Age-dependence and free fatty acid modulation of binding kinetics at the benzodiazepine binding site of serum albumin in neonates and adults determined using fast reaction methods.

Binding kinetics at the benzodiazepine binding site of albumin have been determined as a function of age and fatty acid concentration in serum from 32 neonates (umbilical cord blood), 28 adults aged 23-65 years and 24 adults aged 66-101 years using fluorescence-time curves obtained in a Durrum-Gibson stopped-flow apparatus and the specific marker ligand dansylsarcosine. The binding reaction can be described by a 2-step mechanism characterised by four constants: the association rate constant k2 and dissociation rate constant k-2 for the rate limiting step-2; the affinity constant KA' for the formation of an unstable intermediate complex in step-1; the affinity constant KA for the overall reaction. There were marked differences in k2 between the three groups of subjects with highest values occurring in neonates (mean: 296 s-1), intermediate values in adults aged 23-65 years (mean: 200 s-1, P less than 0.

[Dose-response relationship and serum concentrations of methohexital and hydroxymethohexital following rectal anesthesia induction with 1% and 5% methohexital solutions in children].

Dose-response-curves for rectal induction of anaesthesia in children with 1%- or 5%-methohexitone-solutions and dosages of 5, 10, 15, 20 and 25 mg/kg body wt. were obtained in 10 groups of 20 children. Methohexitone and hydroxy-methohexitone serum-levels were compared in another 23 children after application of 1%- or 5%-methohexitone-solutions at dosages of 15 and 20 mg/kg body wt.

[Intragastric pH increase using antacids or secretin for stress ulcer prevention in surgical risk patients].

The efficacy of an antacid or synthetic secretion on elevations in intragastral pH above 4 was tested in a controlled prospective study. 21 surgical high risk patients received an antacid, and 17 secretin. Antacid prophylaxis resulted in a significantly higher intragastral pH than with secretin.

pH-control via secretin or antacid: prophylaxia of stress ulcers in high-risk surgical patients.

The efficacy of an antacid or synthetic secretin in elevating the intragastric pH above 4 was tested in a controlled, prospective study. Twenty-one high-risk surgical patients received an antacid and 17 secretin. Antacid prophylaxis resulted in a significantly higher intragastric pH than with secretin.

[Cimetidine with suture ligature of ulcers - an alternative in the treatment of severe acute gastroduodenal ulcer hemorrhage].

The results of SPV with suture ligation of the ulcer (n = 60), suture ligation combined with postoperative Cimetidine medication (n = 20) and suture ligation alone (n = 20) for severely bleeding gastroduodenal ulcers were studied retrospectively and compared. No significant difference could be found between suture ligations of the ulcer combined with SPV or Cimetidine concerning recurrent bleeding and specific or overall mortality. Their rate were highest after suture ligation alone as well in bleeding duodenal ulcers as in gastric ulcers.

[Differential peridural analgesia for vaginal delivery. A randomised study of its influence on the progress and mode of delivery (author's transl)].

This randomised study of 611 deliveries deals with the side effects of a modified extradural analgesic technique. The modification is based on a flexible reduction of local anaesthetic concentration (bupivacaine) which allows a reliable analgesia without a marked loss of labour sensation and bearing down reflex. Randomisation was achieved by offering this analgesia to the parturients in an alternating 24 hours rhythm.

Hexobarbitone disposition at different stages of intensive care treatment.

The pharmacokinetics of hexobarbitone were investigated in 22 patients in an intensive care unit. The results were compared with those obtained in a healthy group for three time periods: 3rd or 4th day (I), 5-8th days (II) and 13-29th days (III) of treatment. Hexobarbitone 7.

Verapamil disposition in liver disease and intensive-care patients: kinetics, clearance, and apparent blood flow relationships.

Verapamil kinetics have been determined in liver disease (mainly in cirrhotic patients), in intensive-care patients, and in healthy control subjects. Areas under the concentration-time curves (AUCs) after intravenous 5-mg and oral 80-mg doses were used to calculate systemic blood clearance, intrinsic blood clearance, and bioavailability of verapamil in patients and to calculate apparent hepatic blood flow. Intravenous data showed that verapamil clearance was reduced in all patients with liver disease (mean = -66%), but intensive-care patients were a more heterogenous group in which some patients had increases (five patients; mean = +72%) and others had decreases (two patients; mean = 6-57%) in verapamil clearance.

Current knowledge on pharmacokinetics of halothane and enflurane.

Blood solubilities of halothane and enflurane are in a favourable range and differ only for 21%. There are some pharmacokinetical advantages to enflurane compared to halothane, but more because of its lower tissue/blood partition coefficient than due to the difference in blood solubility. The differences in physical behaviour are of more practical significance during recovery than during induction.

[Plasma concentrations of digoxin in patients under intensive care conditions and in patients undergoing anesthesia and operation (author' transl)].

Pharmacokinetic behavior of digoxin or beta-acetyldigoxin was examined in 66 patients (27 patiets under intensive care conditions, partially with controlled breathing, 22 patients undergoing extirpation of the uterus and 17 patients treated with radium or chemotherapeutics; 19 males and 47 females) by determining plasma concentrations of digoxin (PDC). After intravenous and oral application with a maintenance dose of 0.20--0.

[Hydroxy-ethyl-starch as plasma substitute in transurethral prostatectomy with the "cold-punch" method (author's transl)].

Each of 24 patients undergoing transurethral prostatectomy under spinal anaesthesia received 1000 ml HES and, depending from the clinical situation, some patients received blood-transfusion. Afterwards two groups were formed: group A (11 patients), who received HES only, and group B (13 Patients) with additional blood-transfusions. The following parameters were monitored simultaneously: blood pressure, heart rate, stroke index, cardiac output, active blood volume, hemoglobin and hematocrit in whole blood as well as in the irrigatin fluid of the bladder.

[Plasma renin activity and plasma aldosterone during anaesthesia and operative stress and beta-adrenergic blockade (author's transl)].

In 21 patients undergoing ear operations associated with minimal bleeding plasma renin activity and plasma aldosterone concentration were studied before and during surgical procedure, and in the postoperative state. Studies were performed in two groups, one without (n=9) and one with beta-adrenergic blockade by Practolol (n=12). Plasma renin activity increased significantly during halothane anaesthesia alone whereas the surgical manipulations did not further influence mean values significantly.

[The biotransformation of inhalation anaesthetics and its relevance to clinical side effects (author's transl)].

The volatile anesthetics are not inert substances, but they are metabolised by means of a non-specific drug metabolizing enzyme system of the liver. Thus, in combined administration of several drugs, the knowledge of the metabolic pathways and the influence of the anesthetics on the transforming system is not only theoretically important, but represents a conditio sine qua non to the anesthesist as regards the handling of modern anesthetics. The occasionally observed liver and kidney injuries indicate a potential formation of toxic metabolites.