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T Pasch

Publications and source records attributed to T Pasch.

At least 19 recordsLinked to original sources
PubMed1992

Effects of single-dose intravenous omeprazole and ranitidine on gastric pH during general anesthesia.

We conducted a comparative trial of the gastric proton pump inhibitor omeprazole and the H2-receptor antagonist ranitidine on gastric pH in 50 adult patients scheduled for elective gynecologic surgery. The drugs were administered intravenously in random fashion after induction of general anesthesia and placement of a gastric electrode for continuous pH monitoring. The two drugs caused significant increases in gastric pH that did not differ significantly when compared with one another, yet there were significant differences from the control group, which did not receive either of the two drugs. A gastric pH of 2.5 was reached within median 34 and 26 min after administration of omeprazole (40 and 80 mg, respectively) and within median 32 and 26 min after administration of ranitidine (50 and 100 mg, respectively). After injection of omeprazole, a gastric pH of 3.5 was reached after median 41 and 34 min; injection of ranitidine (50 and 100 mg) produced a pH of 3.5 after median 43 and 48 min, respectively. We conclude that the intravenous administration of a single dose of omeprazole or ranitidine causes a similar increase, both in magnitude and time of onset, in gastric pH during general anesthesia.

Adult↗
PubMed1991

[Goals and methods of patient monitoring].

Monitoring during and after anaesthesia is aimed at recording changes in physiological functions including the patient's response to the anaesthetic and surgery, and identifying avoidable critical incidents caused by human error or equipment failure. Assessment and control of the depth of anaesthesia would be desirable but cannot yet be accomplished in clinical practice. For every anaesthetic, some degree of primary, basic or minimal monitoring is essential and is, in a number of countries, prescribed or recommended by regulations or guidelines. Besides an alert anaesthetist constantly observing the patient and monitoring the function of the anaesthesia machine, these minimal standards include an ECG, noninvasive blood pressure measurement, pulse oximetry, and end-tidal CO2 recording (capnography). ECG, blood pressure, and pulse oximetry also have to be employed during regional anaesthesia and in the post-anaesthesia care unit. The question as to whether further monitoring techniques need to be added (extended or secondary monitoring) will depend upon the medical problems of the individual patient and on the nature and duration of the surgical and anaesthetic procedures. For this purpose, invasive methods are preferentially used, in particular central venous and arterial pressure recording, and a pulmonary artery catheter for measuring pulmonary artery and pulmonary capillary wedge pressures and cardiac output, all in combination with blood gas analysis.

Anesthesia↗
PubMed1991

Heparin-coated left heart bypass: renal function and hormonal response.

The effect of partial (50 ml/min/kg) left heart bypass (LHBP) on renal function, plasma renin activity (PRA), aldosterone, arginine vasopressin and atrial natriuretic peptide (ANP) response was studied in ten anesthetized, open-chested mongrel dogs (weight 23-50 kg) over a period of 6 h. Standard equipment with systemic heparinization (control), initially 300 IU/kg, was employed in five dogs, and heparin-coated equipment without additional heparin in the other five (heparin coated). Urine was continuously collected through a transurethral catheter. Urine samples and pulmonary artery blood samples for hormonal assays were taken at preset intervals before and during LHBP. The results in each group were summarized as median (25th-75th) and compared using the Mann-Whitney U test. In the control group higher blood loss required higher volume substitution. Urine output was maintained in heparin coated and slightly decreased at 3-4 h in control LHBP. Creatinine clearance at 3-5 h and free-water clearance at 3-6 h were significantly higher with heparin-coated LHBP. PRA, aldosterone and vasopressin peaked at 1-2 h of LHBP similarly in both groups, not exceeding the values before perfusion. PRA and aldosterone response was sustained during 6 h and the percentage changes corrected for hemodilution indicated a stronger response with standard equipment. Vasopressin concentrations were slightly but significantly higher in the control group at 1 and 6 h of perfusion. Corrected for hemodilution, vasopressin percentage changes were not different in the two groups. ANP, despite atrial unloading, rose similarly in both groups. There was a tendency to poorly sustained ANP response (control greater than heparin-coated) after 6 h of perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Aldosterone↗
PubMed1991

[Servo-plethysmo-manometry for continuous noninvasive blood pressure monitoring].

