PubMed Health⌕ Search

Biomedical subjects

T Fuchs-Buder

Publications and source records attributed to T Fuchs-Buder.

50 records · Page 3Linked to original sources
PubMed1999

Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review.

We have estimated the effect of omitting antagonism of neuromuscular block on postoperative nausea and vomiting. A systematic search (MEDLINE, EMBASE, Biological Abstracts, Cochrane library, reference lists and hand searching; no language restriction, up to March 1998) was performed for relevant randomized controlled trials. In eight studies (1134 patients), antagonism with neostigmine or edrophonium was compared with spontaneous recovery after general anesthesia with pancuronium, vecuronium, mivacurium or tubocurarine. On combining neostigmine data, there was no evidence of an antiemetic effect when it was omitted. However, the highest incidence of emesis with neostigmine 1.5 mg was lower than the lowest incidence of emesis with 2.5 mg. Numbers-needed-to-treat to prevent emesis by omitting neostigmine compared with using it were consistently negative with 1.5 mg, and consistently positive (3-6) with 2.5 mg. There was a lack of evidence for edrophonium. In two studies, three patients with spontaneous recovery after mivacurium or vecuronium needed rescue anticholinesterase drugs because of clinically relevant muscle weakness (number-needed-to-harm, 30). Omitting neostigmine may have a clinically relevant antiemetic effect when high doses are used. Omitting antagonism, however, introduces a non-negligent risk of residual paralysis even with short-acting neuromuscular blocking agents.

Cholinesterase Inhibitors↗
PubMed1998

[Neuromuscular monitoring. Standard procedures].

In this article current indications and limitations of neuromuscular monitoring are reviewed. Attention is mainly focused on detection of residual curarisation. New insights in the pathophysiological consequences of residual neuromuscular blockade and the actual criteria of complete recovery are discussed. Surprisingly in this context, despite the benefit of neuromuscular monitoring, its utilisation in clinical practice is rather an exception than the routine. A lack of standardisation of neuromuscular monitoring is probably the major problem on the way to a widespread utilisation of the monitoring.

Anesthesia Recovery Period↗
PubMed1998

Thiopental or etomidate for rapid sequence induction with rocuronium.

We have assessed the effect of the choice of i.v. induction agent on intubation conditions, 60 s after administration of rocuronium 0.6 mg kg-1. We studied 60 adult patients, allocated randomly to one of two groups. Anaesthesia was induced with alfentanil 10 micrograms kg-1 followed by thiopental 5 mg kg-1 (AT-R group; n = 30) or etomidate 0.3 mg kg-1 (AE-R group; n = 30). Both groups received rocuronium 0.6 mg kg-1. Laryngoscopy was started 60 s later and intubation conditions were evaluated according to a standard score, which considered ease of laryngoscopy, condition of the vocal cords and reaction to intubation. In the AT-R group, overall intubation conditions were scored as excellent in 20 patients, good in nine and fair in the remaining patient. In the AE-R group, overall intubating conditions were excellent in 24 and good in six patients. The difference between the two groups was not significant. Of the three components of the intubation score assessed, response to intubation stimulus was significantly less pronounced in group AE-R compared with group AT-R (P < 0.05): group AE-R, no reaction in 24 patients, slight diaphragmatic movement in five and mild coughing in one patient; group AT-R, no reaction in 13, slight diaphragmatic movement in 14, mild coughing in two and severe coughing in one patient. We conclude that etomidate as part of an induction regimen containing alfentanil and rocuronium attenuated the reaction to intubation to a greater extent than thiopental.

Adolescent↗
PubMed1998

Effects of neuromuscular blocking agents on excitatory transmission and gamma-aminobutyric acidA-mediated inhibition in the rat hippocampal slice.

