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Biomedical subjects

M R Brandt

Publications and source records attributed to M R Brandt.

15 recordsLinked to original sources
PubMed1990

[Attitude to the criteria of death and kidney transplantation of the relatives of kidney donors].

Fifty near relatives of cadaver kidney donors in the County of Ringkøbing were questioned about how they experienced information concerning the brain death of the donor and the request for permission to remove the kidneys for transplantation. This was undertaken as an interview investigation. In addition, they were questioned as to whether they subsequently experienced doubt about the decision and about their attitude to the criteria for death. It was found that approximately half were aware of the seriousness of the condition before they were told by a doctor but that 35% would have desired more detailed information. Emphasis is placed, in addition, on improved conditions for a dignified parting from the decreased, not information by telephone and that the time for decision making was too short. The reasons for accepting removal of the kidneys were either knowledge of the donor's attitude or consideration of the recipient. Only three donors had drawn up donor testaments. Only one of the relatives regretted the decision while 20% had experienced doubts but the great majority would have liked to discuss the subject with others later. 63% accept the criteria for brain death and 14% the criteria for heart death but only 9% have altered their attitude as a result of the current debate.

Attitude to Death↗
PubMed1979

Effect of epidural analgesia on metabolic profiles during and after surgery.

Blood concentrations of glucose, lactate, alanine, free fatty acids, glycerol and 3-hydroxybutyrate were measured during 24 h in 12 females undergoing elective hysterectomy under either general anaesthesia or epidural analgesia extending from T4 to S5. The results showed that the peroperative and immediate postoperative metabolic profiles in the group receiving general anaesthesia reflected substrate mobilization (increased glucose, lactate, 3-hydroxybutyrate), and that epidural analgesia blocked these changes, probably mediated through an inhibited adrenaline response to surgery. Peroperative values of free fatty acids and glycerol were significantly lowered by epidural analgesia, indicating inhibition of lipolysis. Alanine decreased similarly in both groups. In the later postoperative period metabolic profiles were similar in two groups, indicating that the influence of fasting may override the effect of the relatively minor trauma.

Adult↗
PubMed1979

Epidural analgesia inhibits the renin and aldosterone response to surgery.

Renin activity and aldosterone concentration in plasma and excretion of sodium and potassium in urine were measured during a period of 24 hours in 12 patients undergoing hysterectomy under general anaesthesia or epidural analgesia. Analgesia extended from T4 to S5 and was effective throughout the study. The normal stress-induced increase in plasma renin activity and aldosterone was inhibited by epidural analgesia. Urinary excretion of potassium was significantly lower in the epidural group, but sodium and water retention showed no difference between groups. It is concluded that neurogenic stimuli from the surgical area are important release mechanisms of the renin-aldosterone response to surgery. The results suggest that post-operative sodium retention is caused by factors other than the mineralocorticoid system.

Adult↗
PubMed1978

Epidural analgesia improves postoperative nitrogen balance.

Postoperative nitrogen balance was monitored in twelve patients undergoing hysterectomy under either epidural analgesia or general anaesthesia. The mean cumulative five-day nitrogen losses were significantly lower after epidural analgesia than after general anaesthesia. Nitrogen sparing presumably results from inhibiting the stress-induced release of catabolic hormones, since epidural analgesia abolished postoperative hyperglycaemia and increase in plasma cortisol concentrations. No adverse effects of inhibiting the stress response were observed. Neurogenic stimuli thus play a crucial part in the catabolic response to surgery. Inhibiting the endocrine metabolic response to trauma by neurogenic blockade may reduce the morbidity precipitated in high-risk patients by the catabolic response to surgery.

Adult↗
PubMed1978

Inhibition of aldosterone response to surgery by saline administration.

The renin-angiotensin system, ACTH and hyperkalaemia are known to induce increased plasma levels of aldosterone. In order to assess the relative significance of these mechanisms during surgical stress, aldosterone, cortisol and electrolytes in plasma were measured in 12 otherwise healthy women during and after cholecystectomy. The patients received either isotonic sodium chloride or 5 per cent glucose in water during the experimental period of 22 h. The results showed that the pronounced increase of aldosterone and the concomitant decrease of sodium in plasma found in patients given glucose in water could almost be inhibited by the administration of saline. Cortisol and potassium concentrations were identical in the two groups of subjects. It is concluded that the aldosterone response to surgery is mainly mediated via the renin-angiotensin system. This response is probably due to a reduced sodium content or volume of extracellular fluid, since it could almost be inhibited by administration of sodium chloride. The rationale of saline restriction during and after surgery is questioned.

