Journal of anesthesia
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Journal of anesthesia · Jun 1994
Left ventricular diastolic filling during coronary artery bypass surgery in patients with diabetes mellitus and/or hypertension.
To evaluate left ventricular diastolic filling (DF) using transesophageal Doppler echocardiography in 40 patients with or without diabetes mellitus and/or hypertension, we measured DF after induction of anesthesia, before and after cardiopulmonary bypass (CPB), and at the end of coronary artery bypass surgery (CABS). In 13 patients with complete measurements, there was no significant change in DF but diastolic filling time became shorter and peak velocity during atrial contraction increased significantly following CPB. ⋯ When heart rate (HR) was more than 75 beats·min-1 (RR interval of less than 800 ms), the incidence of fusion points was significantly higher in patients with diabetes and/or hypertension than without (13 of 29s 1 of 9,P<0.05). It is suggested that a slower HR (less than 75 beat·min-1) is desirable in CABS patients with these disorders to avoid impairment of DF due to either prolonged systolic time or isovolumic relaxation time.
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Journal of anesthesia · Jun 1994
Effect of prostaglandin E1 on arterial ketone body ratio in hepatectomy.
We evaluated the effect of prostaglandin E1 (PGE1) administration during hepatectomy on arterial ketone body ratio (AKBR), which is an indicator of liver function, and on other liver functions in the postoperative period. Eighteen patients were divided into two groups: Continuous intravenous administration of PGE1 (0.02 μg·kg-1·h-1) was started immediately before hepatic resection and ceased at the end of operation in nine patients (PGE1 group); the other nine did not receive PGE1 (control group). ⋯ In the PGE1 group, total bilirubin and SGOT recovered more rapidly to the preoperative level than in the control group. These findings suggested that PGE1 might have a protective effect on the liver.
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Journal of anesthesia · Jun 1994
Effects of biogenic amines and intravenous anesthetics on the activity of rat locus coeruleus neurons in vitro.
To examine the effects of biogenic amines and clinically relevant concentrations of intravenous anesthetics on neuronal activities, the authors analyzed both spontaneous and evoked activities of neurons in the nucleus locus coeruleus (LC)in vitro using a single unit recording technique. Spontaneous firing was observed in 37% (14/38) of LC neurons, andN-methyl-D-aspartate (NMDA, 50 μM), glutamate (250 μM), and carbachol (1-2 mM) elicited firing in 100% (38/38), 63% (12/19), and 58% (7/12) of silent LC neurons respectively. Noradrenaline (50 μM) and serotonin (5-HT) (1-5 μM) suppressed spontaneous and drug-induced activities in 47% (15/32) and 23% (8/35) of LC neurons, respectively. ⋯ All neurons activated by NMDA (n=8) and glutamate (n-3) were suppressed by ketamine (40 μM), but fentanyl (1 μM) only suppressed 60% (3/5) of spontaneously active and 75% (3/4) of glutamate-activated neurons. Identical LC neurons were inhibited by various combinations of noradrenaline, 5-HT, pentobarbital, ketamine, and fentanyl. The results suggest that clinically relevant concentrations of anesthetics and opioids modulate the activity of LC neurons induced by biogenic amines, excitatory amino acids, and acetylcholine.
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Journal of anesthesia · Jun 1994
Effects of phenylephrine and ephedrine on pulmonary arterial pressure in patients with cervical or lumbar epidural anesthesia, or enflurane anesthesia.
The authors studied systemic and pulmonary hemodynamic changes with ephedrine (EP) or phenylephrine (PH) when used to normalize arterial hypotension resulting from acute sympathectomy due to cervical or lumbar epidural anesthesia, or enflurane anesthesia in 52 patients. Both EP (0.2±0.05 mg·kg-1) and PH (0.025±0.008 mg·kg-1) produced a significant increase in pulmonary arterial pressure (PAP) with a concomitant increase in arterial pressure (AP). In the patients anesthetized with cervical epidural block and NO2-O2, systolic PAP increased from 22±5 to 28±8 mmHg with EP and from 23±6 to 32±10 mmHg with PH in response to approximately 30 mmHg increase of AP, and the ratio of the increment of systolic PAP to systolic AP (ΔPAP/ΔAP) was 0.15±0.08 with EP and 0.20±0.13 with PH (P<0.05); these changes did not differ significantly from those observed in the patients having lumbar epidural or enflurane-N2O-O2 anesthesia. ⋯ A significant relationship between PAP and AP was found in patients given EP; the regression equation was ΔPAP=0.22×ΔAP-2.9 (r=0.77). The relationship in patients given PH was less significant (r=0.38). The results indicated that EP and PH elicit pulmonary hypertensive effect similarly in the patients with a high level of epidural anesthesia and that although both drugs act differently (EP mainly due to increases in the blood flow and PH solely due to its pulmonary vasconstrictive action), the increases in PAP were predictable, to some extent, from the increase of AP in anesthetized humans without predominant cardiopulmonary disorders.