Servoplethysmomanometry (Penáz method) is based on the principle of "vascular unloading" or "arterial volume clamp". It permits continuous recording of the arterial pressure pulse in a finger. We evaluated such a device (Finapres) intraoperatively in cardiac surgical patients and compared the results with those obtained using simultaneous intra-arterial pressure recording. METHODS. Intravenous anesthesia was employed in a total of 31 patients. Invasive pressure monitoring was carried out in the radial artery. The cuff of the Finapres was wrapped around the 3rd finger, either on the same side as the radial cannula (group I, n = 15) or on the contralateral side (group II, n = 16). Quantitative comparison was accomplished for the paired values obtained by the two methods by calculating linear regression equations and correlation coefficients (r), as well as for the differences between the paired values (means, SD, frequency distributions). RESULTS. In group I (ipsilateral recording), r was 0.74 for systolic (SAP), 0.52 for diastolic (DAP), and 0.77 for mean (MAP) pressure. The means +/- SD of the differences (mm Hg) were -1.6 +/- 16.6 (SAP), 4.6 +/- 11.5 (DAP), and 0.2 +/- 11.3 (MAP). In group II (contralateral recording), r was found to be 0.86 (SAP), 0.72 (DAP), and 0.82 (MAP). The mean differences were -2.7 +/- 13.1 (SAP), 4.7 +/- 9.8 (DAP), and -2.6 +/- 10.9 mm Hg (MAP). Prior to cardiopulmonary bypass (CPB) the results of the two methods corresponded to a higher degree than after CPB; during CPB the MAP values correlated poorly in the two groups (r = 0.62). DISCUSSION. The results obtained may be interpreted to mean that the Finapres will enable us to monitor arterial blood pressure continuously with satisfactory reliability when the cuff design has been improved.

Blood Pressure Monitors↗
PubMed1991

[The effect of halothane, enflurane and isoflurane on resistance and compliance in patients with asthma or chronic obstructive lung diseases].

In order to test the hypothesis that halothane is more effective and safer than enflurane and isoflurane in patients with reactive airway disease, a clinical trial was performed to compare these three agents in patients with asthma or chronic obstructive pulmonary disease (COPD). METHODS. After obtaining institutional approval and informed consent, 31 patients with bronchial asthma or COPD were studied (FEV1 less than 65% of FVC); all patients underwent extensive surgery of the paranasal sinuses. Premedication consisted of i.m. atropine and promethazine; anesthesia was induced with diazepam, fentanyl, etomidate, and succinylcholine and maintained with pancuronium and 50% N2O in O2 together with one of the volatile agents, halothane, enflurane, or isoflurane, selected at random. Patients were mechanically ventilated. On the basis of respiratory pressures, volumes, and flows, inspiratory (Rin) and expiratory (Rex) resistance and compliance (C) were calculated after induction (control), 15 min after the addition of the volatile agent (1.25 MAC), every 15 min during the surgical procedure, and at the end of the operation. RESULTS. In 1 case, airway resistance increased markedly a few minutes after administration of isoflurane. The results obtained in this patient were not included in the evaluation of the data. There were no statistically significant differences in the preoperative data or control values of Rin, Rex, and C among the three groups (n = 10 each). With the respective inhalational agents, Rin increased maximally between 3% (halothane) or 8% (enflurane) and 21% (isoflurane), Rex between 16% (halothane, enflurane) and 29% (isoflurane). For the most part, however, these changes were not statistically significant as compared with controls. Intergroup comparisons failed to reveal any statistically significant differences either. In all groups C decreased continuously to about 90% of control. DISCUSSION. The results show that in patients with asthma or COPD, airway resistance remains virtually unchanged during surgery and anesthesia under halothane or enflurane anesthesia. With isoflurane, however, the resistance may rise by a slight but not statistically significant extent. Furthermore, marked bronchospastic reactions occurred in 2 patients in the isoflurane group. Thus, the three volatile anesthetics studied were not found to be unequivocally safe and effective in preventing increases in bronchomotor tone. However, pharmacodynamic effects other than those on respiration (e.g., cardiovascular actions, arrhythmogenic threshold, metabolism, toxicity) must additionally be taken into consideration.

Adult↗
PubMed1991

[Rest ventricular function in left heart bypass].

