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Biomedical subjects

O Theissen

Publications and source records attributed to O Theissen.

5 recordsLinked to original sources
PubMed1993

[Analgesia after thoracotomy by extrapleural administration of continuous bupivacaine].

This study was aimed to assess the efficiency and the side effects of a continuous administration of bupivacaine into the paravertebral space. Twenty patients, ranked ASA 2 or 3, with a mean age of 57.9 years, and having had a posterolateral thoracotomy for resection of lung tissue, were randomly assigned to one of two groups, B or C. At the end of the surgical procedure, a 22 gauge catheter was inserted into the paravertebral extrapleural space, at T4 levels As soon as pain occurred during recovery (T0), the patients were given two-hourly intravenous boluses of buprenorphine. The patients in group B were also given, through the paravertebral catheter, a 20 ml bolus of 0.25% bupivacaine, followed by a continuous steady rate infusion (10 ml.h-1). Group C patients were given normal saline in the same way. All patients could improve their analgesia with 0.05 ml boluses of buprenorphine given by an auto-analgesia pump (Pharmacia). The following parameters were assessed during the 72 h which followed the first injection: pain with a visual analogic scale, quality of sedation (5 grades), heart and breathing rate, systolic and diastolic blood pressure, arterial blood gases. In group B, plasma bupivacaine concentrations were measured throughout the infusion, and for an 8-hour period after its end. The statistical analysis included 15 patients only, as the catheter had moved into the chest cavity in the other 5. Analgesia was qualified to be adequate by all patients, but there was no statistically significant difference in the amounts of self-administered buprenorphine between groups B and C.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia↗
PubMed1993

[Fatal streptococcus A shock after thoracic surgery].

A 23-year-old man with relapsing pneumothorax underwent surgical removal of left apical lung bullae and pleural rubbing down. Forty-eight hours later, he suddenly developed a state of shock together with tachypnoea, oliguria, and a scarlet-like erythema of the face and trunk. Haemodynamic and other investigations led to the diagnosis of septic shock, although no portal of entry could be found. Despite antibiotics (vancomycin, gentamycin and pefloxacine) and symptomatic treatment, the patient's condition continued to worsen. He had a fever (40 degrees C) with abdominal tenderness. Exploratory laparotomy failed to disclose a septic foyer. On aspiration of the left thoracic cavity, a large pyothorax was found and 600 mls of pus were drained. Gram-positive cocci were found on staining and pefloxacine was replaced by mezlocillin. Nevertheless, the patient died within 24 h. Blood and pus cultures confirmed that the infection was due to a pyrogenic penicillin-sensitive group A Streptococcus. Similar cases have been described recently. Group A Streptococcus is suspected to cause severe infections with multiple organ failure, termed "toxic shock-like syndrome". The clinical similarity between the streptococcal and staphylococcal shocks calls for a precise bacteriological diagnosis, and treatment with antibiotics active on both germs.

Adult↗
PubMed1991

[Sedation with intranasal midazolam for endoscopy of the upper digestive tract].

Twenty-nine patients, ranked ASA 1 or 2, scheduled for diagnostic gastroduodenal fibroscopy were randomly allocated into three treatment groups: intranasal midazolam (IN) 0.15 mg.kg-1; intramuscular midazolam (IM) 0.15 mg.kg-1, and placebo (P). Sedation and the fibroscopy were all carried out by the same anaesthetist and fibroscopist. Efficiency and tolerance of the method were assessed by monitoring the heart rate, systolic and diastolic arterial blood pressure, arterial oxygen saturation (pulse oximetry), the degrees of sedation, anxiety, and anterograde as well as retrograde amnesia. The patient's and endoscopist's reactions were also considered. Patients in group P were older than those of the other two groups (p less than 0.01). Sedation was more important and patients less anxious in groups IN and IM than in group P. Three patients in group IM had retrograde amnesia. There were no significant differences between the degrees of anterograde amnesia in the three groups. At no time during the study were there any significant differences in SpO2 between and within groups. Four out of the 9 patients in group P had a bad opinion of their experience, as compared with two out of the 20 in the midazolam groups; the difference was not statistically significant. Three hours after the procedure, all patients were fully awake. Intranasal administration of midazolam therefore seemed to be an interesting alternative for gastroduodenal fibroscopy, because it was simple, non traumatic, well tolerated, and did not result in arterial desaturation.

Administration, Intranasal↗