BACKGROUND: Although neuromuscular blocking agents do not cross the blood-brain barrier, they may penetrate the central nervous system under particular circumstances and eventually cause neurotoxic consequences. METHODS: The effects of neuromuscular blocking agents on excitatory and inhibitory transmission in area CA1 of rat hippocampal slices were investigated using extracellular and intracellular recording techniques. RESULTS: Application of atracurium in the perfusion medium resulted in a dose-dependent enhancement of excitatory synaptic responses averaging 48.7 +/- 4.3% at a concentration of 10 nM. This effect was correlated with an increase in the size of the presynaptic fiber volley. Laudanosine, but not pancuronium bromide or vecuronium bromide, produced similar changes. In addition, atracurium and laudanosine blocked inhibitory transmission and reduced intracellularly recorded gamma-aminobutyric acidA receptor-mediated potentials. These effects were observed only at concentrations >1 microM and were not reproduced by pancuronium bromide and vecuronium bromide. CONCLUSIONS: Atracurium and its metabolite, laudanosine, contrary to pancuronium bromide and vecuronium bromide, produce two distinct effects on hippocampal slices. They enhance excitatory transmission and neuronal excitability and they block inhibitory gamma-aminobutyric acidA-mediated synaptic responses.

Animals↗
PubMed1998

Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques.

BACKGROUND: Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery. METHODS: Children (3-16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg x m(-2) i.v.; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg x kg(-1) i.v. All children received prophylactic atropine 0.02 mg x kg(-1) and alfentanil. Nitrous oxide was omitted. RESULTS: Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thiopentone-isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number-needed-to-treat was 5.5 (95% CI 2.9-46). Propofol was not different from thiopentone-isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number-needed-to-harm was 3.9 (95% CI 2.6-8). CONCLUSIONS: Thiopental-isoflurane-air/O2-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.

Adolescent↗
PubMed1997

Low incidence of the oculocardiac reflex and postoperative nausea and vomiting in adults undergoing strabismus surgery.

PURPOSE: To investigate the incidence of the oculocardiac reflex (OCR), and of postoperative nausea and vomiting (PONV) in adults undergoing strabismus surgery. METHODS: Adults (18-86 yr) undergoing inpatient strabismus surgery received 10 micrograms.kg-1 atropine and 10 micrograms.kg-1 altentanil iv and were randomly allocated to: (A) 5 mg.kg-1 thiopentone iv, isoflurane/N2O maintenance; (B) 3 mg.kg-1 propofol iv, propofol/N2O maintenance (10-14 mg.kg-1.hr-1); 3 mg.kg-1 propofol iv, propofol/air/O2 maintenance (10-14 mg.kg-1.hr-1). Analyses were with the number-needed-to-treat/harm. RESULTS: In 97 adults the absolute risk of OCR (13-20%) and PONV (21-31% after 24 hr) was low, with no differences between groups. Number-needed-to-treat to prevent PONV with propofol with or without N2O compared with thiopentone-isoflurane was 7 to 11. Number-needed-to-harm for one OCR with propofol compared with thiopentone-isoflurane was 17. CONCLUSION: Adults undergoing strabismus surgery with prophylactic atropine had a low risk of OCR and PONV, independent of the anaesthetic technique used.

Adolescent↗
PubMed1997

Cerebrospinal fluid passage of intravenous magnesium sulfate in neurosurgical patients.

Increasing evidence suggests a neuroprotective potential of magnesium sulfate (MgSO4). Only limited information about the passage of MgSO4 to the cerebrospinal fluid (CSF) is available in neurosurgical patients. However, with regard to the clinical relevance of magnesium's neuroprotective properties, quantitative data about its CSF passage are needed. The present study aims to assess the amount and the time course of magnesium's CSF passage in neurosurgical patients. To this end, 20 patients undergoing general anesthesia for neurosurgery and needing CSF drainage were included. Patients received an i.v. bolus of 60 mg/kg MgSO4. The increase in plasma and CSF magnesium concentration were measured 30, 90, and 240 min after the end of the MgSO4 infusion. These values were compared with the baseline levels taken before the start of the MgSO4 infusion. Thus, each patient served as his or her own control. Values are expressed as means +/- SD. The plasma magnesium levels were measured as follows: baseline, 0.74 +/- 0.12 mM; at 30 min, 1.24 +/- 0.1 mM (p < 0.01); at 90 min, 0.95 +/- 0.15 mM (p < 0.01), and at 240 min, 0.82 +/- 0.14 mM (p < 0.05). The CSF magnesium levels were measured as follows: baseline, 0.95 +/- 0.11 mM; at 30 min, 1.00 +/- 0.15 mM (NS); at 90 min, 1.10 +/- 0.17 mM (p < 0.01); and at 240 min, 1.13 +/- 0.19 mM (p < 0.001). We concluded that a bolus of 60 mg/kg of MgSO4 leads at least after 90 min to a significant increase in the CSF magnesium concentration. Moreover, the increase in plasma and CSF magnesium concentration is not parallel. Thus, plasma magnesium concentration cannot be used to predict the changes in CSF concentrations.

