Vergleichende Untersuchungen Über Blutspiegel Von Mepivagain Nach Resorption Aus Verschiedenen Geweben

Matthes, H; Schabert, P

doi:10.1111/j.1399-6576.1966.tb01035.x

Cited by 6 publications

(7 citation statements)

References 4 publications

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“…Estimates vary widely, but indicate that with higher epidural doses, peak concentrations may be reduced on average by 30 to 40% with lignocaine and prilocaine, and 20 to 30% with mepivacaine, bupivacaine and etidocaine (Abdel-Salam et al 1975;Appleyard et al 1974;Braid & Scott 1965Bridenbaugh et al 1974;Burm et al 1986;Laishley et al 1988;Lund & Cwik 1966;Lund et al 1975;Mather et al I 976a;Matthes & Schabert 1966;Scott et al 1972;Tucker et al 1972;Wilkinson & Lund 1970). The increased effect with the shorter-acting agents is consistent with the greater prolongation of the duration of blockade, and is often attributed to a less extensive uptake into local tissues.…”

Section: Additivesmentioning

confidence: 97%

Clinical Pharmacokinetics of Epidural and Spinal Anaesthesia

Burm

1989

Clinical Pharmacokinetics

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Epidural and spinal anaesthesia results from the interaction of local anaesthetics with nerve structures, primarily those located within the subarachnoid space. Local anaesthetics can reach the sites of action along various distribution pathways. Uptake into extraneural tissues (in particular epidural fat) and systemic absorption compete with neural tissue distribution and thereby affect the clinical potency and duration of action. Consequently, epidural doses must be much higher than spinal doses. The systemic absorption of lignocaine (lidocaine), bupivacaine and etidocaine following lumbar epidural administration has been shown to be biphasic, with a rapid initial absorption phase followed by a much slower absorption phase. Initial absorption rates of lignocaine and bupivacaine following subarachnoid injection are much slower, but the late absorption rates are similar to those after epidural administration. The tissue distribution characteristics of various amide-type agents are similar, because more extensive plasma binding offsets the greater tissue affinity of the more lipophilic compounds bupivacaine and etidocaine. The amide-type agents are predominantly eliminated by hepatic metabolism, except prilocaine, which is also metabolised elsewhere in the body. Ester-type agents are rapidly hydrolysed in blood and liver and are eliminated much faster than amide-type agents. The blood concentrations attained depend primarily upon the dose administered. The addition of adrenaline (epinephrine) reduces the peak plasma drug concentrations; similarly, the age of the patient, disease states and drug interactions may alter the pharmacokinetics to various extents. Because of the low dose requirements, systemic toxicity is not a problem during spinal anaesthesia. During epidural anaesthesia, however, the safety margin is relatively small, and systemic toxicity is very likely to occur after inadvertent intravascular injection of an epidural dose.

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Section: Additivesmentioning

confidence: 97%

Clinical Pharmacokinetics of Epidural and Spinal Anaesthesia

Burm

1989

Clinical Pharmacokinetics

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“…1.18 pg . ml-') measured in the volunteer group, were as high as or higher than those previously recorded during extradural analgesia (8,9). SCR readings were reduced to approximately 20% of the control values after starting the infusion of saline, mepivacaine and bupivacaine.…”

Section: The Infusion Studymentioning

confidence: 46%

“…Mean plasma concentrations of local anaesthetics a t the end of the mepivacaine and bupivacaine infusions were somewhat higher in the mepivacaine group and about three times higher in the bupivacaine group than those usually seen during extensive extradural analgesia (8,9). These plasma levels can hardly have stimulated the SCR centrally since a considerable reduction in SCR was observed.…”

Section: Discussionmentioning

confidence: 84%

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Sympathetic blockade during extradural analgesia with mepivacaine or bupivacaine

Malmqvist

Bengtsson

1989

Acta Anaesthesiol Scand

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The extent of sympathetic blockade in 36 patients, who had been given extradural analgesia, was studied by means of the skin conductance response (SCR). The SCR was also studied in six healthy volunteers who received, in a cross-over fashion, infusions of physiological saline (placebo) and saline containing mepivacaine. Two more volunteers were given saline containing bupivacaine. Extradural analgesia caused a partial blockade of sympathetic activity. The higher the level of analgesia the greater the degree of inhibition of the SCR. Complete blockade of the SCR or only a weak response in the foot was obtained in the majority of cases when the level of analgesia reached a dermatome level of T4 or higher. There was no significant relationship between the degree of motor blockade of the lower extremities and the intensity of blockade of the SCR. Extradural injection of 2% mepivacaine had a greater effect on the SCR than did 0.5% bupivacaine. There was no indication that infusion of mepivacaine or bupivacaine in volunteers, whose blood levels were as high as or higher than those likely to be produced during extradural analgesia, affected the SCR.

