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Biomedical subjects

M Tryba

Publications and source records attributed to M Tryba.

At least 19 recordsLinked to original sources
PubMed1998

[Are tramadol enantiomers for postoperative pain therapy better suited than the racemate? A randomized, placebo- and morphine-controlled double blind study].

The goal of this prospective, randomised and double-blind pilot-study was to investigate the analgesic potency and the side-effects of tramadol enantiomers in clinical practice. One hundred patients recovering from orthopaedic surgery with a postoperative pain intensity of more than 50 on a visual analogue scale 0-100 mm (Table 1) were recruited for the study. They were treated in a randomised, double-blind way with a maximal dose of 150 mg i.v.(+)-,(-)-tramadol, racemate, or 15 mg i.v. morphine or saline in the placebo group (5 groups, 20 patients each). The primary criterium of efficacy was the number of responders defined as patients with a pain reduction of at least 20 on VAS after 40 min. In case of pain, responders were allowed to continue with the double-blind drug up to six hours. The non-responders were treated with morphine as the rescue analgesic. The secondary criterium was the incidence and severity of side-effects. Six patients terminated the study prematurely. One patient was excluded because of an allergic reaction to morphine, one patient could not be treated sufficiently with morphine, four were excluded because of protocol violations. There were 8 responders in the (+)-tramadol-,6 in the (-)-tramadol- and 6 in the racemate group, 16* (P < 0.05) in the morphine group, and 5 in the placebo group. Pain intensity after 40 min was reduced by 20 (p < 0.05), 17 (p < 0.05), 17 (p < 0.05), 36 (p < 0.01 vs placebo, p < 0.05 vs (+)-,(-)-tramadol, and racemate group) and 5 mm on the VAS in the (+)-, (-)-, (+/-)-tramadol-, morphine- and placebo-group, respectively. Thirty eight adverse events like nausea, vomiting, PCO2-increase, and urinary retention occurred in 20 patients, most frequently in the (+)-tramadol- and morphine group. Sedation was significantly less profound in the (-)-tramadol group 1-4 h postoperatively. There were no side-effect in the tramadol racemate group. The enantiomers were equal to the racemate in analgesic potency, but inferior by far to morphine. They showed more adverse events and, hence, can not be preferred to the racemate in postoperative pain therapy.

Analgesics, Opioid↗
PubMed1998

[Prevention of intraoperative hypothermia in children].

UNLABELLED: Children are very sensible to the occurrence of intraoperative hypothermia (HT) (core temperature < or = 36.0 degrees C) during general anaesthesia because their regulation capacity is less effective than in adults and due to a large skin-surface area compared with their body mass. We compared the efficacy of different heating devices to prevent HT in children during surgery. METHODS: With approval of the local ethics committee 50 children between one and seven years, scheduled for peripheral surgery lasting at least 2 hours were included in this study. Anaesthesia was standardized in all patients. Patients were randomly divided into 5 groups. In group 1, in addition to the usual cotton blankets, room temperature was elevated to 27-28 degrees C. In group 2, room temperature was maintained at 27-28 degrees C, and the patients were additionally wrapped into an aluminum blanket. In group 3, elevated room temperature was combined with a convective heating blanket. Patients in group 4 were warmed with an aluminum blanket, while the room temperature was maintained at 22 degrees C. In group 5, room temperature was maintained at 22 degrees C and patients were warmed with a convective heating device (Tab. 1). Room and core body temperature (tympanon membrane) were continuously measured. ANOVA and Fisher's exact Test (significance level: p < 0.05) were performed for the statistical analysis of the results. RESULTS: The demographic data of all 5 groups, the infused fluid volume and the anaesthetic technique were similar. There were no significant differences concerning age, height and weight of the pediatric patients (Tab. 2). The core temperature decreased by -1.7 degrees C in group 1. In group 4 core temperature decreased by -1.6 degrees C. Using a convective warming system in normal ambient temperature (group 5) core temperature increased by 0.2 degree C and was as effective in the prevention of HT as group 2. A significant increase in core temperature occurred in group 3 +0.7 degree C (Tab. 3 and Fig. 1). DISCUSSION: OR temperature seems to be a critical factor influencing heat loss. Increasing OR temperature and covering with cotton sheets was not effective in preventing the heat loss. Increasing room temperature in combination with aluminum sheets is one alternative to prevent HT. Our study shows that the use of a convective warming device prevents HT during a 2-hour surgery in young children even at a OR temperature of about 22 degrees C. In conclusion, in pediatric patients the use of a convective heating system proved to be an effective alternative to room heating.