Adult↗
PubMed1996

Overnight sedation with midazolam or propofol in the ICU: effects on sleep quality, anxiety and depression.

OBJECTIVE: To assess and compare the impact of overnight sedation with midazolam or propofol on anxiety and depression levels, as well as sleep quality, in non-intubated patients in intensive care. DESIGN: Open, comparative prospective, randomised study. SETTING: Surgical intensive care unit (ICU) in a university hospital. PATIENTS: 40 conscious patients expected to stay in the ICU for at least 5 days who were admitted following trauma or elective orthopaedic, thoracic or abdominal surgery. MEASUREMENTS AND RESULTS: Evaluation of a self-assessment scale (Hospital Anxiety and Depression Scale, HAD) on the day following the 1st, 3rd and 5th night of sedation with either midazolam or propofol. Heart rate, pulse oximetry and blood gases were monitored. Eight patients were excluded from the analysis. The level of anxiety was severe (HAD > 10) in 31% of the patients receiving midazolam and in 26% (p = 0.1) receiving propofol after the first night of sedation with no significant improvement over the next few days. The levels of depression remained high (> 10) in 54% of patients receiving midazolam, and in 16% of the patients receiving propofol (p = 0.15). Sleep quality tended to improve during the study in the two groups. CONCLUSIONS: These data show that half of the patients in the ICU experienced high levels of anxiety and depression during the first 5 post-operative or post-trauma days in the ICU. The beneficial effects of sedation on sleep quality were comparable for midazolam and propofol, regardless of a lack of improvement in anxiety and depression. However, an improved quality of sleep could help to re-establish a physiological night and day rhythm.

Adult↗
PubMed1996

Magnesium sulphate enhances residual neuromuscular block induced by vecuronium.

Magnesium sulphate (MgSO4) is currently used for haemodynamic control during anaesthesia and the early postoperative period. We have investigated the effect of this treatment on residual neuromuscular block after administration of vecuronium. Twenty adult patients were allocated randomly to one of two groups to receive MgSO4 60 mg kg-1 either at recovery from vecuronium block to a train-of-four (TOF) ratio of 0.7, or 1 h after recovery to a TOF ratio of 0.7. Neuromuscular transmission was monitored using electromyography and TOF stimulation. MgSO4 caused rapid and profound recurarization in all 20 patients. MgSO4 decreased the amount of acetylcholine released at the motor nerve terminal and thus may lead to recurarization in patients previously exposed to neuromuscular blocking agents.

Anesthesia, General↗
PubMed1996

Intubating conditions and time course of rocuronium-induced neuromuscular block in children.

We have investigated the potential of rocuronium 0.6 mg kg-1 (2xED95) and 0.9 mg kg-1 (3xED95) for rapid sequence induction in 100 children, aged 3-7 yr. Intubating conditions with the two different doses of rocuronium were assessed in 70 children (n = 35 in each group) undergoing elective surgery. Intubation was carried out by mimicking rapid sequence induction, and intubation conditions were evaluated according to a standard score. Intubating conditions were good to excellent in all 70 patients investigated (2xED95: excellent 29, good 6; 3xED95: excellent 33, good 2). In another 30 children (n = 15 in each group), we examined the times of rocuronium-induced neuromuscular block using electromyography. Lag time and recovery index did not differ significantly between the two groups (lag time: 37 (SD 12) vs 33 (14) s; recovery index: 9 (3) vs 10 (4) min). Three times the ED95 induced deeper neuromuscular block, 1 min after injection compared with 2xED95 (twitch height: 42 (24) vs 25 (19)%, respectively; P < 0.05). The same was true for onset time (193 (47) vs 118 (23) s; P < 0.01), clinical duration (21 (4) vs 34 (11) min; P < 0.01) and duration to 75% recovery (30 (6) vs 44 (4) min; P < 0.01). By mimicking rapid sequence induction, both doses of rocuronium offered clinically acceptable (good or excellent) intubating conditions.

