Biomedical subjects
V Hempel
Publications and source records attributed to V Hempel.
[60 years thiopental].
In 1994, thiopentone has been in clinical use as an induction agent for 60 years. For this reason, a literature review is given dealing with its chemical properties and pharmacokinetics with special regard to plasma protein binding, recommended speed of injection, diaplacentar transfer to the foetus in Caesarean section and the transfer to breast milk. The pharmacodynamics of thiopentone are reviewed with emphasis on the effects on the CNS, the cardiovascular system, the respiratory system, renal function, liver and the effect in porphyria. Its side effects such as local reactions and release of histamine are also reviewed. The clinical importance of thiopentone in anaesthesia induction and the present state of cerebral protection are discussed, as well as the results of controlled trials comparing thiopentone to other induction drugs. Thiopentone has the main disadvantage of a slow elimination resulting in minor CNS depression, which seems of very limited clinical importance. In most respects thiopentone seems to be comparable to its younger competitors.
[Drug therapy of postoperative pain].
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[The laryngeal mask with > 1900 general anesthesias--report of experiences].
Since November 1990 until January 1993, the laryngeal mask airway was employed for 1925 general anaesthesias, i.e. 19.6% of all general anaesthesias in our hospital. On the basis of the protocols the age distribution of the patients, the practice of anaesthesia (premedication with oral benzodiazepines, induction with thiopental, anaesthesia sustained with enflurane/nitrous oxide/oxygen) and the complications are reported. The complications not directly related to the laryngeal mask were: hypotension (5.92%), dysrhythmias (3.17%) and hypertensive states (1.71%). Other complications directly related to the laryngeal mask (bronchospasm, laryngospasm, difficult insertion of the mask, intraoperative vomiting) were less than 1.3% each. One aspiration was recorded, but could not be attributed to the laryngeal mask. Complications with major influence on the postoperative course and hospital stay were not seen.
[Continuous spinal anesthesia. A statement on its practical application].
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[The modified Magill forceps].
The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. There are several disadvantages of the standard Magill forceps; however: the danger of cuff perforation, the necessity of readjusting the forceps when placing a tube or catheter, and the risk of injury to the mucous membrane. For these reasons the standard Magill forceps have been modified: the jaws of the forceps have been changed to give curved atraumatic parts without any serrations or sharp edges. RESULTS. The resulting benefits are as follows: Reduced risk of injuring the mucous membrane and perforating the cuff. Tubes and catheter are safely guided between the semiround jaws, making it unnecessary to open the forceps repeatedly to advance the tube. Tampons being placed in the throat no longer get caught between the serrations, and even small foreign objects can easily be extracted from the pharynx.
[Prognostic parameters in peptic ulcer disease].
Tendency of peptic ulcer to frequent recurrence and spontaneous healing as to life-threatening complications are apart of the natural history of ulcer disease. In a retrospective study of 7 years, we examined 27 simple factors for their prognostic value by 218 patients suffering from ulcer disease which were diagnosed by fibroscopy. The interpretation with help multi analysis, the variant and discriminant analysis showed by patients with stomach ulcer that, the prognosis of the combination between renunciation of nicotine the begin of the disease until 30th years of the people, more than three foods daily, stomach cancer in the family, blood group A and left finger position would be suitable. The prognosis was better for patients with duodenal ulcer who have nicotine abstinence, childlessness negative history of the family with view to ulcer disease, blood group 0, positive Rh-factor and the working time.
[Spinal anesthesia].
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[The origin of non-emulsified fat during autotransfusions in elective hip surgery].