During partial left heart bypass (LHBP), the flow delivered by an assist device is easy to measure while residual left ventricular function (LVI) seems difficult to assess. In this study, we have attempted to define the separate right and left ventricular function during LHBP. In 6 anesthetized dogs, following thoracotomy and systemic heparinization, aorta and left atrium were cannulated and connected to the servo-controlled roller pump (modified Stöckert-System). Following saline infusion (30 ml/kg), LHBP was started and maintained at 50 ml/min/kg throughout 6 h. Standard hemodynamic parameters were continuously monitored. Cardiac output, blood gas analyses, hemoglobin and activated coagulation time were measured at regular intervals. LVI was calculated as the difference between cardiac output and assist-flow rate. Other derived variables were obtained using standard formulas. The Wilcoxon rank-test was used for the statistical analysis. The results, as median and 25th-75th percentile, are summarized in the graphics 1-6. Under the experimental conditions of this study, the flow performance and stroke work of the right ventricle remained unchanged, while the work-unloaded left ventricle maintained only a part of systemic perfusion. Neglecting the physiological shunt and its changes, which influences the difference between the left and right ventricular output, the simple formula to assess LVI during LHBP seems plausible.

Animals↗
PubMed1990

Epidural anesthesia for cesarean section in a patient with severe pulmonary hypertension.

The case of a parturient previously operated on for transposition of the great arteries is reported. On account of Eisenmenger's syndrome with high pulmonary vascular pressures, she was admitted to hospital with hemoptysis in the 27th week of gestation. At the end of the 34th week the child was delivered by elective cesarean section under epidural block. Bupivacaine 0.75% was administered as local anesthetic, and small incremental doses of local anesthetic proved capable of maintaining hemodynamic stability for the duration of the operative procedure.

Adult↗
PubMed1990

Effect of epidural anesthesia for cesarean delivery on maternal femoral arterial and venous, uteroplacental, and umbilical blood flow velocities and waveforms.

The effect of epidural anesthesia on the maternal femoral arterial and venous, uteroplacental, and umbilical circulations was studied by the pulsed Doppler technique in 13 women undergoing elective cesarean delivery. Resistance and pulsatility indices of umbilical arterial velocity waveforms did not change with the use of epidural anesthesia. In the uteroplacental circulation, these indices increased in 11 patients, suggesting an increase in resistance. Reduction of sympathetic tone in resistance and capacitance vessels was reflected in the femoral artery by an increase in systolic and end-diastolic velocities, a reversal of the post-systolic backward flow, and an increase in mean velocity. The latter also occurred in the femoral vein. The diameters of these large maternal vessels did not change. This study suggests an impairment in uteroplacental circulation associated with a drop in peripheral vascular resistance and an increase in leg blood flow after epidural anesthesia.

Anesthesia, Epidural↗
PubMed1989

[Applied pharmacology of anesthetics].

Inhalation anesthetics, intravenously applied anesthetics, opiates, muscle relaxants and local anesthetics are the most commonly used anesthetic drugs. From the direct anesthetic effects interactions with other organ systems and functions, especially those involved in vital functions such as the pulmonary and cardio-vasculary systems, must be distinguished. Although the safety-margins for individual drugs vary, side effects are minimal on appropriate dosage and use. Substance-related complications, such as severe hepatic damage or malignant hyperthermia, are rare. Procedure-related differences (general or local anesthesia) were not found for post-operative morbidity and mortality, nor was there a detectable impairment of concentration and mnestic performance.

Anesthesia, Inhalation↗
PubMed1989

Measurement of blood pressure during the intraoperative period.

For the monitoring of arterial blood pressure in the peri-operative period, three different methods are available. The classical approach is the indirect measurement employing a cuff applied to the upper arm as described by RIVA-ROCCI, known as sphygmomanometry. Thanks to the development of automatic devices employing the oscillometric principle, measurement of the mean arterial pressure has now become possible, blood pressure monitoring simplified, and documentation made easy. The particular indications for direct arterial pressure measurement are very low, very high, and widely fluctuating pressure, as well as major and prolonged surgery. Furthermore, arterial catheterisation provides the additional advantage of permitting blood gas analysis, while, properly employed, the rate of associated complications is low. Recently, it has become possible to perform continuous recording of the blood pressure with a non-invasive method known as servo-plethysmomanometry. The device employed for this method (Finapres) measures the pressure in the arteries of a finger using a small cuff incorporating a photoplethysmograph. Experience to date with this method in clinical usage is good. It is thus to be expected that the technique will in future offer an alternative to invasive methods of blood pressure measurement in many cases.

Blood Pressure Determination↗
PubMed1989

[Noninvasive monitoring].

