[Complications of intravenous therapy with peripheral indwelling catheter]. / Komplikationen bei intravenöser Therapie über periphere Verweilkatheter.

Intravenous fluid replacement via a peripheral catheter harbours several risks. The study presented emphasizes that about 50% of the patients show complications during the first days after positioning of an intravenous line. Women patients have been affected more often than male patients. Small catheters positioned in a major vessel away from a joint in the forearm, yield the best results. Peripheral lines should be removed within 8 to 12 hours after surgical procedures, when early symptoms are observed. Complications can be avoided by following these recommendations.

[Stress bleeding and postoperative pneumonias in intensive care patients on ranitidine or pirenzepine]. / Stressblutungen und postoperative Pneumonien bei Intensivpatienten unter Ranitidin oder Pirenzepin.

To prevent stress bleeding, 400 postoperative patients in intensive care but not expected to need long-term mechanical ventilation, were randomly given either 50 mg pirenzepine or 200 mg ranitidine daily intravenously for a mean of 3.9 days. Macroscopically visible bleeding was the criterion of stress bleeding. In addition, special attention was also paid to any signs of pneumonia. There was a significantly higher incidence of gastric pH values of less than 4 in the pirenzepine patients. Six episodes of bleeding occurred in the ranitidine group vs. three in the other. There was a significantly higher incidence of pneumonia among ventilated patients (18.0% vs. 2.7%). Among ventilated patients the pneumonia rate under ranitidine was 28.6% vs. 9.1% in the pirenzepine group (P less than 0.05). The probable cause of the higher pneumonia rate under ranitidine was the gastric colonization with gramnegative organisms. Pirenzepine assures an effective prophylaxis against stress bleeding at least as good as ranitidine. At the same time, the risk of lung infection is also lower with pirenzepine than ranitidine.

[Vecuronium in crash intubation]. / Vecuronium zur Blitzintubation.

A prospective controlled study was conducted to compare the efficacy of vecuronium and succinylcholine for the crash-induction technique. Following precurarisation with 0.02 mg/kg vecuronium and 0.1 mg fentanyl (group A and B) or NaCl 0.9% and 0.1 mg fentanyl (group C) preoxygenation via face mask was maintained until the patients reported heavy eye-lids or weariness or the precurarization-time attained 120 s. The patients then received 5 mg/kg thiopentone followed by 1.5 mg/kg succinylcholine (group B) or 0.08 mg/kg vecuronium (group A) resp. 0.1 mg/kg vecuronium (group C) directly before the thiopentone. Rapid intubation and scoring of the intubation condition was performed by an anaesthetist who was unaware of the grouping. The intubation time was defined as the interval from the end of the injection of the drugs until cuff-inflation of the tracheal tube. All patients in group A and B could be intubated within 60 s, in contrast to only 15 patients in group C (p less than 0.05). The intubation conditions in the succinylcholine group and in the vecuronium group with divided doses showed no significant differences, while in group C the conditions were significantly worse. The modified crash-induction technique with vecuronium in divided doses could become beneficial in patients with contraindications of the use of succinylcholine who are at risk of aspiration.

Prevention of histamine-induced cardiovascular reactions during the induction of anaesthesia following premedication with H1- + H2-antagonists i.m.

In a prospective controlled double-blind study, 60 elective surgical patients were randomly assigned to three premedication groups. Twenty patients received promethazine 0.5 mg kg-1 i.m. 45 min before induction of anaesthesia; a further 20 patients received an additional i.m. injection of cimetidine 400 mg 120 min before induction. The third group (n = 20) served as the control group. Following vecuronium 0.02 mg kg-1, anaesthesia was induced with fentanyl, and etomidate. All patients then received suxamethonium 1.5 mg kg-1 i.v. The combined administration of H1- + H2-antagonists as premedication led to a significant reduction in the increase in heart rate when compared with the effects in the other groups.

Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication.

