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Biomedical subjects

M Tryba

Publications and source records attributed to M Tryba.

At least 109 records · Page 6Linked to original sources
PubMed1987

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↗
PubMed1987

[Therapy of perioperative sinus tachycardia with the new calcium antagonist falipamil].

The haemodynamic responses after application of 100-200 mg falipamil (5,6-dimethoxy-2-(3-((alpha (3,4-dimethoxy)-phenylethyl) methylamino)propyl)phthalimidine, AQ-A 39) a new calcium channel blocker with specific action on the sinus node, was studied in 11 patients with perioperative sinus tachycardia (greater than 120/min). A drop in the heart rate of at least 10% could be observed in all patients. In 8 patients 100 mg falipamil decreased the mean heart rate from 130 +/- 19 to 97 +/- 8/min 5 min after the application (p less than 0.001). In the resting 3 patients a second dose of falipamil was injected because of insufficient clinical response. In these patients the mean heart rate dropped from 162 +/- 27 to 125 +/- 40/min 10 min after the second dose. No significant changes of the blood pressure could be observed. Falipamil may become a valuable drug for the therapy of sinus tachycardia due to catecholamines during the perioperative period.

Adult↗
PubMed1987

[Clinical and toxicologic study of axillary plexus block with prilocaine or mepivacaine].

A prospective controlled double-blind study was designed to compare the efficacy and the toxicity of mepivacaine and prilocaine for the axillary blockade of the brachial plexus. Twenty patients in each group received 40 ml of either 1.5% mepivacaine or 1.5% prilocaine. The sensory and the motor blockade achieved in both groups were comparable. The mean plasma levels attained following mepivacaine were significantly higher than those attained after prilocaine (peak-plasma level (mean +/- SD): 2.02 +/- 0.28 micrograms/ml vs 5.37 +/- 1.83 micrograms/ml). In four patients of the mepivacaine group, the plasma levels entered the toxic range. While no methemoglobinemia could be detected following mepivacaine, four of the patients receiving prilocaine developed methemoglobinemia with a maximum level of 10%. No complications due to methemoglobinemia were observed in any of the patients. Because of its significantly lower toxic potential, prilocaine seems to be the better local anaesthetic for axillary blockade of the brachial plexus.

Adult↗
PubMed1986

Prevention of histamine-induced cardiovascular reactions during the induction of anaesthesia following premedication with H1- + H2-antagonists i.m.

In a prospective controlled double-blind study, 60 elective surgical patients were randomly assigned to three premedication groups. Twenty patients received promethazine 0.5 mg kg-1 i.m. 45 min before induction of anaesthesia; a further 20 patients received an additional i.m. injection of cimetidine 400 mg 120 min before induction. The third group (n = 20) served as the control group. Following vecuronium 0.02 mg kg-1, anaesthesia was induced with fentanyl, and etomidate. All patients then received suxamethonium 1.5 mg kg-1 i.v. The combined administration of H1- + H2-antagonists as premedication led to a significant reduction in the increase in heart rate when compared with the effects in the other groups.

Adult↗
PubMed1986

[Sympathetic block after plexus anesthesia. Comparison with stellate ganglion block].

Plethysmographic measurements of the upper extremity were performed in ten patients after axillary plexus block and in eight patients after stellate ganglion block. Axillary plexus block was followed by a mean increase of 396% in arterial blood flow. After stellate ganglion block, the arterial blood flow increased by 232% (P less than or equal to 0.001) compared to the pre-block value. There was no change in venous capacity after either method. The results indicate that both blocks can alternatively be used, as they have the same effects regarding increased arterial flow and stable venous capacity.

Adult↗
PubMed1986

[Vecuronium in crash intubation].