Body Temperature↗
PubMed1998

[Paraspinal opioids and pump systems].

The regional application of opioids close to the spinal cord by using pumps induces a pain reduction comparable to the systemic medication of the WHO analgesic ladder. However, this method does not reduce the side effects of these drugs, e.g. nausea, vomiting, dysfunctional bladder emptying, and obstipation. Problems and complications leading to revision surgery and system explantation, respectively, are of more severe importance. Pump explantation occurs in a frequency of 7.3% and revision surgery in a frequency of 6.2%. Catheters and port systems have to be revised in 15% of all cases. Therefore, the indication for this method has to be considered carefully and includes the following criteria: pain of somatic origin, exclusion of mental diseases and psychogenic causes of pain, causal therapy is exhausted, insufficient effects of peripheral analgesics and co-analgesics, oral or transdermal opioids are insufficient despite dosages resulting in side-effects, pain is sensible to opioids, regional application of opioids has been tested effective before implantation.

Analgesia, Epidural↗
PubMed1997

[Effectiveness of autologous blood donation in coronary surgery--a retrospective analysis].

OBJECTIVE: This study was performed to evaluate whether autologous blood donation prior to coronary artery bypass graft surgery (cabg) reduces homologous blood requirements and the risk of homologous blood transfusion. METHODS: Within a period of 18 months, 633 patients undergoing cabg surgery were retrospectively included into the study. Non-donors were included if preoperative haemoglobin concentration exceeded 12.5 g%. RESULTS: According to demographic data, risk scores of patients who donated blood (n = 201) were lower. More patients of this group received left internal mammary bypass grafts (63% vs. 51%; p = 0.047). Nevertheless, blood loss did not differ between donors and non-donors. Prior to blood donation, haemoglobin-concentration was significantly higher in male donors (n = 177) compared to female donors (n = 24) (15 +/- 1.2 vs. 13.8 +/- 1 g%; P < 0.001). Compared to female donors, male patients donated significantly more blood units. The risk of homologous blood donation was significantly lower in male donors than in male non-donors (no homologous transfusion: 20% vs. 42%; P < 0.0001; Odds Ratio: 0.34; 95% confidence-interval: 0.23-0.52). Accordingly, homologous blood requirements were lower in male donors (0.9 +/- 3.4 vs. 1.6 +/- 3.6 blood units; P = 0.02). Between female donors and non-donors neither the number of patients treated with homologous blood (no homologous transfusion: 29% vs. 33%, P = 1; odds ratio: 1.17; 95% confidence-interval: 0.4-3.4), nor the mean number of transfused homologous blood units (1.8 +/- 1.6 vs. 1.9 +/- 2.4; P = 0.83) was different. Reactions during blood donation requiring treatment (bradycardia, hypotension, angina, arrhythmias) occurred more often in female patients (5/24 vs. 9/177; P = 0.015). CONCLUSION: In our study, autologous blood donation significantly decreased the risk of homologous transfusion and homologous blood requirements in male cabg patients. We were not able to prove the efficacy of autologous blood donation in female cabg patients. Due to the small sample size of our investigation, further prospective studies are necessary to answer the question whether patients with low blood volume, body weight and body height scheduled for cabg surgery should be excluded from autologous blood donation.

Aged↗
PubMed1997

Current guidelines on stress ulcer prophylaxis.

Acute uppergastrointestinal bleeding in intensive care unit (ICU) patients may occur due to peptic ulcer disease, adverse drug effects, gastric tube lesions, acute renal failure, liver failure or stress-induced gastric mucosal lesions. Gastric acid hypersecretion can be observed in patients with head trauma or neurosurgical procedures. Gastric mucosal ischaemia due to hypotension and shock is the most important risk factor for stress ulcer bleeding. Preventive strategies aim to reduce gastric acidity (histamine H2 receptor antagonists, antacids), strengthen mucosal defensive mechanisms (sucralfate, antacids, pirenzepine) and normalise gastric mucosal microcirculation (sucralfate, pirenzepine). However, the most important prophylactic measure is an optimised resuscitation and ICU regime aiming to improve oxygenation and microcirculation. All drugs approved for stress ulcer prophylaxis in Europe (H2 antagonists, antacids, pirenzepine, sucralfate) have been shown to be effective in prospective controlled randomised trials. However, due to insufficient clinical data, prostaglandins and omeprazole cannot be recommended for this use. Stress ulcer prophylaxis is indicated only in patients at risk, and not in every ICU patient. The selection of drugs today depends not only on efficacy but also on possible adverse effects and on costs. In this regard, the most cost-effective drug is sucralfate. The clinical relevance of nosocomial pneumonia due to gastric bacterial overgrowth has decreased during the past decade due to several changes in the management of critically ill patients.