In addition to hemodilution and preoperative blood donations, mechanical intraoperative autotransfusion (MAT) is an important method of preventing or minimizing the transfusion of homologous blood in operations with major blood loss. Using cell separators allows most of the problems of MAT to be solved, but the processed red cell concentrates of patients having hip joint replacement contain fat. Due to the high risk of fat embolism during bone surgery, as well as other circulatory problems, it is of interest whether the infusion of up to 15 ml of fat does not expose patients to an even higher risk. This study aimed to research the pathogenesis of fat embolism and possibly support one of the existing theories. METHODS. Semiquantitative oil measurement: in 45 cases with first insertion of hip joint prosthesis and 16 cases with change of prosthesis MAT was used intra- and postoperatively. For comparison, 10 patients with aortic aneurysm repair were checked for fat as well. In these cases MAT was only used intraoperatively. After the red cell concentrate was processed there was a time lag of 10 min to allow better sedimentation of fat. At the end of retransfusion 50 ml of blood were saved. They were then separated into 10-ml plastic tubes, centrifuged, and fat content was measured using a mm-scale. The results were transformed to ml by means of a previously determined calibration. Analogous to hematocrit values, it was thus possible to establish a lipocrit for these patients. In another 16 cases of hip surgery we carried out cholesterol/triglyceride investigations in red cell concentrates, and in 5 cases analysis of the fatty acids by gas chromatography was performed. RESULTS. The lack of an emulsifier causes biochemical analysis of cholesterol-triglyceride levels to be impossible. Therefore, triglycerides and cholesterol in MAT blood were below normal levels although a high quantity of fat could be seen in the blood. No oil was found in any of the patients in the vascular surgical group. There were 61 patients in the orthopedic group; no oil was found in 34.4%, we found 1-2 ml in 16.4%, and in 49.2% there was more than 2 ml of oil. With regard to age, sex, weight, height, and deviation from Broca index no significant difference in lipocrit could be seen. Differences in lipocrit were observed depending on the type of operation (i.e. new insertion/change of hip prosthesis), these were not significant possibly due to the small number of patients undergoing a change of prosthesis. The more MAT blood was transfused, the more significant were the rises in lipocrit level. The rinsing solution itself (1000 ml NaCl 0.9% with heparin 30,000 IU) does not influence the oil concentrations. Gas chromatography revealed that there was more than 40% oleic acid and 20% palmitic acid. Combined with linoleic acid, this comprised 4/5 of the total amount of oil (Table 3)...
[Anesthesia in interventions on the hypopharynx, larynx and trachea].
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[Treatment of frostbite of the extremities by combined axillary plexus and peridural anesthesia: a case report including blood levels of bupivacaine].
To enhance peripheral perfusion after local frostbite, temporary or definitive interruption of the sympathetic activity in the region of injury is useful as an adjunct to systemic treatment. The common catheter techniques of axillary or epidural block provide the advantage of continued sympathicolysis without the risks of serial punctures or irreversible surgical alterations of the autonomic nervous system. bupivacaine into the three catheters (Fig. 2). A very satisfactory clinical result was observed. There was no loss of fingers
[Effect of hydroxyethyl starch, oxypolygelatin and human albumin on the phagocytic function of the reticuloendothelial system in healthy subjects].
RES phagocytic function was determined in healthy volunteers prior to and up to 5 h after application of 10 ml/kg body weight of 6% hydroxyethyl starch (450,000; 0.7), 5.5% oxypolygelatin (30,000), or 5.0% human albumin solution. Phagocytosis (phagocytic index K) was evaluated in vivo by intravascular lipid clearance (Lipofundin clearance test). Immediately after infusion, the phagocytic rate increased by 30% in the hydroxyethyl starch group (n = 10; p less than 0.05), 14% in the oxypolygelatin group (n = 10; ns), and 24% in the albumin group (n = 8; ns). 2 h after infusion phagocytosis was still increased by 35% in the hydroxyethyl starch group (n = 10; p less than 0.05), by 18% in the oxypolygelatin group (n = 10; ns), and 13% in the albumin group (n = 8; ns). 5 h after infusion, K values had returned to normal in the albumin group (n = 4), but were still increased by 40% in the hydroxyethyl starch group (n = 4; ns). No statistically significant differences could be established among the 3 groups. The increase in the phagocytic rate, particularly after application of hydroxyethyl starch, might be explained by a dilution effect.
Failure of thyrotropin releasing hormone to reverse fentanyl-flunitrazepam anesthesia in man.
The effect of thyrotropin releasing hormone (TRH) on modified neuroleptanesthesia with fentanyl-flunitrazepam was investigated in an open pilot study of 15 neurosurgical patients. Before and 15, 30, and 60 minutes after extubation and subsequent administration of 400 micrograms TRH, the following parameters were evaluated: PaO2, PaCO2, vigilance, and pain sensation. Although no TRH-related impairment of postoperative analgesia was observed, respiratory depression and impaired vigilance were not significantly reversed. These findings contradict a number of experimental studies using animal models which indicated that TRH, due to its centrally mediated ergotropic activity, antagonizes the narcotic effect of various CNS depressants and anesthetics.
