Fewer failed spinal anesthetics with the Sprotte needle.
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Anesthesia, Spinal↗
Biomedical subjects
R Klose
Publications and source records attributed to R Klose.
[The effect of adding clonidine to mepivacaine. Axillary brachial plexus blockade].
Clonidine (Cl) added to local anaesthetics (LA) prolongs the duration of both anaesthesia and analgesia after peripheral nerve blocks. In this study, we investigated the dose-dependent effect of Cl added to mepivacaine (M) on clinical efficacy, onset, and regression time of brachial plexus block. METHODS. Ninety patients were randomly assigned to one of three groups. Every patient received 46 ml of a mixture containing 400 mg M (pH adjusted with NaHCO3 to 7.25) and either 0.9% NaCl (group A), 0.12 mg Cl (group B), or 0.24 mg Cl (group C). The axillary block was performed using the catheter technique. In a double-blind fashion, the onset of sensory and motor blockade was tested every 5 min for 30 min. Duration of anaesthesia, analgesia, and motor blockade (time between injection and return of sensation, onset of pain, or ability to move, respectively) was assessed using a questionnaire. M plasma levels were measured by HPLC in 10 patients from each group for up to 120 min. Blood pressure (BP), heart rate (HR), and respiratory rate (RR) were measured for up to 120 min. Sedation was assessed using a verbal rating scale. RESULTS. There was no difference in the onset of blockade. There was dose-dependent prolongation of the duration of anaesthesia, analgesia, and motor blockade with significant differences between groups C and A regarding all three parameters, between groups C and B regarding duration of anaesthesia, and between groups B and A regarding duration of analgesia. There was no significant difference in M plasma levels. Although there was only a slight but significant decrease in mean BP values in groups B+C and no difference in HR and RR, 2 patients (1 group B, 1 group C) had marked decreases in BP and HR (less than 70 mmHg systolic resp. less than 50/min) after 120 and 210 min. Sedation occurred in most patients receiving Cl. CONCLUSIONS. Addition of Cl to LA produces a dose-dependent prolongation of anaesthesia, analgesia, and motor blockade. Neither the onset time nor the number of patients with adequate surgical anaesthesia was influenced by Cl. Considering the M plasma levels, it is unlikely that the prolongation of the block is caused by local vasoconstriction, which is proposed to be the mechanism of action of epinephrine. The mean differences in haemodynamic parameters were not of clinical relevance, but the two dramatic drops in BP and HR, probably caused by Cl, were significant.
Adult↗
[Alkalinization of mepivacaine for axillary plexus anesthesia using a catheter].
One disadvantage of perivascular axillary block using a catheter technique is delayed temporal development of the blockade. Some clinical studies have concluded that pH-adjusted solutions of local anesthetics produce a more rapid onset of blockade. Alkalinization of mepivacaine for brachial block produced conflicting results. In the present study, we attempted to define the effect of alkalinization of mepivacaine 1% on clinical efficacy, onset, and regression in patients undergoing upper extremity surgery with axillary block using the catheter technique. METHODS. Sixty consecutive adult patients (ASA I-II) scheduled for upper extremity surgery under axillary block, were randomly assigned to one of two groups. In a double-blind fashion, 30 patients received 40 ml 1% mepivacaine, the pH of which had been raised to 7.25 by adding 4 ml 8.4% NaHCO3, and 30 received 40 ml commercially prepared 1% mepivacaine hydrochloride solution containing 4 ml 0.9% NaCl (pH 6.0). All patients received axillary block using the catheter technique. After placement of the block, a blinded observer tested sensory and motor blockade after 2 min, 5 min and then every 5 min for 30 min in each of the terminal nerves of the brachial plexus. Sensory blockade was determined by pinprick and graded in accordance with the scale proposed by Hollmèn: 0: Normal sensation of pinprick. 1: pinprick felt as sharp-pointed but weaker compared with the same area in the other upper extremity. 2: Pinprick recognized as touch with a blunt object. 3: No perception of touch. The gradation of motor blockade was 0: normal muscular function; 1: slight depression in muscular function compared with preanesthetic strength; 2: very weak action persisting in muscles; and 3: complete block. The results for each group were compared at every time interval. Duration of blockade was compared by evaluating the rate of regression within the first 2 h after placement of the block in each group. Mepivacaine plasma levels were measured by HPLC in 10 patients of each group prior to injection and 5, 10, 15, 20, 30, 60, and 120 min thereafter. Statistical comparison was made using the chi 2 and t tests. Differences were considered statistically significant when P-values were less than 0.05. RESULTS. The bicarbonate and saline groups were similar with respect to age, height, weight, and sex distribution. Significantly more patients in the bicarbonate group showed onset of motor blockade (grade 1) after 2 min with respect in the axillary, musculocutaneous, radial, and median nerves as well as onset of sensory blockade in the same nerves with a significant difference in blockade of the radial nerve. (ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
An experimental model for pelviscopic tubal anastomoses.