A prospective controlled study was conducted to compare the efficacy of vecuronium and succinylcholine for the crash-induction technique. Following precurarisation with 0.02 mg/kg vecuronium and 0.1 mg fentanyl (group A and B) or NaCl 0.9% and 0.1 mg fentanyl (group C) preoxygenation via face mask was maintained until the patients reported heavy eye-lids or weariness or the precurarization-time attained 120 s. The patients then received 5 mg/kg thiopentone followed by 1.5 mg/kg succinylcholine (group B) or 0.08 mg/kg vecuronium (group A) resp. 0.1 mg/kg vecuronium (group C) directly before the thiopentone. Rapid intubation and scoring of the intubation condition was performed by an anaesthetist who was unaware of the grouping. The intubation time was defined as the interval from the end of the injection of the drugs until cuff-inflation of the tracheal tube. All patients in group A and B could be intubated within 60 s, in contrast to only 15 patients in group C (p less than 0.05). The intubation conditions in the succinylcholine group and in the vecuronium group with divided doses showed no significant differences, while in group C the conditions were significantly worse. The modified crash-induction technique with vecuronium in divided doses could become beneficial in patients with contraindications of the use of succinylcholine who are at risk of aspiration.

Anesthesia↗
PubMed1985

Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication.

In a prospective, controlled, randomized study of a prophylaxis for stress bleeding, 100 high-risk patients in an intensive care unit received, on a daily basis, 1 g of sucralfate every four hours, an antacid every two hours, or 2 g of cimetidine intravenously. All patients also received 50 mg of pirenzepine by intravenous infusion each day. 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 than in patients treated with the other agents, but stress bleeding occurred only in patients treated with cimetidine (n = 2) or antacids (n = 2). In the latter two treatment groups, the probability of bleeding correlated with the incidence of pH values below 4. No side effects of sucralfate therapy were observed. The results indicate that prophylactic treatment of stress bleeding with pirenzepine and sucralfate is at least as effective as combined treatment with pirenzepine and cimetidine or antacids.

Adult↗
PubMed1985

[Long-term therapy of cancer pain. A controlled study on buprenorphine].

Sublingual tablets of buprenorphine (Temgesic sublingual) were given in a controlled trial of 41 patients for 2804 patient-days. With a mean starting dose of 1.09 mg and a final dose of 1.53 mg buprenorphine daily there was a good pain-relieving effect. The interval between doses was six to eight hours. The trial did not reveal any direct pointers as to tolerance or addictiveness after long-term intake of the drug. Because of its effectiveness and good duration of action, as well as the absence of negative long-term effects, the drug can be recommended in the long-term management of cancer pain.

Buprenorphine↗
PubMed1985

Epidural opiates: long-term experiences in cancer pain.

Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. With a mean daily dose of 15.6 mg morphine (range 2-290 mg) or 0.86 mg buprenorphine (range 0.15-7.2 mg) half of the patients could be treated as outpatients. The mean duration of therapy was 72 days (range 1-700 days), 26 catheters being in place for more than 100 days and one catheter being in place for 510 days. Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.

Adult↗
PubMed1985

[Potentiation of the effect of non-depolarizing muscle relaxants by acylaminopenicillins. Studies on the example of vecuronium].

In a prospective controlled clinical study interactions between nondepolarizing muscle relaxants and acylaminopenicillins were investigated electromyographically. Six patients in each group received either apalcillin, azlocillin, mezlocillin or piperacillin during the operation. Muscle relaxation was maintained using the short acting nondepolarizing relaxant vecuronium, which shows no cumulative effect within clinical dosages. The intra-individual comparison with the control period (100%) showed a significant prolongation of the duration of action after a fixed dose of vecuronium. The mean increase was +26% following apalcillin, +46% after piperacillin, +38% following mezlocillin and +55% following azlocillin. The shortest time of the control periods was 8.6 min and the maximum time was 32.6 min. We also found a significant depression of the EMG-response. No significant differences could be detected between the four antibiotics. The method described here has proven to be sensitive enough to detect clinically relevant interactions with muscle relaxants. As a result of our study, caution seems to be necessary if acylaminopenicillins are administered in the early postoperative period.

