[Have indications for preventing stress ulcer been changed in relation to aspiration pneumonia?].
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Antacids↗
Biomedical subjects
M Tryba
Publications and source records attributed to M Tryba.
Treatment of acute migraine with subcutaneous GR43175 in West Germany.
A subcutaneous preparation of GR43175, a novel antimigraine 5-HT 1-like agonist, was considered to represent a convenient way of administering the drug to patients during an acute migraine attack. In a series of open, uncontrolled dose-ranging studies, 82 patients with migraine were assessed serially for changes in severity of headache and associated symptoms following subcutaneous GR43175 in doses of 1-4 mg. Subcutaneous injection of 3 mg or 4 mg was found to be most effective. Within 60 min, 90% of patients had obtained complete relief of all migraine symptoms. Tolerability was good, 59% of patients reporting no adverse effects. Those reported mainly comprised transient local irritation to the injection. There were no changes attributable to GR43175 in heart rate, blood pressure, ECG readings or laboratory parameters.
Adult↗
[A new procedure for decreasing transfusion risk in administration of fresh frozen plasma].
About 2% of patients in central Europe who receive transfusions of whole blood or blood components still develop typical transfusion-induced infections, most often non-A-non-B hepatitis. The risk of infection increases in direct correlation to the number of transfused units, which mainly means the number of different donors. We have developed a new and simple method that leads to a significant reduction of infection risk in patients who receive multiple units of fresh frozen plasma. Plasma from individual donors is gathered over a period of about 9 months, after which 5000-6000 ml is stored separately for each donor. The plasma of each donor is numbered, e.g. 1/87, 2/87, 3/87 ... 1/88. This procedure allows an immediate overview of which are the oldest units. If a patient needs multiple units of fresh frozen plasma, he receives only plasma from a single donor. The donors are under strict control; the plasma must be stored for at least 3 months. Only if the donors are free of any signs of infections such as hepatitis or HIV during that period is the plasma allowed to be transfused. If only a few units will be transfused the plasma store can be refilled within 2-4 weeks. This regimen reduces the risk of transfusion-induced infections in patients who receive 10 double units of fresh frozen plasma by at least 90%. Apart from the additional logistic costs, only a refrigerator with the capacity to store a large number of plasma units is needed.
Blood Donors↗
[Interactions of H2 antagonists and non-depolarizing muscle relaxants].
Many drugs potentiate the action of non depolarizing relaxants. These interactions are of clinical importance if such drugs are administered during the perioperative period. H2 Antagonists are increasingly often used for premedication. Cimetidine inhibits the elimination of a number of drugs used in the perioperative period. We therefore investigated whether H2 antagonists enhanced neuromuscular blockade by vecuronium, a medium short acting non depolarizing muscle relaxant. METHODS. The study was carried out in 24 female patients (ASA class I or II) scheduled for microsurgical procedures. Neuromuscular transmission was recorded electromyographically using four stimulations every 20 s to the ulnar nerve. After induction with thiopentone, anesthesia was maintained with fixed concentrations of volatile anesthetics. Fentanyl was administered for additional analgesia. Vecuronium was used as the sole muscle relaxant. Fixed repetitive doses of vecuronium (0.8-1.2 mg) were injected whenever the T1 returned to 25%. This time interval was defined as the T1-25 period. The study proper started when the T1-25 period had stabilized. After two control periods, six patients in each group received either 200 or 400 mg cimetidine or 100 mg ranitidine. The fourth group was the control group. The T1-25 periods and the maximal EMG depression were recorded automatically for at least two further periods. The first measured period was recorded as 100% and the length of each other periods was calculated as a percentage of the control period. This method enables an intraindividual comparison of the length of the T1-25 period and the maximal EMG depression before and after administration of the H2 antagonists. A two-tailed Student's t-test was used to test statistical significance, P less than 0.05 being accepted as significant. RESULTS. In the control group and in the group with 200 mg cimetidine or 100 mg ranitidine no statistical significant prolongation of the T1-25 period or of the maximal EMG depression could be observed, while after 400 mg cimetidine there was significant prolongation (mean 161 +/- 14.8%) of the T1-25 period and significantly greater EMG depression compared with the pre-cimetidine values. In the groups with 200 mg cimetidine or 100 mg ranitidine few patients showed prolongation of the T1-25 period up to 130%. DISCUSSION. Our results confirm experimental studies that have shown cimetidine to enhance aminoglycoside--relaxant interactions. Because we found an immediate response to the administration of the H2 antagonists, the interaction cannot be on the elimination side; it must be at the neuromuscular junction. Experimental investigation has shown that calcium reverses the cimetidine effects. It is therefore probable that the cimetidine--relaxant interaction occurs at the presynaptic level. Careful observation seems to be necessary if H2 antagonists, especially cimetidine, are administered intraoperatively at the same time as drugs that also enhance
Adult↗
[Vecuronium in dystrophia myotonica (Curschmann-Steinert)].
