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R Stienstra

Publications and source records attributed to R Stienstra.

At least 37 records · Page 2Linked to original sources
PubMed1997

Double-blind comparison of alizapride, droperidol and ondansetron in the treatment of post-operative nausea.

To compare the efficacy in the treatment of post-operative nausea and/or vomiting (PONV), 75 patients undergoing gynaecological procedures under general anaesthesia using N2O/enflurane who suffered from PONV in the first hour after surgery were randomly allocated to three groups containing 25 patients each to receive either alizapride 100 mg, droperidol 1 mg or ondansetron 8 mg (i.v.). Patients expressed the severity of their nausea on a Visual Analogue Scale (VAS) ranging from 0 (none) to 10 (as bad as possible). Vomiting was recorded as present or absent, and the number of emetic events was noted. Data were recorded until rescue medication was given or until 4 h after the administration of the study drug. There were no significant differences between the three groups in the average VAS scores and the presence of vomiting at the time of entry into the study. Fifteen and 30 min after the administration of the study drug, VAS decreased notably in all groups. This decreases was similar and statistically significant within each group. However, comparison between the three groups showed no statistically significant differences. There was no statistically significant difference between the three groups in the number of patients receiving rescue medication, the number of emetic events and the time from administration of the study drug until rescue medication was given. It is concluded that alizapride 100 mg, droperidol 1 mg and ondansetron 8 mg intravenously are equally effective in the treatment of PONV after gynaecological procedures and that the newer drugs alizapride and ondansetron offer no advantage over droperidol.

Adolescent↗
PubMed1996

Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effect of site of injection on spread of analgesia.

In this randomized, observer-blind study, we have examined, in elderly patients, the effect of site of injection on analgesia levels after spinal injection of 0.5% hyperbaric bupivacaine solution. Thirty male patients, aged 68-87 yr, undergoing minor urological surgery during spinal anaesthesia received 3 ml of a 0.5% hyperbaric bupivacaine solution at either the L3-4 (n = 15) or L4-5 (n = 15) interspace. The solution was injected with the patient in the sitting position. The patient remained sitting for 2 min and was then placed in the supine horizontal position. Analgesia levels were assessed bilaterally using pin-prick. The highest analgesia levels did not differ between groups (medians were approximately T7). There were no significant differences in the time to maximum cephalad spread of analgesia, maximum degree of motor block or haemodynamic changes. We conclude that injection at the L4-5 interspace has no advantage compared with injection at the L3-4 interspace.

Aged↗
PubMed1996

Mechanism of action of an epidural top-up in combined spinal epidural anesthesia.

The purpose of this study was to elucidate the mechanism of action by which an epidural top-up reinforces anesthesia in combined spinal epidural anesthesia. Thirty patients scheduled to undergo lower limb orthopedic surgery were randomly allocated to three groups of 10 patients each. In all patients, a 16-gauge Tuohy needle was introduced into the epidural space. Using the needle through needle technique, each patient received a subarachnoid injection of 10 mg plain bupivacaine 0.5% through a long 27-gauge Whitacre spinal needle introduced into the subarachnoid space through the Tuohy needle. After withdrawal of the spinal needle, an epidural catheter was introduced into the epidural space. After the maximum level of sensory block after the subarachnoid injection had been established, an epidural top-up with 10 mL bupivacaine 0.5% (Group 1) or 10 mL saline (Group 2) was administered; patients in Group 3 received no epidural top-up. The maximum level of sensory block was then assessed for an additional 30 min. After the epidural top-up the maximum level of sensory block increased significantly by 4.8 +/- 1.6 segments in Group 1 and 2.0 +/- 2.0 segments in Group 2. In Group 3 there was a nonsignificant increase of 0.3 +/- 0.5 segments. Intergroup comparisons showed that this increase in Group 1 was significant compared with those in Groups 2 and 3, and that the increase in Group 2 was significant compared with that in Group 3. We conclude that the mechanism of action by which an epidural top-up reinforces anesthesia in combined spinal epidural anesthesia can be explained partly by an epidural volume effect and partly by an effect of the local anesthetic itself.

Adolescent↗
PubMed1996

Epidural vs. intravenous infusion of alfentanil in the management of postoperative pain following laparotomies.

