patients with normal hepatic and renal function. Sufentanil 3 micrograms/kg was given intravenously as a bolus injection and venous plasma concentrations were measured at intervals up to 10 hrs. The average (+/- SD) elimination half life was 3.5 +/- 0.9 hrs in controls and did not differ in cirrhotics: 4.1 +/- 0.6 hrs. The plasma clearance did not differ between the two groups: 11.3 +/- 2.5 ml.min-1.kg-1 in controls and 10.8 +/- 4.6 ml.min-1.kg-1 in cirrhotic patients. The sufentanil free fraction was also similar in controls (8.3 +/- 1.5%) and in cirrhotic patients (9.6 +/- 1.8%). These data suggest that sufentanil in a single dose should have a similar duration of action in patients with uncomplicated cirrhosis and in normal patients.

Adult↗