An emergency laparotomy was performed in a 31-year-old female (body wt 48 kg) with known myotonic dystrophy. Premedication with dantrolene (1 mg/kg i.v.) was used to prevent a myotonic response. Muscle relaxation was monitored electromyographically. Following induction with fentanyl (0.3 mg) and thiopental (200 mg), muscle relaxation was achieved with 2 mg vecuronium titrated for about 3 min until the T1-response was reduced to 10%. The recovery time was normal. A repetitive dose of 0.5 mg vecuronium was necessary after 20 min, when the T1 reached 60%. Extubation and the early postoperative period were uneventful. Because of the unknown predisposition of our patient for the development of malignant hyperthermia, anesthesia was performed with trigger-free anesthetics.
Adult↗
[Death on the table during implantation of a hip prosthesis--a neglected peroperative risk?].
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Anesthesia, Spinal↗
[Hemostatic requirements for the performance of regional anesthesia. Workshop on hemostatic problems in regional anesthesia].
There is uncertainty as to which preoperative examinations are necessary before performing regional anesthesia. Therefore an interdisciplinary consensus conference was established to obtain recommendations on some of the open questions related to this topic. Preoperative laboratory examinations are not necessary prior to peripheral nerve blocks near large vessels if these are easy to compress. In patients on anticoagulant therapy direct puncture of the vessel should be avoided. Prior to spinal or epidural anesthesia, no preoperative laboratory examinations are necessary if no anamnestic or clinical evidence of coagulation disorders exists. Otherwise the following examinations are useful: clotting time, prothrombin time, partial thromboplastin time (PTT), and thrombocyte count. Low-dose heparin prophylaxis is no contraindication to spinal or epidural anesthesia. However, in patients at increased risk of bleeding or with low body weight, PTT and thrombocyte count are necessary. Since at present no definite data exist as to the bleeding risk in patients treated with low-molecular-weight heparin prophylaxis, spinal/epidural anesthesia should be performed in controlled studies only under these conditions. This particular precaution seems to be necessary because low-molecular-weight heparin increases levels of plasminogen activators (t-PA) and therefore has fibrinolytic activity. If plasma expanders are administered perioperatively, the highest bleeding risk exists after dextran infusions. There is also an increased bleeding risk if nonsteroidal anti-inflammatory drugs, especially acetylsalicylic acid, are administered repeatedly within 5 days prior to spinal/epidural anesthesia. In these patients preoperative determination of the clotting time appears necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesia, Conduction↗
[A new positioning aid for administering axillary plexus anesthesia].
A "plexus-table" is introduced as a new help to place an arm for application of the axillary plexus block. A modified Maquet arm posturing device offers a sufficient big plate, which is adjustable in all planes. The plate is fixed closely to the operation table. A more comfortable placement of the patient's arm is possible, due to the reduction of the externally rotation of the shoulder. The new table can be adapted to patients with restrictions of the movements of the shoulder. For the anaesthetist this results in a good presentation of the axillary region.
Anesthesia, Conduction↗
Acute treatment of severe haemorrhagic gastritis with high-dose sucralfate.
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Drug Administration Schedule↗
[Stress bleeding and postoperative pneumonias in intensive care patients on ranitidine or pirenzepine].
To prevent stress bleeding, 400 postoperative patients in intensive care but not expected to need long-term mechanical ventilation, were randomly given either 50 mg pirenzepine or 200 mg ranitidine daily intravenously for a mean of 3.9 days. Macroscopically visible bleeding was the criterion of stress bleeding. In addition, special attention was also paid to any signs of pneumonia. There was a significantly higher incidence of gastric pH values of less than 4 in the pirenzepine patients. Six episodes of bleeding occurred in the ranitidine group vs. three in the other. There was a significantly higher incidence of pneumonia among ventilated patients (18.0% vs. 2.7%). Among ventilated patients the pneumonia rate under ranitidine was 28.6% vs. 9.1% in the pirenzepine group (P less than 0.05). The probable cause of the higher pneumonia rate under ranitidine was the gastric colonization with gramnegative organisms. Pirenzepine assures an effective prophylaxis against stress bleeding at least as good as ranitidine. At the same time, the risk of lung infection is also lower with pirenzepine than ranitidine.
