Anesthesiology
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Clinical Trial
Transesophageal echocardiographic monitoring of preoperative acute hypervolemic hemodilution.
Preoperative acute hypervolemic hemodilution is used in anesthesia to reduce the loss of blood cells during intraoperative bleeding. Indications for use of the technique might be broadened if it can be shown to be safe in older as well as younger patients. Few data are available describing heart function in humans subjected to hypervolemic hemodilution. ⋯ The described regimen of acute hypervolemic hemodilution is well tolerated during anesthesia by patients without heart disease and does not lead to cardiac failure. It leads to an increase in stroke volume that is generated initially from an increase in end-diastolic volume, followed in many patients by a decrease in end-systolic volume, the mechanism of which is as yet unclear.
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Milrinone is a phosphodiesterase inhibitor with positive inotropic and vasodilator effects that are useful in the treatment of ventricular dysfunction after cardiac surgery. However, the pharmacokinetics of the drug have been investigated only in healthy volunteers and in patients with chronic congestive heart failure. This study investigates the pharmacokinetics of milrinone in adult cardiac surgical patients after cardiopulmonary bypass. ⋯ A milrinone dose of 50 micrograms/kg with an infusion at 0.5 micrograms.kg-1.min-1 maintains plasma concentrations at or above the threshold of therapeutic effects.
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It is well known that endotoxin causes acute lung injury resulting in adult respiratory distress syndrome. Numerous cellular and humoral factors such as macrophages, neutrophils, platelets, and inflammatory mediators (e.g., activated complements, cytokines, and arachidonic acid metabolites) are thought to play a pivotal role in the pathogenesis of endotoxin-induced lung injury. Furthermore, pulmonary edema in acute lung injury is associated with an increase in vascular permeability that may arise from a perturbation of the endothelial cell surface membrane. Lidocaine has been shown to inhibit function of these cells and stabilize cell membranes. The aim of the current study was to determine whether pretreatment with intravenous lidocaine could attenuate acute lung injury induced by endotoxin in rabbits. ⋯ These results suggest that intravenous lidocaine pretreatment has a prophylactic effect on endotoxin-induced lung injury in rabbits. However, further studies are required to investigate the therapeutic (as an early posttreatment) effect of the drug given after lung injury because rabbits in the current study received lidocaine before endotoxemia.