[Effect of L-carnitine on post-stress metabolism in surgical patients].
The positive influence of L-carnitine administration on postaggression metabolism was investigated. Clinical examinations were executed on three groups of patients K1, K2, K3). Comparable surgical operations like stomach- and intestinal- resections were performed on these groups of patients. During the first three days after operation a nutritional diet (parenteral, standardized hypocaloric) with (K2: 2 g; K3: 4g) and without L-carnitine (K1) was given. The effects of L-carnitine administration were evaluated by the following parameters: free fatty acids (FFS), triglycerides (TG), beta-hydroxybutyric acid (beta-OH-BS), acetacetate (ACAC), blood sugar (BZ), insulin (INS), lactate (LAK), pyruvate (PYR), total protein (GE), cholinesterase (CHE), urea production rate (PU), nitrogen of alpha-aminogroups (alpha-AN), nitrogen balance (NB), catabolic index (KI), BUN-Creatinine-quotient (B/K), total carnitine (GC), free carnitine (FC), acetyl carnitine (AC) and also the ratio between acetyl carnitine and free carnitine (AC/FC) in serum and urine. The results show no statistical significance. But they could lead to the following conclusions: Carnitine obviously reduces the insulin resistance. But it does not influence the post-operative perturbation of glucose-utilization. Carnitine reinforces the utilization of long chain fatty acids and thus improves the energy conversion. Carnitine leads to an earlier positive nitrogen balance. By giving 4 g of carnitine a day, already after three days a repletion of tissue deposits is possible, and a dose dependence for carnitine administration exists for the utilization of long chain fatty acids and the repletion of tissue deposits.
Pyrazolones in the treatment of postoperative pain.
The aim pursued in postoperative analgesia is to mobilize patients, to prevent thrombo-embolism, to improve subjective well-being, and to reduce the stress reaction caused by pain. In sufficiently high doses, metamizol is equally as suitable for the treatment of postoperative traumatic pain as are opioids. Comparative studies provide evidence that metamizol is no less potent in its action than pethidine, and that in cases of pain in the head and neck region it is superior to buprenorphine in its usual dose. It can also be used to supplement opioid medication where this does not produce satisfactory analgesia. In patients with a history of drug abuse, metamizol is in fact the drug of choice for immediate postoperative analgesic treatment.
[Plasma concentration and amnesia following lormetazepam and flunitrazepam in i.v. premedication].
The correlation between serum levels and degree of amnesia following 0.03 mg/kg lormetazepam or 0.02 mg/kg flunitrazepam was analysed in a prospective randomised single-blind study evaluating 20 patients with ASA classification I in each group. Blood specimens were drawn and amnesia tests performed 20, 40 and 60 min. after drug administration. The plasma level of lormetazepam was 1.8 to 2.0 times higher than that of flunitrazepam; however, the difference of lormetazepam concentrations was considerably large between the investigated individuals. There was no difference in the degree of amnesia, but also no correlation with plasma levels was measured. A serum level breakpoint for the occurrence of amnesia could not be defined.
[Plexus anesthesia with a bupivacaine-mepivacaine mixture. Clinical results and blood level].
A mixture of 0.2% bupivacaine and 0.75% mepivacaine was employed for brachial plexus block in 20 patients scheduled for surgery of the forearm-hand-region. Volumes of 40-60 ml were given. The spread of motor and sensory block was monitored during 80 min. The first postoperative pain sensation was reported about seven hours after injection of the local anaesthetic. The results are compared to those obtained with 1% plain mepivacaine. The spread of the block was slightly slower after the mixture than after plain mepivacaine. Blood levels after the mixture showed a maximum 30 min after injection.
[Postpuncture headache].
The present study recorded prospectively subjective complaints after lumbar puncture as diagnostic procedure (n = 59), spinal - (n = 41) and peridural anaesthesia (n = 45) over a time interval of 28 days. Posture dependent headaches were never observed following peridural anaesthesis. This result disproves the hypothesis of a purely psychogenic origin of postpunctional headache. The frequency of occurrence of the postpunctional syndrome was 39% after lumbar puncture, but only 4.9% after spinal anaesthesis. The observed difference is due to the fact that needles with a smaller diameter are applied in spinal anaesthesia.