An endoscopic technique for tubal anastomosis has been developed in a rat uterine horn model. Uterine segments were anastomosed endoscopically in a training device for surgical pelviscopy ('Pelvitrainer') by fibrin glue, using an inlaying splint as a guide. The anastomoses were accomplished by a seromuscular 6-0 suture at the anti-mesenteric border. Morphological studies revealed good patency of the anastomosed segments without stenoses or occlusions. The tissue continuity was good. In only two cases out of the 20 studied was a tapering of the uterine wall found adjacent to the anastomosis. It is concluded that this endoscopic technique for tubal anastomosis presents a useful alternative to classical microsurgical reversal of sterilization by laparotomy.
Anastomosis, Surgical↗
[Does a cone-shaped cannula needle offer an advantage in spinal anesthesia?].
The so-called atraumatic spinal cannula of Sprotte is a modification of the Whitacre spinal needle. It consists of a conical tip with a lateral opening. This cannula (24 G) is said to cause a very low incidence of postspinal headache. In a prospective study, it was compared to a 25 G cannula with a Quincke tip. PATIENTS AND METHOD. The study was carried out on 500 patients who received spinal anesthesia for operations on the lower extremities. The cannulas were randomly assigned to the patients. Puncture characteristics and number of incomplete blocks were evaluated. Postoperatively patients were interviewed on days 1, 3, 5, and 7. Neither the subjects nor the investigator were aware of the type of cannula used. RESULTS. There were no differences with regard to age and sex; 80% of the patients ranged between 15 and 55 years, with a homogeneous spread. Performance of the block was superior with the Sprotte cannula and the incidence of incomplete blocks was lower (1.6% vs 7.8%, P = 0.0011). There was no significant difference with regard to postspinal headache (8.2% vs 7.8%). CONCLUSIONS. The atraumatic cannula had better puncture characteristics, but there was no statistically significant difference with regard to postspinal headaches.
Adolescent↗
[Problems of intubation using the flexible LF-1 fiberoptic bronchoscope. Development of an intubation aid].
Fiberoptic endotracheal intubation with an endoscope (external diameter 4 mm) especially designed for anesthesiologists proved to be safe providing small-diameter tubes were used. The use of large-diameter tubes (I.D. 7.5-8.5 (mm)) involves a risk of the tip of the tube clinging to the arytenoid cartilages preventing any further advancement. To avoid this complication another special tube has been constructed, which fills the space between the endotracheal tube and the bronchoscope and centers the bronchoscope within the endotracheal tube. When this new tube was used there were no problems either in passing the bronchoscope through this "inner" tube or in withdrawing the inner tube after successful intubation. With the new device it was even possible to pass tubes with wider lumen into the trachea over the fiberscope with minimal difficulty and trauma.
Bronchoscopes↗
[Continuous axillary catheter plexus anesthesia--a method of postoperative analgesia and sympathetic nerve block following hand surgery].
During a period of one year (March 1985 to March 1986) 52 axillary brachial plexus catheters were left in place for two to twelve days. The main indications were postoperative analgesia and sympatholysis after microvascular surgery of the hand. With the continuous infusion of 0.25% or 0.375% bupivacaine, 6-8 ml/h a sufficient effect was seen. There was no evidence of accumulation of the administered drug after a prolonged period of infusion. A steady state of serum levels built up in the range between 0.5 to 1.5 micrograms/ml. There were no toxic side effects by the local anaesthetic agent. In one case an infection of the axillary region developed, which disappeared after removal of the catheter without any consequences. In summary the continuous axillary brachial plexus block is an acceptable method for intra and postoperative analgesia and sympatholysis in microvascular surgery of the hand.