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“…for 10 minutes before obtaining the first sign of toxic reactions and the same dose for 20 minutes before obtaining marked signs of toxic reactions. The blood concentration was far higher than whatis found in clinical anaesthesia ( DHUNBR 1964, D H U N~R et al 1965and MATTHES and SCHABERT 1966.…”

Section: Preoperative Diagnosesmentioning

confidence: 66%

Frequency of General Side Reactions after Regional Anaesthesia with Mepivacaine with and without Vasoconstrictors

Dhunèr

1972

Acta Anaesthesiol Scand

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SUMMARY 30,885 regional anaesthesias have been performed with mepivacaine without vasocon strictor or with addition of adrenaline or noradrenaline. Of these 5,282 were brachial plexus blocks, 1,616 axillary blocks, 1,333 sciatic and femoral blocks and 2,435 caudal blocks. Systemic reactions were observed 74 times. Many of these were observed after relatively small doses and the frequency was not markedly changed when large doses had been used. The admixture of vasoconstrictors to the mepivacaine did not decrease the rate of systemic reactions. Some of these reactions could be attributed to the vasocon strictor. Effects on blood pressure and pulse rate have been studied in several types of blocks. In brachial plexus blocks and axillary blocks adrenaline caused higher frequency of patients with tachycardia. No marked changes of the blood pressure were observed. Noradrenaline caused higher frequency of patients with blood pressure rise, while effects on pulse rate were not very marked. In caudal blocks adrenaline and noradrenaline caused the same reactions with one exception; adrenaline caused a marked increase of the blood pressure. Special studies of part of the material did not reveal the presence of late toxic reactions. ZUSAMMENFASSUNG 30,885 Regional‐Anästhesien wurden mit Mepivacaine ohne Vasokonstriktor oder Zusatz von Adrenalin oder Noradrenalin durchgeführt, wovon 5,282 Brachialplexus‐Blockaden, 1,616 Axillar‐Blockaden, 1,333 Nervus ischiadikus‐ und Memoralis‐Blockaden und 2,435 Kaudal‐Blockaden. 74 mal wurden Reaktionen des Körpersystems beobachtet. Davon wurden viele nach relativ geringen Dosen bemerkt. Die Frequenz war nicht markant verändert, wenn grosse Dosen gegeben wurden. Die Beimischung von Vasokonstriktoren zu Mepivacaine führte nicht zu einer Senkung des Grades der Reaktionen des Körpersystems. Einige der Reaktionen könnten dem Vasokonstriktor zugeschrieben werden. Die Wirkungen auf den Blutdruck und auf den Pulsschlag wurden bei verschiedenen Typen von Blockaden untersucht. Bei Brachialplexus‐Blockaden und Axillar‐Blockaden ergab Adrenalin eine höhere Frequenz von Patienten mit Tachykardie. Keine besonderen Veränderungen des Blutdrucks wurden beobachtet. Noradrenalin ergab eine höhere Frequenz von Patienten mit erhöhten Blutdruck während die Wirkungen auf den Pulsschlag nicht markant waren. Bei Kaudal‐Blockaden ergaben Adrenalin und Noradrenalin die gleichen Reaktionen, mit einer Ausnahme; Adrenalin verursachte eine markante Erhöhung des Blutdrucks. Spätere Studien von Teilen des Untersu‐chungsmaterials zeigten keinerlei Erscheinungen von nachträglichen toxischen Reaktionen.

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Vergleichende Untersuchungen Über Blutspiegel Von Mepivagain Nach Resorption Aus Verschiedenen Geweben

Cited by 6 publications

References 4 publications

Clinical Pharmacokinetics of Epidural and Spinal Anaesthesia

Clinical Pharmacokinetics of Epidural and Spinal Anaesthesia

Sympathetic blockade during extradural analgesia with mepivacaine or bupivacaine

Frequency of General Side Reactions after Regional Anaesthesia with Mepivacaine with and without Vasoconstrictors

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