Adult↗
PubMed1978

Influence of morphine anaesthesia on the endocrine-metabolic response to open-heart surgery.

Twelve patients scheduled for aortic valve replacement during extracorporal circulation were randomly allocated to either morphine anaesthesia or fluroxene anaesthesia. Morphine in a total dose of 4 mg/kg was administered before skin incision. At the start of extracorporal circulation all patients received 25 g glucose intravascularly. The endocrine-metabolic response to surgery, as expressed by changes in plasma ACTH, cortisol, insulin, growth hormone, cyclic adenosine-3',-5'-monophosphate (cyclic AMP), glucose, free fatty acids, blood b-hydroxybutyrate and cumulative nitrogen balance was measured before and during anaesthesia and surgery, and on the first five post-operative days. It was found that morphine anaesthesia blocked the increase in ACTH, cortisol, growth hormone, cyclic AMP, and glucose during surgery. However, after initiation of extracorporal circulation only ACTH, cortisol, and, to a lesser degree, the glucose and insulin response to glucose were lowered by morphine anaesthesia. From the first to the fifth days after operation no differences between the two groups could be demonstrated in any parameter. Cumulative nitrogen balance was similar in the two groups. It is concluded that morphine in large doses administered before skin incision inhibits the initial endocrine-metabolic response to open-heart surgery, but that the effect is short-lasting and without effect on overall postoperative protein catabolism.

Adolescent↗
PubMed1978

Halothane anaesthesia and suxamethonium III. Atropine 30 s before a second dose of suxamethonium during inhalation anaesthesia: effects and side-effects.

The protection against bradycardia afforded by atropine given intravenously just prior to a second dose of suxamethonium during halothane inhalation anaesthesia was studied in 100 healthy, adult patients randomly allocated to one of five groups characterized by dosage of atropine. ECG monitoring was continuous, and regular determinations were made of serum potassium, PaCO2, PaO2 and blood pressure. Slowing of the heart rate was seen in more than 50% of patients in each group, but bradycardia (heart rate less than 60 beats/min) was seen only in patients receiving the lowest dose of atropine--0.0075 mg/kg. In the other four groups (atropine 0.01 mg/kg-0.02 mg/kg), bradycardia prophylaxis was effective, but at the cost of serious ventricular arrhythmias in 15% of the patients. The incidence of these arrhythmias seemed to increase with increasing atropine dosage. Marked tachycardia was also seen. Because of the incidence of side effects in this and other studies, no absolute recommendation can be made about suxamethonium bradycardia prophylaxis during halothane inhalation anaesthesia, but our present experience suggests that atropine in a dose not exceeding 0.01 mg/kg, given 30 s prior to a second dose of suxamethonium is best.

Anesthesia, Inhalation↗
PubMed1977

Inhibition of plasma cyclic AMP, glucose and cortisol response to surgery by epidural analgesia.

Cyclic AMP, glucose and cortisol in plasma were measured in three groups of patients undergoing hysterectomy. The operations were performed under general anaesthesia, under general anaesthesia combined with epidural analgesia and under epidural analgesia alone. Surgery elicited a significant rise in plasma cyclic AMP, glucose and cortisol when performed under general anaesthesia alone. Epidural analgesia extending from T4-6 to S5 combined with general anaesthesia abolished the rise in cyclic AMP and reduced the increase in glucose and cortisol and epidural analgesia alone extending from T4 to S5 blocked the rise in glucose and cortisol as well as that in cyclic AMP. The results support the theory that afferent nerve impulses from the area of trauma are of major importance for the catabolic state induced by surgical procedures and indicate that anaesthetic management which includes blockade of afferent nerve impulses which includes blockade of afferent nerve impulses from the area of trauma can be reduce the catabolic response to surgery. These observations could be of value in the operative management of patients with diabetes mellitus and possibly in other groups by patients with a high surgical morbidity.

Adult↗
PubMed1977

C-peptide and insulin during blockade of the hyperglycaemic response to surgery by epidural analgesia.