For a number of reasons, invasive and non-invasive measuring procedures for monitoring purposes must not be considered to be mutually exclusive alternatives. The transitions between the two are fluid, and their respective advantages and disadvantages frequently complement one another. The complication rate characteristic of a given procedure is the greater, the more invasive this procedure is. For this reason, a non-invasive technique should always be given preference over an invasive method provided it is capable of recording the parameter to be monitored at least as reliably and accurately as the latter. For minimal monitoring during anaesthesia, non-invasive procedures are applied exclusively. These include the monitoring of ventilation (FIO2, pressures, volumes, flows), ECG, measurement of blood pressure employing the cuff method, temperature measurement, and a nerve stimulator for establishing the degree of relaxation. In addition, pulse oximetry and capnography are increasingly becoming accepted elements of basic monitoring. The question as to whether further monitoring procedures need to be employed will depend upon the condition of the patient and the nature and duration of the surgical operation and anaesthesia. Here, preferential use is made of invasive methods of recording pressures and flows (cardiac output) within the circulatory system and of various blood parameters (for example, blood gas analysis). To an increasing extent, they are being supplemented, expanded or replaced by newly developed non-invasive methods. Thus, for example, the time and material requirement for non-invasive blood pressure measurement in the finger by means of servomanometry (Finapres) is reduced as compared with intra-arterial pressure recording.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1989

Biochemical and hormonal parameters in patients with multiple trauma.

We measured amount, course and duration of different parameters in order to assess metabolic-endocrine changes in patients with multiple trauma and the final outcome. Injures were initially quantified according to the Injury Severity Score. Serum levels of lactate, creatinine, bilirubin, somatomedin and thyroid hormons were measured in 51 patients (39 survivors, 12 deceased patients) for six days following the injury. In addition, neopterin levels were measured in 26 patients (19 survivors, 7 deceased patients). The patients were devided into two groups (survivors vs non-survivors). Global Index Scores and Septic Severity Scores were significantly different at the 1% and 5% level (p less than 0.05 to p less than 0.01). The same statistical differences were shown for lactate, somatomedin, neopterin and thyroid hormones.

Biomarkers↗
PubMed1987

Can the outcome after trauma or sepsis be predicted from biochemical or hormonal parameters?

The severity of shock of 36 surgical ICU patients was classified using the Injury Severity Score (N = 20) and the Sepsis Score (N = 16). A great number of laboratory parameters were repeatedly determined on 5 days following the trauma or the onset of septic symptoms. Blood lactate, C-peptide, BUN, osmolality, and thyroid hormones were most closely related to the severity of the disease. This correlation was, however, less pronounced in the trauma than in the septic patients. Lactate and thyroid hormones showed a typical course in the non-survivors and may therefore be valuable as prognostic indices.

Adolescent↗
PubMed1987

[Effect of fentanyl and enflurane on sensory evoked potentials in the human in basic flunitrazepam/N2O anesthesia].

The use of evoked potential recording is commonly employed for monitoring peripheral and central sensory functions during neurosurgical procedures. However, the neuronal structures studied must not be changed by the anesthetic agents used. In this connection, the influence of two anesthetics, fentanyl and enflurane, on evoked potentials was investigated under basic anesthesia. A total of 60 patients undergoing lumbar disc removal were included in the study. Somatosensory (SEP), auditory (AEP), and visual (VEP) evoked potentials were each recorded in 20 patients the day before operation. Basic anesthesia was induced with flunitrazepam, nitrous oxide, and pancuronium bromide. Following induction, recordings of evoked potentials were again made. One half of each group of 20 patients received increasing doses of fentanyl (1.8, 3.6, and 7.2 micrograms/kg in the somatosensory and auditory groups; 4.0 and 8.0 micrograms/kg in the visual group). The other half was given increasing inspiratory concentrations of enflurane (0.5, 1.0, and 1.5 vol.%). At each level of anesthesia, SEPs, AEPs or VEPs were recorded. As compared with preoperative recordings, post-stimulus latencies were virtually unaffected by the basic anesthesia. Fentanyl caused little increase in the latencies of middle-latency-SEPs and of peak P2 of the VEPs. With enflurane, however, the latencies of the SEPs were dose-dependently prolonged, in particular those of the later components (P25 to N55). The same was true for the peak P2 in the VEPs. AEPs were not changed at all. From the results it can be concluded that enflurane, but not fentanyl, impairs impulse conduction in central synaptic pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