Androstanols↗
PubMed1996

Time course of procoagulant activity and D dimer in bronchoalveolar fluid of patients at risk for or with acute respiratory distress syndrome.

Intraalveolar fibrin deposition is a typical finding in acute lung injury and is not necessarily harmful. However, persistence of intraalveolar fibrin deposit may lead to hyaline membrane formation and subsequent alveolar fibrosis, a histologic hallmark of late stages of acute respiratory distress syndrome (ARDS). Thus, timing of the intraalveolar clotting disorder seems to be critical. To explore the time course of factors contributing to fibrin deposition and resolution, we sequentially analyzed procoagulant activity and fibrin degradation (by D dimer) in bronchoalveolar lavage (BAL) fluid of patients developing ARDS and those at risk for, but finally not developing, the syndrome. A total of 36 bronchoalveolar lavages were performed in 11 patients developing ARDS and 15 lavages in 10 patients at risk for but not developing this syndrome. All patients were admitted to the intensive care unit for the treatment of sepsis, trauma, or shock. In early phases of ARDS, the procoagulant activity (PCA) in BAL was significantly higher than in the patients at risk, 320 +/- 83 U (mean +/- SEM) versus 50 +/- 25 U, p < 0.05. A similar difference was noted in subacute stages (280 +/- 91 versus 46 +/- 16 U, p < 0.05). In early ARDS we observed higher levels of D dimer in BAL than in patients at risk: 1,841 +/- 827 versus 293 +/- 134 ng/ml, p < 0.05. Similarly, values of D dimer in the subacute phase were 2,776 +/- 836 versus 237 +/- 125 ng/ml, p < 0.05. In ARDS as well as in the at-risk group, D dimer in BAL fluid showed good correlation with the polymorphonuclear leukocyte count and with protein content of BAL. There was no correlation between plasma and BAL levels of D dimer. We conclude that in ARDS both the procoagulant pathway and the fibrin degradation are markedly activated compared with these in patients at risk but finally not developing this syndrome. These findings expand our understanding of intraalveolar coagulation abnormalities by providing evidence of increased fibrin breakdown in this syndrome.

Acute Disease↗
PubMed1995

Interaction of magnesium sulphate with vecuronium-induced neuromuscular block.

We have investigated the interaction between magnesium sulphate 40 mg kg-1 i.v. and vecuronium. First, we determined the effect of pretreatment with magnesium on the potency of vecuronium using a single bolus dose-response technique. In addition, we compared the time course of vecuronium-induced neuromuscular block (vecuronium 100 micrograms kg-1) with and without magnesium pretreatment. For both parts, neuromuscular block was assessed by electromyography. In addition, the effect of magnesium pretreatment on vecuronium-induced neuromuscular block was investigated in the context of rapid sequence induction of anaesthesia. We found that the neuromuscular potency of vecuronium was increased by pretreatment with magnesium sulphate. The ED50 and ED90 of vecuronium with MgSO4 were 25% lower than without MgSO4 (ED50: 21.3 vs 26.9 micrograms kg-1; ED90: 34.2 vs 45.7 micrograms kg-1; P < 0.05 for both). Mean onset time was 147.3 (SD 22.2) s in the MgSO4-vecuronium group vs 297.3 (122) s for controls (P < 0.05). Clinical duration was prolonged (MgSO4-vecuronium 43.3 (9) min vs 25.2 (5.1) min for controls; P < 0.05). This was also true for the recovery index (20.1 (6.6) min vs 10.6 (3.4) min; P < 0.05) and duration to 75% recovery (63.4 (9.9) min vs 35.8 (6.9) min; P < 0.05). In the context of rapid sequence induction, pretreatment with MgSO4 improved the intubating score of vecuronium compared with vecuronium without MgSO4, reaching the same quality as that with suxamethonium 1 mg kg-1. We conclude that magnesium pretreatment increased the neuromuscular potency of vecuronium, in addition to modifying the time course of its neuromuscular block.

Adolescent↗