Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 1998
The end-systolic pressure-volume relationship and ventriculoarterial coupling in patients undergoing coronary artery bypass graft surgery.
The end-systolic pressure-volume relationship and analysis of ventriculoarterial coupling have been established as a useful tool to determine the left ventricular performance and arterial loading conditions. The purpose of this study was to evaluate the end-systolic pressure-volume relationship and ventriculoarterial coupling in anesthetized patients with either a normal heart or coronary artery disease (CAD) using a transesophageal echocardiography (TEE) monitor. ⋯ We found that patients with CAD and a normal LVEF had a physiological Ea/Ees identical to the control subjects. We also demonstrated that patients with CAD and a reduced LVEF showed a deterioration in Ea/Ees.
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Acta Anaesthesiol Scand · Mar 1998
Plasma levels of clonidine following epidural bolus injection in children.
The use of clonidine as an adjunct to epidural administration of local anesthetics in children has been reported to substantially improve the duration and quality of postoperative analgesia. The aims of the present study were to determine the pharmacokinetic profile and to investigate the interaction between postoperative sedation and analgesia after epidurally administered clonidine in children. ⋯ The pharmacokinetic profile associated with epidural clonidine administration in children (1-9 y) was similar to that previously reported in adults. The postoperative analgesia seen after administration of epidural bupivacaine-clonidine during general anesthesia in children cannot only be explained by residual postoperative sedation.
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Acta Anaesthesiol Scand · Mar 1998
Effects of inhaled nitric oxide on platelet-activating factor-induced pulmonary hypertension in dogs.
Platelet-activating factor (PAF), a lipid mediator released during endotoxin shock, induces pulmonary hypertension, systemic hypotension and cardiac dysfunction. In this study, we compared the effect of inhaled nitric oxide (NO) on PAF-induced pulmonary hypertension and NO metabolism with that on pulmonary hypertension induced by a stable thromboxane A2 mimetic, U46619. Since PAF-induced hypotension might be mediated by NO, the effect of inhaled NO combined with an intravenously administered NO synthase inhibitor, NG-nitro-L-arginine (L-NNA), on PAF-induced hemodynamic change was also investigated. ⋯ Inhaled NO at the dose of 5-40 ppm effectively reversed PAF-induced pulmonary hypertension, especially following pretreatment with L-NNA. Inhaled NO did not affect PAF-induced hypotension or cardiac dysfunction. These findings indicate that low concentrations of inhaled NO may be useful in reversing pulmonary hypertension in the endotoxemia where PAF may be one mediator.
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Acta Anaesthesiol Scand · Mar 1998
Improved oxygenation using the prone position in patients with ARDS.
The prone position is known to increase oxygen uptake in patients with Adult Respiratory Distress Syndrome (ARDS). ⋯ The prone position together with PEEP appears to improve ventilation-perfusion matching. The prone position is simple, effective and readily available and could be used early in most patients with ARDS.
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Acta Anaesthesiol Scand · Mar 1998
Case ReportsCombined overdose with verapamil and atenolol: treatment with high doses of adrenergic agonists.
A 55-year-old man was admitted following an overdose of sustained-release verapamil (calcium channel blocker) and ordinary-release atenolol (beta-1 blocker). At admission, there was extreme bradycardia (20-25 beats min-1) and hypotension (systolic arterial pressure 40-50 mm Hg). To counteract the cardiovascular depression, prenalterol, dopamine, dobutamine, isoprenaline, adrenaline and noradrenaline were used. ⋯ The infusion of the adrenergic agonists could be interrupted on day 3. Prolonged ventilator treatment was necessary but the patient recovered without sequelae. Treatment options for similar cases are outlined.