In a prospective, controlled, randomized study of a prophylaxis for stress bleeding, 100 high-risk patients in an intensive care unit received, on a daily basis, 1 g of sucralfate every four hours, an antacid every two hours, or 2 g of cimetidine intravenously. All patients also received 50 mg of pirenzepine by intravenous infusion each day. Gastric pH was determined every eight hours. Bleeding was defined as macroscopically visible bleeding. The intragastric pH was less than 4 significantly more often in patients treated with sucralfate than in patients treated with the other agents, but stress bleeding occurred only in patients treated with cimetidine (n = 2) or antacids (n = 2). In the latter two treatment groups, the probability of bleeding correlated with the incidence of pH values below 4. No side effects of sucralfate therapy were observed. The results indicate that prophylactic treatment of stress bleeding with pirenzepine and sucralfate is at least as effective as combined treatment with pirenzepine and cimetidine or antacids.

[Prevention of acute stress hemorrhages of the upper gastrointestinal tract with pirenzepine and antacids. A controlled comparison between pirenzepine and cimetidine]. / Prophylaxe akuter Stressblutungen des oberen Gastrointestinaltraktes mit Pirenzepin und Antazida. Ein kontrollierter Vergleich zwischen Pirenzepin und Cimetidin.

H2-antagonists, antacids and pirenzepine are effective drugs for prophylaxis of stress ulcer bleeding. Combined medication seems to be superior to single medication, but investigations of the effectiveness of a pirenzepine-antacid prophylaxis have not been carried out. We therefore evaluated the effect of this combination on gastric pH and on prevention of stress bleeding in ICU patients. In a prospective controlled randomized study 33 patients in each group received 50 mg. pirenzepine intravenously as a basic medication and alternatively 2000 mg. cimetidine i.v. or 2-hourly 10 ml. antacid. Gastric pH was determined three times per day. Stress bleeding was defined as bloody gastric juice, haematemesis or melaena. Two stress bleedings could be detected in each group. The pirenzepine-antacid combination proved to be superior to ensure a gastric pH of more than 3.5 than the pirenzepine-cimetidine group. After removal of the nasogastric tube the 2-hourly application of antacids proved to be impracticable.

[Prevention of anaphylactoid reactions using intramuscular promethazine and cimetidine. Studies of a histamine infusion model]. / Prophylaxe anaphylaktoider Reaktionen mit Promethazin und Cimetidin bei intramuskulärer Applikation. Untersuchungen am Histamininfusions-Modell.

The effect of combined intramuscular premedication with H1 + H2-receptor-antagonists on histamine-induced cardiovascular and cutaneous reactions was studied in 8 volunteers in a randomized placebo-controlled double-blind crossover trial and compared with premedication with H1-receptor antagonist alone and with the histamine-induced effects without premedication. As H1-receptor antagonist the volunteers received 0.5 mg/kg promethazine i.m. 45 min before the start of histamine infusion; as H2-receptor antagonist we used 400 mg cimetidine i.m. 120 min before application of histamine. While the premedication with promethazine alone could prevent histamine-induced tachycardia, fall of blood pressure and cutaneous reactions only partially, these reactions were almost completely prevented by combined premedication. Like intravenous application of H1 + H2-receptor antagonists shortly injected before induction of anesthesia, intramuscular premedication with promethazine and cimetidine can prevent anaphylactoid reactions. In contrast to intravenous application, the latter application is also effective in reducing the risk of acid aspiration syndrome and as a sedative.

[Report of 2 cases of irreversible Horner syndrome after puncture of the internal jugular vein]. / Berich über 2 Fälle eines irreversiblen Horner-Syndroms nach Punktion der Vena jugularis interna.

Two cases are presented with irreversible Horner's syndrome after cannulation of the internal jugular vein during the intraoperative period. In the first case the cannulation succeeded only after several attempts. In the second case the cannulation succeeded the first time. All cannulations were performed by experienced anaesthesiologists. This means, that a strict indication for the cannulation of the internal jugular vein must be considered, because of the possibility of irreversible damage, even if the cannulation is performed by an experienced physician.