Clinical Trials as Topic↗
Prevention of stress bleeding with ranitidine or pirenzepine and the risk of pneumonia.
In a prospective, controlled, randomized trial of stress bleeding prophylaxis, 400 patients in a surgical intensive care unit received 50 mg pirenzepine (n = 200) or 200 mg ranitidine (n = 200) daily. The drugs were administered continuously via an intravenous line. The mean duration of the treatment was 3.9 days. Patients were included in the study if no long-term ventilation was expected. In patients with a stomach tube in place, the intragastric pH was determined every eight hours. Bleeding was defined as macroscopically visible. Along with stress bleeding, the development of postoperative pneumonia was documented. The intragastric pH was less than 4 significantly more often in patients treated with pirenzepine. In patients treated with ranitidine, six stress bleedings were observed, while in the pirenzepine group three bleeding episodes occurred. Seven of the nine bleeding patients were found to have a very high bleeding risk. In mechanically ventilated patients, a significantly higher risk of pneumonia was observed compared with non-ventilated patients (18.0% vs 2.7%). Fourteen of the 20 pneumonias occurred in patients treated with ranitidine. In ventilated patients treated with ranitidine, the pneumonia rate was 28.6%, while in the pirenzepine group the pneumonia rate reached only 9.1% (p less than 0.05). The increased frequency of pneumonia in patients treated with ranitidine appears to be caused by overgrowth of gram-negative bacteria in the stomach. Pirenzepine provides adequate protection against stress bleeding while also minimizing the danger of pneumonia caused by infection via the gastropulmonary route.
Adult↗
The use of roxatidine acetate in fasting patients prior to induction of anaesthesia as prophylaxis against the acid aspiration syndrome.
Aspiration pneumonitis is one of the major causes of anaesthesia related deaths. H2-receptor antagonists are effective drugs for the prevention of the acid aspiration syndrome (Mendelson's syndrome). The new long-acting H2-receptor antagonist roxatidine acetate may be the first H2-receptor antagonist which could effectively reduce acid secretion following a single bedtime premedication on the evening before an operation. A prospective controlled randomised double-blind study was conducted in 60 elective patients undergoing gynaecological operations requiring tracheal intubation. 30 patients received oral roxatidine acetate 150 mg at 10 pm, the other 30 patients received placebo. Immediately after intubation, at 15 minutes and at the end of the operation gastric pH and the volume of the aspirate were measured. In the placebo group, 13 patients (43%) had gastric pH values below the critical value of 2.5, while in the roxatidine acetate group gastric pH values were raised above 2.5 in all but 3 patients (10%) [p less than 0.05]. In the roxatidine acetate group pH values were significantly higher than in the placebo group (p less than 0.01). The mean gastric volume in the placebo group was 23.3 +/- 27.1 ml, compared to 14.5 +/- 9.4 ml for roxatidine acetate. The 5 highest gastric volumes were observed in the placebo group (max 146 ml). A single bedtime oral premedication with roxatidine acetate 150 mg ensures a gastric pH above 2.5 until 11 am the following day.
Adult↗
Penetration of roxatidine into the cerebrospinal fluid.
Central nervous system side effects are occasionally associated with the administration of H2-receptor antagonists. There seems to be a direct correlation between the occurrence of side effects such as mental confusion and the drug concentration in the cerebrospinal fluid. In animal experiments the new H2-blocker roxatidine did not cross the blood-brain barrier. We therefore investigated the penetration of roxatidine into human cerebrospinal fluid (CSF). Nine healthy subjects scheduled for elective spinal anesthesia were premedicated with 150 mg roxatidine orally. Blood samples were taken at 30-min intervals for up to 6 h. A 2-ml CSF sample was taken from each patient at the time of spinal puncture. Small amounts of roxatidine were detectable in the CSF, the CSF to plasma ratio ranging from 0 to 0.89.
Animals↗
[Cardiovascular reactions and histamine release following atracurium--a problem of dosage?].