BACKGROUND: This study was designed to compare the efficacy of epidural vs. intravenous administration of alfentanil for treatment of postoperative pain. METHODS: Twenty patients were randomly allocated to one of the two study groups to receive either an epidural bolus dose (0.75 mg) followed by an epidural infusion (0.36 mg/h) (EPI group) or an intravenous infusion (0.36 mg/h) of alfentanil (IV group) for 24 h. These dose regimens were chosen such that equivalent and subanalgesic plasma concentrations of alfentanil were obtained. PCA-morphine was available to both groups. Morphine consumption, pain scores measured on a Visual Analogue Scale (VAS) and the number of demands were used as variables to evaluate the efficacy of the postoperative analgesic therapy. In addition, plasma concentrations of alfentanil were measured. RESULTS: The mean plasma concentrations of alfentanil were similar and < 20 ng/ml in both groups. Total morphine consumption (EPI: 40 mg, i.v.: 43 mg), pain scores (time when the VAS-score > 3.0: EPI: median 215 min; i.v.: median 215 min) and number of valid demands (EPI: median 25; i.v.: median 34) did not differ between the groups. CONCLUSION: Compared to intravenous infusion of alfentanil epidural infusion resulting in the same plasma concentrations is not more effective in relieving postoperative pain. In view of this observation we were not able to demonstrate a spinal mechanism of alfentanil.

Adolescent↗
PubMed1995

Ropivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: a double-blind comparison.

We compared the effects of continuous epidural infusion of ropivacaine 0.25% with bupivacaine 0.25% on pain relief and motor block during labor, and on the neonate. Seventy-six full-term parturients in active labor requiring epidural analgesia were randomly allocated to receive either bupivacaine 0.25% or ropivacaine 0.25%. Fifteen minutes after a loading dose of 10 mL of the study drug, an epidural infusion with the same drug was started at 6-12 mL/h to maintain an adequate block. Top-up doses of 6-10 mL were given as required. At full cervical dilation, the epidural infusion was discontinued. The onset of pain relief (verbal scale), contraction pain (visual analog scale), intensity of motor block (modified Bromage scale), and duration of motor block were not statistically different between the groups. Apgar scores at 1 and 5 min after delivery were comparable. There was a higher proportion of the neonates in the ropivacaine group (26/31 = 84%) who had a neurologic and adaptive capacity score (NACS) > or = 35 2 h after delivery than in the bupivacaine group (18/29 = 62%). We conclude that ropivacaine 0.25% and bupivacaine 0.25% are equally effective for epidural pain relief during labor. Ropivacaine may have an advantage over bupivacaine regarding neonatal neurobehavioral performance during the first few hours after delivery, although further studies will be required to substantiate this.

Adolescent↗
PubMed1995

A double blind comparison of lidocaine 2% with or without glucose for spinal anesthesia.

The aim of the study was to compare lidocaine 2% plain to lidocaine 2% with glucose 8% for spinal anesthesia. Forty male patients scheduled for urologic surgery participated. The patients were randomly divided into two groups: the plain (P) group received 4 ml of glucose-free lidocaine 2%, the heavy (H) group received 4 ml of lidocaine 2% containing 8% glucose. After the injection, the patients remained in the sitting position for three minutes before they were placed supine. The onset and maximum level of sensory blockade were similar with both preparations (T7-T8). In both groups there were respectively 3 (P) and 4 (H) patients who did not acquire a sensory level above T10. There was a tendency towards a longer duration of sensory blockade in the P group. The patients in both groups developed an almost complete motor blockade within approximately 10 minutes. Duration of complete motorblockade of the lower extremities was significantly shorter for the H group: 59.1 +/- 6.5 minutes (mean +/- SEM) than the P group: 89.5 +/- 6.4 minutes. We consider lidocaine 2% with or without glucose a suitable agent for subarachnoid anesthesia for short procedures. As hyperbaric lidocaine results in a more rapid recovery of motor blockade, it may have advantages for patients in day-case settings.

Aged↗
PubMed1989

Spinal anesthesia with plain bupivacaine 0.5%: regression of sensory and motor blockade with different temperatures of the anesthetic solution.