Adult↗
PubMed1985

[Massive hemorrhage following multiple epidural punctures as a late complication in thrombocythemia].

We present a female patient in whom numerous lumbar punctures for epidural anaesthesia were followed by a delayed development of a large subcutaneous haematoma in the lumbar region. The outcome was fatal. The patient's basic disease was found to be chronic myeloic leukaemia that had caused an excessive elevation of platelet count. We, therefore, suggest that lumbar punctures for epidural anaesthesia should be approached with extreme care in cases of thrombocytaemia. If possible, repeated punctures for the placement of epidural catheters should be avoided.

Aged↗
PubMed1985

[Modified patient positioning in long-term hand surgery intervention by regional anesthesia].

The authors report a modified positioning of patients for long-term handsurgical operations under regional anaesthesia. After equalizing the level of hand- and operating table, the operating table is tilted 10-15 degrees towards the hand-table. The upper limb is abducted only 30-40 degrees and then rotated outwards. This guarantees a comfortable positioning of the patients for a longer period of time.

Anesthesia, Conduction↗
PubMed1985

[New viewpoints on the mode of action of intravenous regional anesthesia].

The site of action of intravenous regional analgesia is controversial. We developed a new method to investigate if the local anaesthetic primarily blocks the peripheral nerve endings or the main nerve trunks. Intravenous regional analgesia was carried out in six volunteers who received 4 mg/kg prilocaine 1.5%. An additional finger tourniquet was placed at the third finger. While in the other four fingers complete analgesia was observed after five minutes, no adequate analgesia could be detected in the third finger distal of the finger tourniquet. This observation proves that the principal site of action of intravenous regional analgesia is at the peripheral nerve endings. Two further studies, with contrast media and radio isotopes, were carried out to investigate the spread of the injected volume. Both investigations show that the injected volume spreads distally into the fingers.

Adult↗
PubMed1984

Reduction of gastric acid secretion. The efficacy of pre-anaesthetic oral cimetidine in children.

Cimetidine 10 mg/kg orally was given at varying times from 60 to 240 minutes pre-operatively to 100 healthy children between the ages of 6 months and 14 years. Cimetidine proved to be most effective when given between 120 and 180 minutes before the induction of anaesthesia. All patients in this group had a gastric pH of more than 2.5 and the mean volume aspirated was also significantly lower than that in the control group. The average peak blood concentration after 10 mg/kg oral cimetidine in four healthy children was 3.25 micrograms/ml (range 1.20-4.80) and occurred 75 minutes after administration (range 60-120 minutes). In these patients the mean (SD) half-life of cimetidine was 138 (18) minutes. The reduction of gastric juice volume and acidity produced by 10 mg/kg oral cimetidine given 120-180 minutes prior to induction of anaesthesia has important clinical implications.

Adolescent↗
PubMed1984

[Prevention of acute stress hemorrhages of the upper gastrointestinal tract with pirenzepine and antacids. A controlled comparison between pirenzepine and cimetidine].

H2-antagonists, antacids and pirenzepine are effective drugs for prophylaxis of stress ulcer bleeding. Combined medication seems to be superior to single medication, but investigations of the effectiveness of a pirenzepine-antacid prophylaxis have not been carried out. We therefore evaluated the effect of this combination on gastric pH and on prevention of stress bleeding in ICU patients. In a prospective controlled randomized study 33 patients in each group received 50 mg. pirenzepine intravenously as a basic medication and alternatively 2000 mg. cimetidine i.v. or 2-hourly 10 ml. antacid. Gastric pH was determined three times per day. Stress bleeding was defined as bloody gastric juice, haematemesis or melaena. Two stress bleedings could be detected in each group. The pirenzepine-antacid combination proved to be superior to ensure a gastric pH of more than 3.5 than the pirenzepine-cimetidine group. After removal of the nasogastric tube the 2-hourly application of antacids proved to be impracticable.

Antacids↗