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M Behne

Publications and source records attributed to M Behne.

47 records · Page 3Linked to original sources
PubMed1990

[Life-threatening lactic acidosis during total parenteral nutrition. Successful therapy with thiamine].

Two patients, 37 and 44 years old, respectively, developed severe metabolic acidosis after abdominal surgery which was followed by three weeks of total parenteral nutrition. Septicaemia, peritonitis or hypoxia were excluded as possible causes. Both patients had very high serum lactate concentrations (24.3 and 22.8 mmol/l, respectively). Conventional treatment with buffer agents was unsuccessful. Because vitamin B1 deficiency was suspected, two doses of 400 mg thiamine were administered. In both patients the extreme lactic acidosis disappeared immediately after the injections. Both patients were later discharged without any symptoms.

Acidosis, Lactic↗
PubMed1989

[The plasma histamine level during anesthesia induction using midazolam].

Midazolam has not yet been investigated for its possible properties as a histamine releaser. The aim of the following study was to ascertain whether histamine release follows the i.v. injection of midazolam. METHODS. Twenty patients between 18 and 58 years of age were split into two groups at random. Either 0.15 mg/kg midazolam or 0.15 ml/kg NaCl 0.9% were injected i.v. Venous blood was drawn 2 min before and 2, 5, and 10 min after each injection. The content of histamine in plasma was determined by HPLC. RESULTS. In the midazolam group, histamine levels decreased from 0.37 ng/ml to 0.29 ng/ml after 5 min (P less than 0.05). The kinetics typical of histamine release could not be observed in any of the patients. We observed a slight decrease in the blood pressure or tachycardia in 3 patients, but even in these cases there was no increase in histamine level. In the NaCl group, the histamine level decreased from 0.34 ng/ml to 0.23 ng/ml after 2 min (P less than 0.05). The hemodynamics of these patients remained unchanged. One patient had an abnormally high histamine level prior to the injection (2.33 ng/ml). CONCLUSION. Our results show that midazolam is not a histamine releaser. The relevance of 1 patient having a high baseline level of histamine remains unclear.

Adult↗
PubMed1989

[Prolongation of the QT interval in the ECG following surgery of the neck (neck dissection)].

The QT interval on the ECG was determined in 40 patients undergoing major resection plus neck dissection. The readings were taken before operation, between 1 and 3 h after operation, and the 1st and the 7th day after the operation. The QT interval was prolonged significantly more often and more intensively in patients undergoing surgery on the right side (from 411 +/- 17 to 459 +/- 50 ms) than in those operated on the left side (409 +/- 14 to 431 +/- 32 ms; all values mean +/- SD). The cause of the prolongation of QT interval is thought to be either direct surgical damage to the sympathetic cardiac nerves during the operation, or a temporary disturbance of nerve function due to pressure, tension or oedema in the wound. An explanation for the observed side difference might be differing functional effects of right- and left-sided sympathetic innervation of the heart. Attention is drawn to the meaning of these findings as a predisposing factor for ventricular tachyarrhythmias.

Adult↗
PubMed1989

[The pharmacokinetics of midazolam following intramuscular administration].

There have been conflicting reports on the pharmacokinetics of midazolam, administered i.m. The aims of this study were to determine the pharmacokinetic data of midazolam following different doses and to test whether a correlation exists between its plasma level and sedative effect. METHODS. Fifteen patients between the ages of 18 and 50 were divided into three groups for i.m. administration of midazolam 0.05 mg/kg (group 1), 0.1 mg/kg (group 2), or 0.15 mg/kg (group 3) i.m. Venous blood was drawn 6, 12, 18, 24, 30, 36, 42, 48, 54, 60 min, and 2, 3, 4, 6, 8 h after the injection. After the same times the sedative effect was estimated by the anesthetist (awake, sleeping but easy to wake, sleeping and difficult to wake, unconscious). The plasma midazolam levels were determined by gas chromatography. The following pharmacokinetic parameters were ascertained: Cmax (peak concentration), tmax (time to attain peak concentration), clearance, elimination half-life. RESULTS. The peak concentration is directly proportional to the dosage of midazolam and the relation between the two is linear. The median Cmax values were 35.3 ng/ml (group 1), 103 ng/ml (group 2) and 123.5 ng/ml (group 3). The duration of tmax was between 12 and 36 min (means = 27 min). There was no significant difference between the groups in clearance, tmax, or elimination half-life. A significant correlation was found between the plasma midazolam levels and the degree of sedation. However, we observed a considerable variability in the effect. CONCLUSION. A 95% confidence interval for the prediction of the peak concentration of midazolam after i.m. injection is stated. Midazolam should be administered at a dose of 0.05 mg/kg at the most, if unconsciousness after premedication is to be avoided.

Adult↗
PubMed1988

[Effect of glycopyrrolate and atropine on the behavior of heart rate and pH value of gastric juice during microlaryngoscopies].