Onset (defined as the time between injection and achievement of the highest level of sensory blockade), duration, and regression of sensory and motor blockade after the intrathecal administration of 3 mL plain bupivacaine 0.5%, previously equilibrated to either 37 degrees C or 20 degrees C, were studied in two groups of 20 patients. In patients receiving the solution equilibrated to 37 degrees C, the maximum level of sensory blockade was significantly higher (T 4.6 vs T 7.5), variability was smaller (SEM 0.33 vs 0.58), and duration of the sensory level of blockade at or above T 6, T 8, and T 10 was significantly longer (56 min vs 20 min, 101 min vs 59 min, and 131 min vs 77 min, respectively). There were no significant differences with regard to onset of sensory and motor blockade or either the time needed both for the sensory level of blockade to regress two segments from its highest level and to the first lumbar segment, or the duration of complete motor blockade of the lower limbs. It is concluded that the intrathecal administration of a bupivacaine solution previously equilibrated to 37 degrees C as compared with a solution injected at room temperature results in a higher, more predictable maximum sensory level of blockade with longer duration at or above T 6, T 8, and T 10.

Aged↗
PubMed1989

Needle direction affects the sensory level of spinal anesthesia.

The effect of the direction of the spinal needle on the sensory level of anesthesia was investigated. Three ml plain bupivacaine 0.5%, previously equilibrated to 37 degrees C, were injected intrathecally in two groups of twenty patients, who were kept sitting for three minutes after injection. In patients in group 1 a paramedian approach was used with an angle between the spinal needle and the patient's back of 50 degrees or less. In patients in group 2 a median or paramedian approach was used, the resultant angle between the spinal needle and the patient's back being between 70 degrees and 100 degrees. The differences between segmental levels of sensory loss between groups 1 and 2 (T 3.4 and T 5.1, respectively) and of temperature loss (T 2.6 and T 4.2, respectively) 30 minutes after injection of bupivacaine were statistically significant. It is concluded that a steep paramedian approach of the subarachnoid space with an angle of less than 50 degrees results in a cephalad spread averaging about 1.6 segments greater than when the needle is in the perpendicular position.

Anesthesia, Spinal↗
PubMed1988

The temperature of bupivacaine 0.5% affects the sensory level of spinal anesthesia.

Three milliliters of plain bupivacaine 0.5% was injected intrathecally in two groups of 20 patients. Group 1 received a solution that had been equilibrated to 37 degrees C, group 2 received a solution that had been equilibrated to 4 degrees C. Patients were kept sitting for 3 minutes after injection. All observations were observer-blind. The differences between segmental levels of sensory loss between groups 1 and 2 (T4 and T9, respectively) and of temperature loss (T3 and T8, respectively) 10 and 20 minutes after injection of bupivacaine were statistically significant. It is concluded that the time needed for thermal equilibration in the cerebrospinal fluid and hence temperature of the injected solution plays an important role in the sensory spread of plain bupivacaine 0.5%.

Aged↗
PubMed1987

Plain or hyperbaric bupivacaine for spinal anesthesia.

Three ml of bupivacaine 0.5%, either plain or in 8% glucose, was injected intrathecally in three groups of twenty patients. Group 1 received bupivacaine 0.5% plain; group 2 received bupivacaine 0.5% in 8% glucose. Patients in groups 1 and 2 were kept sitting for 3 min after injection. Patients in group 3 received bupivacaine 0.5% in 8% glucose and were placed in the supine horizontal position immediately after injection. Observations of patients in group 3 were observer blind and in groups 1 and 2 double blind. The differences between segmental levels of sensory and temperature loss between groups 1 and 2 and between groups 2 and 3 were statistically not significant. Motor blockade of the lower extremities was more intense in the patients who were kept sitting for 3 min (groups 1 and 2). It is concluded that both solutions are equally suitable for spinal anesthesia, provided patients receiving the plain solution are kept sitting for at least 2 min. When using hyperbaric bupivacaine, posture seems to have no influence on cephalad spread.

Aged↗
PubMed1983

Methyl atropine bromide versus atropine sulphate. A clinical comparison.

In a double blind clinical investigation we compared methyl atropine bromide to atropine sulphate in equivalent doses for their effects on changes in the heart rate and dryness of the mouth. Drugs were administered five minutes before the induction of anesthesia. Methyl atropine bromide appeared to have a stronger positive chronotropic effect on the heart rate and a more pronounced mouth drying action. Less dysrhythmias were observed after the methyl congener. Both drugs failed to alter blood pressure significantly. We concluded that methyl atropine bromide is superior to atropine sulphate because it does not produce side effects which may cause the central anticholinergic syndrome. For clinical use, however, methyl atropine bromide should be administered only in half-equivalent dose of atropine sulphate to prevent excessive tachycardia and dryness of the mouth.

Adult↗