Autonomic Nerve Block↗
[Axillary blockade of the brachial plexus. A prospective evaluation of 1133 cases of plexus catheter anesthesia].
UNLABELLED: The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year. METHOD: The puncture was performed with an 18-gauge plastic cannula fitted with a solid steel stylet. The stylet has a 45 degrees, short bevel with rounded edges. When puncturing the axillary neurovascular sheath, no attempt was made to elicit paresthesias with the needle. A distinct "click" and very easy advancement of the plastic cannula were signs of being well inside the neurovascular sheath. To confirm the correct positioning, 0.5-3 ml refrigerated saline solution were injected. If no paresthesias could be produced, a new puncture was performed using a nerve stimulator. The plastic cannula was fixed to the skin. For long-lasting operations or if postoperative analgesia or sympatholysis was required, a more flexible catheter was introduced through the plastic cannula. As an initial dose 40 ml 1% mepivacaine was injected via the cannula. If there was an insufficient block after 20 min, another 20 ml 1% mepivacaine was given. For long-lasting operations, 40 ml 1% mepivacaine was injected every 2 h. RESULTS: Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)
Axilla↗
Evidence against increased glomerular pressure initiating diabetic nephropathy.
Studies were carried out to determine whether exaggerated glomerular hydraulic pressure (PG) initiates the development of glomerular pathology and proteinuria in insulin-dependent diabetic rats. Normotensive (WKY) and hypertensive rats (SHR) were made diabetic by streptozotocin injection. One group of SHR diabetic rats was treated with antihypertensive drugs to reduce blood pressure. One week after onset of diabetes, micropuncture determinations of PG, measured by stopped-flow technique, revealed that PG was higher in WKY diabetics than in non-diabetic WKY controls, and that PG was even higher in SHR diabetics (P less than 0.05). Similarly prepared groups of animals were followed for six months, approximately one fifth to one third of the expected life span of these rats. Tail systolic blood-pressure measurements documented continuous severe systolic-hypertension in SHR diabetics, normal pressure in the WKY diabetics and hypotension in the SHR diabetics treated continuously with antihypertensive drugs. Urinary protein excretion, measured monthly, was statistically the same in all groups, with no evidence of a progressive rise in the SHR diabetics. PG measured in two rats from each group after four months of diabetes was similar to values found after one week of diabetes. Semiquantitative histologic scoring of glomerular mesangial expansion after six months of diabetes failed to demonstrate any significant difference between the normotensive WKY diabetics and the hypertensive SHR diabetics. These observations suggest that elevated PG does not in itself initiate glomerular pathology or proteinuria in diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Effect of 10% hydroxyethyl starch 200/0.5 and 10% dextran 40 on the flow property and coagulation of whole blood in vivo].
In randomized order 18 hypovolemic patients undergoing minor surgery received either 500 ml of 10% dextran 40 (n = 8) or 500 ml of 10% hydroxyethylstarch 200/0.5 (n = 10) preoperatively. There were no significant changes in hemoglobin, hematocrit, colloid osmotic pressure, total serum protein, platelet count, platelet aggregation and hemostatic tests. The shear dependent viscosity of whole blood was determined at the relevant range of 1.24-91.0 s-1. Both colloids cause a marked decrease of whole blood viscosity, which is detectable at low shear rates still 24 h later. Plasma viscosity shows no changes in either group. The criteria for preferring one of the colloids for decreasing the blood viscosity will depend on the incidence and severity of undesired adverse reactions.
Adult↗
[Contusion of the heart].