In a prospective study a total of 51 patients were given either a premedication with atropine (10 micrograms/kg) (n = 17), with glyopyrrolate (5 micrograms/kg) (n = 15) or no anticholinergic premedication (n = 19). In the group of patients premedicated with glycopyrrolate the pH levels of the gastric juice were more often above 2.50 than in the group without anticholinergic premedication (p less than 0.05). During the microlaryngoscopic interventions there was a trend to fewer A-node rhythms or bradycardias in the group premedicated with glycopyrrolate than in the other groups. Reduction of salivary gland secretion by anticholinergics made intervention easier. Glycopyrrolate has advantages over atropine as far as the induction of anaesthesia for microlaryngoscopic interventions is concerned.

Aged↗
PubMed1987

[The pharmacokinetics of midazolam in various kinds of anesthesia].

Several authors reported a decrease in metabolism of drugs during inhalational anesthesia. In this study we investigated the influence of several kinds of anesthesia on the metabolism of midazolam. Methods. In 43 patients who underwent minor surgery, anesthesia was induced by injecting 0.2 mg fentanyl followed by 0.15 mg/kg midazolam. Anesthesia was maintained by either halothane/nitrous oxide (group 1), isoflurane/nitrous oxide (group 2), fentanyl/droperidol/nitrous oxide (group 3), or halothane/air/oxygen (group 4). Venous blood was drawn after 5, 15, 30, 60, 90, 120, 180, 240, 300 and 360 min. Using the two-compartment model we estimated distribution half-life (t1/2a), elimination half-life (t1/2el), clearance (Cl), and volumes of distribution (Vz = volume in elimination phase). Results. There were no significant differences of elimination parameters between the four groups. Elimination half-life ranged from 0.72 to 15.06 h. Cl ranged from 2.5 to 12.8 ml/min per kilogram. Four patients (= 9%) had a t1/2el of 7-15 h; in 16 cases we found secondary concentration peaks. There was no correlation between drowsiness in the postoperative period and midazolam concentration. Conclusion. Even if anesthesia should influence the metabolism of midazolam, for example by reducing liver blood flow, we did not find any difference between the four groups. In accordance with others, we found some patients with a half-life of up to 15 h, which might reflect the influence of the anesthesia itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Continuous Midazolam infusion for sedation of respirator patients].

UNLABELLED: Most intensive care (ICU) patients need pharmacological sedation during ventilatory support. The short-acting drug midazolam might be preferable to neuroleptic agents and opiates because of its anxiolytic and sedative properties. The dosage of a drug given in a continuous infusion is based upon knowledge of its clearance and of the function of concentration and effect. METHOD: A midazolam infusion (7.5 or 15 mg/h) was given to 16 patients receiving ventilatory support for 24 h. Clearance was estimated using the rule Cl = R/C (R = rate of infusion, C = concentration in steady state). To estimate the concentration of midazolam necessary for good sedation, the amount of supplementary injected neuroleptic during midazolam infusion was compared with that of the day before. Plasma cortisol and parameters of energy metabolism, electrolytes, and liver and kidney function were measured. RESULTS: Patients with disease of abdominal organs showed the lowest values for clearance (1.0-2.92 ml/min/kg). Some of the injured patients showed elevated values for clearance (3.0-21.36 ml/min/kg). Elimination half-life ranged from 1.5-50 h. Changes in intestinal perfusion or cardiac output might be responsible for the wide range. For good sedation, plasma midazolam concentrations had to be above 600 ng/ml. Plasma cortisol levels were not affected by midazolam, nor were metabolism, electrolytes, or liver and kidney function. CONCLUSION: Continuous infusion of midazolam is a useful way of sedation for ICU patients, but the wide range of clearance values must be considered.

Adult↗
PubMedDate not supplied

Midazolam does not antagonize fentanyl-mediated analgesia in surgical patients.

STUDY OBJECTIVE: To determine whether midazolam possesses a clinically significant antianalgesic action in surgical patients. DESIGN: Randomized, controlled study. SETTING: Inpatient anesthesia at a university department of neurosurgery. PATIENTS: 2 groups of 10 patients each who were scheduled for supratentorial brain surgery, did not have elevated intracranial pressure, and were free from systemic disease. INTERVENTIONS: Patients underwent anesthesia induction with hexobarbital, succinylcholine, and pancuronium; anesthesia was maintained with injections of droperidol-fentanyl (Group 1) or with midazolam-fentanyl (Group 2) following a predetermined repetitive dosing schedule, such that fentanyl 0.1 mg was injected upon predominant increases in heart rate, whereas droperidol 2.5 mg or midazolam 2.5 mg was injected upon increases in blood pressure. MEASUREMENTS AND MAIN RESULTS: Duration of anesthesia and invasiveness of surgery were similar in both groups. The amount of fentanyl required was 0.55 +/- 0.18 mg/hr (mean +/- SD) in Group 1 and 0.53 +/- 0.17 mg/hr in Group 2. Injections of droperidol 7.5 +/- 3.4 mg/hr (Group 1) and midazolam 5.9 +/- 2.3 mg/hr (Group 2) were administered intraoperatively. This redosing regimen was associated with uninterrupted hemodynamic stability, indicating comparable and adequate anesthetic depth. Plasma concentrations of metabolites and hormones indicative of humoral stress activation did not differ between groups. CONCLUSION: Under these clinical conditions, the administration of midazolam, when compared with droperidol, was not associated with signs of any antagonistic or antianalgesic action toward fentanyl-mediated analgesia.

Adolescent↗