All muscle relaxants can induce allergic or pseudo-allergic reactions. The medium-long-acting, nondepolarizing muscle relaxant atracurium has been shown to be a potent histamine liberator. Up to now it is unknown if a clinical dosage of atracurium exists where no clinically relevant histamine release occurs. In a prospectively controlled study we therefore investigated the effects of different dosages of atracurium on cardiovascular reactions and histamine release.
Adult↗
[Benefits and risks of H2 antagonists in anesthesia and intensive medicine].
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Anesthesia↗
[Clinical effectiveness and systemic toxicity of various mixtures of prilocaine and bupivacaine in axillary plexus block].
The presently existing local anesthetics (LA) do not guarantee a rapid onset and simultaneously a long duration of action. The combination of a medium-long acting LA with bupivacaine, a long-acting LA with slow onset, could be means to achieve these aims. Prilocaine was chosen as the medium-long acting LA because it has the lowest toxicity of this group and for pharmacological reasons. METHODS. In a prospective, controlled double-blind study 100 patients scheduled for axillary block for elective surgical procedures of the hand or wrist were randomly assigned to five groups. Twenty patients in each group received either 40 ml prilocaine 1.5%; 40 ml bupivacaine 0.375%; 20 ml prilocaine 1% + 20 ml bupivacaine 0.5%; 20 ml prilocaine 2% + 20 ml bupivacaine 0.5%; or 20 ml prilocaine 2% + 20 ml bupivacaine 0.375%. The LA mixtures were freshly mixed 15 min prior to the axillary block. The blocks were performed using an immobile, short-beveled needle by anesthesiologists who were familiar with this technique. Analgesia was classified using the pin-prick method with 0 = no analgesia, 1 = analgesia, 2 = anesthesia. Motor blockade was classified with 0 = no motor block, 1 = paresis, 2 = paralysis. The following nerves were analyzed: ulnar, radial, median, musculocutaneous, and medial antebrachial. In 6 patients of each group plasma levels of the LA were measured by gas chromatography and methemoglobinemia was determined. Statistical analysis of the data was performed using the Student t-test and chi-square test on a level of significance of P less than 0.05. Results. All surgical procedures could be performed as planned in regional anesthesia. Twenty minutes after injection of the LA only 15% of the blocks were sufficient in the bupivacaine group, while in the other four groups 40%-50% of the blocks were complete (P less than 0.05). The degree of analgesia was deeper in the groups with 2% prilocaine and prilocaine alone than in the group with 1% prilocaine. Forty minutes after injection there were no significant differences between the groups. Motor blockade after 20 min was significantly lower in the bupivacaine group than in the prilocaine group (P less than 0.05). After 4 h all three prilocaine-bupivacaine mixtures showed a significantly more pronounced analgesia of the median nerve than the prilocaine group (P less than 0.02-0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids.
In a prospective, controlled, randomized study of the prophylaxis of stress bleeding, 100 ventilated high-risk patients in a surgical intensive care unit received, on a daily basis, 1 g of sucralfate suspension (n = 50) every four hours, or an antacid (n = 50) every two hours. The mean duration of the treatment was about six days in both of the groups. Gastric pH was determined every eight hours. Bleeding was defined as macroscopically visible bleeding. The intragastric pH was less than 4 significantly more often in patients treated with sucralfate. In each group, one case of macroscopically visible bleeding occurred. Both of the patients had a very high risk of bleeding. None of the bleedings influenced the outcome of the patients. When patients with primary thoracic trauma or pneumonia were excluded, nosocomial pneumonia developed in significantly fewer (p less than 0.05) patients in the sucralfate group (three of 29) than in the antacid group (11 of 32). In four of the latter patients, pneumonia influenced the outcome of the patients. Sucralfate provides adequate protection against stress bleeding while also minimizing the danger of pneumonia caused by infection via the gastropulmonary route.
Adult↗
Antibacterial activity of sucralfate in human gastric juice.
A series of experiments was conducted to determine the rate of bacterial growth in human gastric juice at various pH values in relation to the addition of sucralfate and antacid. Whereas the addition of antacid resulted in bacterial growth in gastric juice, sucralfate showed an antibacterial effect. This may account for the decreased rate of pneumonia among intensive-care patients who are receiving artificial ventilation and being treated with sucralfate for the prevention of stress-induced gastrointestinal bleeding compared with the rate in patients receiving conventional prophylaxis with histamine (H2)-antagonists or antacids.
Aluminum Hydroxide↗