Whereas heart contusion can be identified by autopsy as a traumatic damage to the heart, clinical diagnosis during life is mostly made by exclusion only and subsequently, the more so since there is no absolutely reliable parameter that permits diagnosis ad hoc. Complications often develop only hours or days after the accident. Heart contusion can be masked by haemorrhagic-traumatic shock and accompanying injuries and delay its diagnosis. Traumatic damage to the myocardium can equal a myocardial infarction. Hence, it is imperative that persons injured in an accident who are suspected of having suffered a contusion of the heart, are placed in an intensive-care ward to recognise complications well in time and to institute therapeutic measures without delay. As is the case with acute myocardial infarction, anaesthesia and surgery can be performed only in case of a vital indication.
Arrhythmias, Cardiac↗
[Comparative study of 1% prilocaine and 1% mepivacaine in axillary plexus anesthesia].
In a randomized double-blind study, the latency period and spread of axillary brachial plexus block using 40 ml mepivacaine hydrochloride (1% solution), or prilocaine (1% solution) was studied in 60 patients scheduled for surgery of the hand and forearm regions. The sensory block of the axillary, musculocutaneus, radial, median, ulnar and medial brachial cutaneous nerves was recorded using the pin-prick test every 5 min after injection and the motor block was assessed by testing the power of the corresponding muscles up to 30 min after injection. The degree of intraoperative analgesia attained was also determined. The venous methemoglobin level was determined before and 2 h after the administration of the local anesthetic agent. The development of sensory blockade was significantly faster after 10 min and 15 min in the radial nerve, and the development of motor blockade after 15 min and 20 min in the axillary nerve, using mepivacaine. After 30 min, there were no significant differences in the degree of sensory or motor block attained between the two groups. Intraoperative analgesia was attained in 27 patients of the mepivacaine group, versus 23 patients of the prilocaine group (NS). The methemoglobin level was always elevated following prilocaine, but not following mepivacaine. Two patients had an increase of the methemoglobin concentration to more than 11% after the administration of prilocaine. Neither the higher toxicity to the central nervous and cardiovascular systems from mepivacaine, nor the methemoglobin formed by prilocaine seems to be of clinical significance with the dosage and technique employed.
Anesthesia, Local↗
[Comparison of the effect and serum level of mepivacaine HCL and mepivacaine CO2 in axillary brachial plexus anesthesia].
The latency period and spread of axillary plexus block using 40 ml mepivacaine carbonate (1% solution) or mepivacaine hydrochloride was studied in thirty patients scheduled for surgery of the hand-forearm region. The sensory block of the nervus axillaris, musculocutaneus, radialis, medianus, ulnaris and cutaneus brachii medialis was recorded using the pin prick test every 4 min after injection and the motor block was assessed by testing the strength of the corresponding muscles. The only significant difference between the two local anaesthetic solutions was a few more frequent and faster anaesthesia of the nervus musculocutaneus after 16, 20 and 24 min. A comparison between the serum levels of the first five patients of each group showed a faster increase and a higher level after the injection of carbonated mepivacaine. Carbonated mepivacaine doesn't have any practical advantage for axillary plexus block.
Anesthesia, Conduction↗
[Mepivacaine in brachial plexus anesthesia in surgical interventions of long duration].
To evaluate the use of mepivacaine-HCl for continuous axillary brachial plexus block for surgery lasting several hours a prospective study was performed. Mepivacaine-HCl 400 mg was injected every two hours. Over a period of eight to twenty hours there was in all cases adequate analgesia and muscle relaxation for microsurgical repair of limbs. Mean serum levels of mepivacaine-HCl did not exceed the concentration of 5-6 micrograms/ml. There were no side effects caused by the local anaesthetic agent.
Anesthesia, Conduction↗
[Peculiarities of anesthesia in severely burned patients].
The main problem of anaesthesia for necrectomy and grafting is the correct evaluation of blood loss. Intensive monitoring enables one to avoid major complications. One has to have at least two venous lines of large calibre. Loss of volume is substituted by packed erythrocytes, fresh frozen plasma, warm whole blood and crystalloids. No particular type of anaesthesia is to be preferred. One should avoid depolarizing muscle relaxants between 5 to 90 days after the burn. Because of the possibility of microstomia and contractures the anaesthetist should be familiar with the technique of bronchofiberscope intubation.
Anesthesia, General↗
Proximal tubular Na, Cl, and HCO3 reabsorption and renal oxygen consumption.