Antacids↗
PubMed1996

[Anesthesia and intensive care management of severely burned children of Jehovah's Witnesses].

A 3.5-year-old girl suffered from a thermal injury affecting 37% of the body surface area. The parents, being Jehovah's witnesses, refused permission for their child to receive blood transfusions. As the haemoglobin level was only 7.5% and a necrectomy was planned, the patient was likely to need blood transfusions. Indications for transfusion were defined as clinical signs of hypoxia and/or cardiovascular instability. A judicial declaration was proposed. Hb decreased during the therapy. To stimulate the erythropoiesis erythropoietin and iron were administered. During the clinical course the anaemia worsened. First, a conservative treatment with polyvidoniodine ointment for tanning was started, to avoid an operation during the acute phase after the injury, as in this case it was thought a blood transfusion would definitely be necessary. On the 19th day after the injury a necrectomy of 10% of the body surface was necessary because of fever and leucocytosis not responding to antibiotics. The most likely cause of the symptoms was an infection of the burned area. Hb was 4.6 g/dl%. General anaesthesia was performed with midazolam, ketamine and vecuronium and mechanical ventilation. No blood transfusion was required during the operation. Vital signs were stable during the preoperative period, during anaesthesia and following the operation. There were no signs of tissue hypoxia. Peripheral oxygen saturation ranged between 98% and 100%, lactate and arterial blood gas samples were normal, and the child was awake and cooperative before and after anaesthesia. The lowest Hb was 3.3 g/dl on the 22th day after injury (3rd postoperative day). In this phase the patient was still playing and riding a tricycle. On the 45th day after injury the child was discharged home with Hb of 10.9 g/dl and reticulocytosis of 33%.

Anemia↗
PubMed1996

Preoperative alpha2-adrenergic receptor agonists prevent the deterioration of renal function after cardiac surgery: results of a randomized, controlled trial.

OBJECTIVE: To evaluate the influence of the alpha2-adrenergic receptor agonist clonidine on creatinine clearance as a measure of renal function. DESIGN: Prospective, double-blind, randomized, placebo-controlled clinical trial. SETTING: University hospital. PATIENTS: Patients undergoing coronary artery bypass graft surgery (n = 48) with normal risk. INTERVENTIONS: Administration of clonidine (4 micrograms/kg iv)) or placebo 1 hr before induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Induction and maintenance of anesthesia (etomidate, midazolam, and fentanyl) and cardiopulmonary bypass technique (nonpulsatile, normothermic, intermittent cold blood cardioplegia) were standardized in all patients. The night before surgery and the first and third night after surgery, creatinine clearance was calculated from a 12-hr urine collection period. Venous blood samples for determination of plasma antidiuretic hormone (ADH) concentrations were taken the evening before surgery, immediately before induction of anesthesia and the evening after surgery (n = 16). Arterial catecholamine plasma concentrations were determined (high-performance liquid chromatography) before induction, 15 mins after induction of anesthesia, immediately after sternotomy, before initiation of cardiopulmonary bypass, as well as 5, 15, and 30 mins after initiation of cardiopulmonary bypass (n = 16). The total amount of anesthetics, infusions, transfusions, diuresis, and blood loss was not different between the groups. Creatinine clearance decreased over the first postoperative night from 98 +/- 18 (preoperatively) to 68 +/- 19 mL/min (p < .05) in placebo-treated patients. Creatinine clearance remained unchanged in clonidine-treated patients (90 +/- 19 [preoperatively] to 92 +/- 17 mL/min). There was a significant difference in creatinine clearance between the groups during the first postoperative night (p < .05; Mann-Whitney U test). In the third postoperative night, mean creatinine clearance of both groups was not different (75 +/- 31 vs. 86 +/- 28 mL/min). ADH concentrations were not different between the groups at any time, while plasma catecholamine concentrations were always significantly lower in clonidine-treated patients. CONCLUSIONS: Preoperative treatment with clonidine (4 microgram/kilogram) prevents the deterioration of renal function after cardiac surgery. This effect might be due to clonidine-induced reduction in the sympathetic nervous system response to coronary artery bypass graft surgery.