UNLABELLED: Insulin secretion, as expressed by peripheral plasma insulin and C-peptide levels, was studied during and after abdominal hysterectomy in six patients having general anaesthesia and in six patients having epidural analgesia. The hyperglycaemic response to surgery was abolished during epidural analgesia. Insulin as well as C-peptide levels in plasma were low and unchanged during general anaesthesia and low and slightly decreasing during epidural analgesia. CONCLUSIONS: (1) Insulin secretion to the hyperglycaemic stimulus is blocked during surgery: (2) abolition of the hyperglycaemic response to surgery by epidural analegesia is not caused by an increased insulin secretion.

Adult↗
PubMed1977

The blocking effect of epidural analgesia on the adrenocortical and hyperglycemic responses to surgery.

The adrenocortical and hyperglycemic responses to hysterectomy were studied in five groups of patients receiving: general anesthesia (group I), general anesthesia + epidural analgesia extending from Th10-S5 (group II), general anesthesia + epidural analgesia extending from Th8-S4--5 (group III), general anesthesia + epidural analgesia extending from Th4--6-S5 (group IV) and epidural analgesia extending from Th4-S5 without general anesthesia (group V). The results showed that the cortisol response was abolished in group V, inhibited in group IV and normal in groups II and III. The hyperglycemic response to surgery was inhibited in groups II, III and IV, and abolished in group V. Epidural analgesia from Th4 to S5, preventing the adrenocortical and hyperglycemic responses to hysterectomy, and possibly also inhibiting other components of the endocrine-metabolic response to surgery, may have important applications in further studies of the physiologic significance of the endocrine-metabolic response to surgery.

Adrenal Cortex↗
PubMed1976

Rapid decrease in plasma-triiodothyronine during surgery and epidural analgesia independent of afferent neurogenic stimuli and of cortisol.

Changes in circulating triiodothyronine (T3), thyroxine (T4), binding of thyroid hormones to plasma proteins (resin-T3 test), cortisol, and glucose were evaluated in sixteen patients undergoing abdominal hysterectomy. In eight of the patients afferent neurogenic impulses from the surgical area were blocked during and after operation by epidural analgesia. These patients were pain-free, and the normal stress-induced increase in cortisol and glucose was abolished. During epidural analgesia and general anesthesia plasma-T3 fell rapidly and values in the hypothyroid range were found 6 hours after skin incision. Similarly, an increase in the resin-T3 test reflected decreased binding of T3 to plasma proteins. Plasma-T4 decreased slightly during surgery and epidural analgesia (as it does when other anaesthetics are given), but increased during general anaesthesia. These results indicated that the alterations in thyroid hormones and their binding to plasma proteins after surgery are not caused by a stress-induced increase in plasma-cortisol or by neurogenic afferent stimuli from the surgical area, factors which are both known to affect concentrations of other hormones.

Adult↗
PubMed1976

The postanesthetic antiemetic effect of premedication with dehydrobenzperidol before ether anesthesia.

A study was performed to evaluate the antiemetic effects after ether anesthesia when dehydrobenzperidol (DHB) and pentobarbital were used for premedication and to compare these effects with halthane anesthesia when pentobarbital was used as premedication. Eighty-four patients undergoing minor surgical operations were randomly divided into three groups. The patients received ether and ether DHB 0.2 mg/kg or pentobarbital 2 mg/kg for premedication, or halothane and pentobarbital 2 mg/kg for premedication. The complaints of nausea and vomiting were recorded 24 h after anesthesia. We found that DHB compared to pentobarbital had a greater antiemetic effect after ether anesthesia, but the difference was not significant (P greater than 0.05). However, if only persistent nausea and vomiting were considered, the difference was significant (P less than 0.05). The incidence of nausea/vomiting after ether anesthesia with DHB as premedication was a little higher compared to halothane anesthesia with pentobarbital as premedication, but the difference was not significant (P greater than 0.05). However, if only persistent nausea/vomiting was considered, the incidence of complaints was equal in the two groups. It is concluded that when used for premedication to ether anesthesia DHB seems to lead to less postanesthetic nausea/vomiting than pentobarbital. Further DHB seems able to reduce the incidence of nausea/vomiting after ether anesthesia roughly to the level of that seen after pentobarbital premedication for halothane anesthesia.

Adolescent↗