The majority of the oxygen consumed by the rat kidney appears to occur in the proximal tubule. Therefore changes in metabolically linked ion transport in this segment of the nephron should result in changes in renal oxygen consumption. To study the role of bicarbonate reabsorption in metabolically linked proximal tubular ion transport a series of micropuncture-clearance-extraction experiments were performed comparing the effects of the carbonic anhydrase inhibitor benzolamide and of hypertonic sodium bicarbonate infusion with control conditions in the rat. End-proximal tubular fluid and chloride reabsorption were measured. From these, the rates of sodium and bicarbonate reabsorption were estimated. Simultaneously with the tubular fluids, extraction collections were obtained for determination of renal oxygen consumption. Both benzolamide and hypertonic bicarbonate reduced proximal tubular fluid reabsorption while concomitantly reducing the transepithelial gradient for chloride. The mean rate of renal oxygen consumption did not differ from the control rate in either experimental group and could be dissociated from the calculated net rates of proximal tubular sodium, chloride, and bicarbonate reabsorption. We interpret these data as evidence that proximal tubular hydrogen ion secretion supporting bicarbonate reabsorption requires at most small amounts of oxidative energy, less than detectable by these techniques. The data, in contrast, support the conclusion that the chloride-bicarbonate transepithelial gradient appears to be an important passive driving force in vivo for proximal tubular fluid reabsorption.
Animals↗
Evidence for PAH extraction from superficial cortical efferent vessel plasma.
Consistent with its anatomical association with the proximal tubule we have previously shown that superficial cortical efferent vessel blood contains an admixture of early and late proximal tubular reabsorbate. Since tubular secretion of p-aminohippurate (PAH) occurs predominantly in the late proximal tubule, extraction of this compound should occur preferentially from efferent vessel blood. As a result, the midportion of the proximal convoluted tubule supplied by the more downstream peritubular capillaries would receive blood containing a disproportionately reduced concentration of PAH. To study this, proximal and distal tubular fluid and efferent vessel blood samples were collected from rats. The data confirm that preferential secretion of PAH occurs in the pars recta and demonstrate that PAH is extracted from efferent vessel plasma by the pars recta. This in turn preferentially reduces PAH concentration in early postglomerular blood before it reaches the peritubular capillary network. We speculate that PAH and similar substances secreted by the pars recta are short-circuited by rapid extraction from early postglomerular blood, reducing their delivery to the mid-proximal convoluted tubule. Such circumstances must be considered in any analysis of organic compound secretion by the in vivo proximal tubule.
Aminohippuric Acids↗
[Effects of positive end-expiratory pressure (PEEP) or prolonged inspiration time on lung mechanics, gas exchange and hemodynamics in differential pulmonary ventilation].
In the case of patients with unilateral lung disorders one must anticipate a further increase in the intake volume of the more elastic lung and a decrease in intake volume of the less elastic lung when the inspiratory pressure is increased or the inspiratory time is extended within the framework of mechanical ventilation. Therefore, differential pulmonary ventilation lends itself for the treatment of unilateral damage of the lung by enabling the selective application of a positive end-expiratory pressure or an inverse inspiratory time. For a better understanding of the overlapping pathophysiologic reactions, the changes in lung mechanics, haemodynamics and gas exchange were measured on the healthy lung with unilateral application of a positive and expiratory pressure or an increased inspiratory time. Thirteen male and female patients, who had to undergo intracranial surgery were ventilated with two synchronized servoventilators using a Carlens tube. The positive end expiratory pressure varied in the right lung in spans of 6 cm each, 0-12 cm H2O, inspiratory time varied 34-70%. The left lung was ventilated with a 35% inspiratory time and an end expiratory pressure of 0. The respiratory intake volume was divided up into 45% (left lung) and 55% (right lung) based on the physiological difference in size between the left and right lung. Our results show that a directed unilateral application of a positive end expiratory pressure or an increased inspiratory time does not have any relevant damaging effects on the other lung. It can be expected that in the case of non-differentiated mechanical ventilation the ensuing unequal distribution of alveolar ventilation and perfusion with consecutive increase of intrapulmonary shunt volume can be decreased by the discriminate treatment of each lung.
Adult↗