Adrenergic alpha-Agonists↗
PubMed1996

Choices in sedation: the balanced sedation technique.

Patients undergoing surgery under regional anaesthesia may be anxious, uncomfortable or in pain. Therefore, effective sedation throughout the procedure is an important aspect of patient management. The balanced sedation technique uses combinations of sedatives to meet the anxiolytic and analgesic needs of the individual patient. For example, benzodiazepines are effective anxiolytics, while propofol can be used to provide a suitable level of sedation, especially in patients who have expressed a wish to remain asleep during the procedure. Analgesics should be considered only in those patients who are likely to experience pain during the procedure. Basic measures to increase the comfort of the patient and to facilitate the effect of pharmacological methods include supplementary non-pharmacological techniques, for example the use of a soft mattress to prevent back pain, infusion of warmed fluids and a warm operating atmosphere. This may extend to the opportunity for patients to listen to music if they have a fear of the sounds associated with the operating room, such as technical discussions by surgical staff or the sound of surgical instruments being used and discarded. The balanced sedation technique can, therefore, help to achieve the ideal goal of a comfortable patient who is free from anxiety and pain, and can sleep if desired.

Anesthesia, Conduction↗
PubMed1996

Epoetin alfa plus autologous blood donation in patients with a low hematocrit scheduled to undergo orthopedic surgery.

A low predonation hematocrit (Hct) can preclude the collection of sufficient autologous blood (AB) to meet the transfusion requirements of patients scheduled for orthopedic surgery. Subcutaneous (s.c.) administration of epoetin alfa, in conjunction with intravenous (i.v.) iron supplementation, has proved effective for the facilitation of AB donation by such patients. Compared with untreated controls and patients treated with i.v. iron alone, epoetin alfa 50 to 150 IU/kg SC plus i.v. iron twice weekly for 3 weeks prior to surgery significantly increased total red blood cell (RBC) production (P < .01) and the volume of RBCs donated (P < .05). Epoetin alfa was particularly effective in females and patients with a predicted blood volume (PBV) less than 5 L. Treatment with epoetin alfa led to an increase (albeit nonsignificant) in the number of AB units predonated compared with i.v. iron alone. However, in patients with a PBV less than 5 L, a substantially greater percentage of epoetin alfa-treated patients donated > or = 4 AB units (80% v 30%). Allogeneic blood requirements were reduced, albeit not significantly (P = .051), in patients treated with epoetin alfa. However, in comparison with untreated controls, there was a significant reduction in the mean volume of allogeneic blood transfused per transfused patient in the epoetin alfa groups. The optimum s.c. dose of epoetin alfa in patients with a low predonation Hct scheduled for orthopedic surgery appears to be between 100 and 150 IU/kg twice weekly for 3 weeks.

Anemia↗
PubMed1996

Epoetin alfa plus autologous blood donation and normovolemic hemodilution in patients scheduled for orthopedic or vascular surgery.

In previous studies, treatment with epoetin alfa facilitated preoperative donation of autologous blood (AB). However, some patients may not be able to donate sufficient AB to meet their surgical blood requirements when the time to surgery is short. In this multicenter, double-blind, placebo-controlled study, the ability of epoetin alfa combined with normovolemic hemodilution (NVHD) to facilitate the collection of > or = 4 AB units within 2 weeks of surgery was investigated in 112 nonanemic patients scheduled for elective orthopedic or vascular surgery. All patients received oral iron supplementation and were treated with three intravenous (i.v.) injections of epoetin alfa (300 or 600 IU/kg) on days 1,4, and 7; surgery, in combination with NVHD, was performed on day 13. A total of 4 units of AB were predeposited if the patient's hemoglobin (Hb) level exceeded 11 g/dL at each donation. Compared with placebo, epoetin alfa dose-dependently increased reticulocyte counts prior to surgery and significantly minimized the decrease in hematocrit (Hct) associated with AB donation, although there were no significant differences between dosages. While significantly more patients treated with epoetin alfa were able to donate > or = 4 AB units compared with placebo, there was no difference between the groups in exposure to allogeneic blood. This effect of epoetin alfa was particularly apparent in female patients. I.v. epoetin alfa 300 IU/kg, administered three times within 1 week, appears to be the optimum dose for facilitating the collection of > or = 4 units of AB in nonanemic patients scheduled for elective surgery and NVHD within 2 weeks.

Administration, Oral↗