PubMed Health⌕ Search

Biomedical subjects

A J McLintic

Publications and source records attributed to A J McLintic.

5 recordsLinked to original sources

The effect of preoperative beta-blocker therapy on cardiovascular responses to weaning from mechanical ventilation and extubation after coronary artery bypass grafting.

The hemodynamic and electrocardiographic changes during weaning from mechanical ventilation and tracheal extubation were studied in 75 patients after elective coronary artery bypass surgery. Transfer from synchronized intermittent mandatory ventilation to spontaneous respiration through a T-piece was associated with an increase greater than 20% over baseline in systolic (SBP) and diastolic (DBP) blood pressure in 27% of patients, and in heart rate (HR) in 5% of patients. Although baseline SBP, DBP, and HR differed significantly between the patients taking chronic beta-blocker therapy and those not on beta-blockers (P values all < 0.003), there were no differences between these groups in their response to transfer to the T-piece. (P values: SBP = 0.98; DBP = 0.46; HR = 0.20). Tracheal extubation was associated with an increase greater than 20% of baseline in SBP in 18.9%, DBP in 16.2%, and HR in 5% of patients. However, there were significant differences between the chronically beta-blocked and non-beta-blocked groups, both in baseline values for SBP, DBP, and HR (P values all < 0.001), and also in the SBP response (P = 0.007) and HR response (P = 0.02) to extubation. Extubation was associated with a greater than 20% increase in SBP in 8.2% and DBP in 12.2% of chronically beta-blocked patients, compared to 40% and 23% of non-beta-blocked patients, although the DBP response was not statistically different (P = 0.14) between the groups. Similar proportions of patients in both groups increased their HR more than 20% above baseline, but the increase was much greater in the non-beta-blocked group (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

The influence of arm position and cardiac output on bolus clearance from the arm.

The importance of arm position and cardiac output on the clearance of a bolus injection from the arm was assessed in 63 patients using technetium-99m. Injections were made in the left arm which was either adducted, abducted or adducted with the forearm flexed over the lower chest. The clearance of isotope was assessed by measuring the amount of radioactivity remaining in the arm at 10 s intervals and calculating it as a fraction of the injected dose. The clearance of Tc-99m was significantly faster and more complete from the abducted arm than from the adducted arm. There was no correlation between clearance and cardiac output.

Arm↗

Electrocardiographic changes during cesarean section under regional anesthesia.

To determine electrocardiographic changes and whether myocardial ischemia occurs during cesarean section, electrocardiograms were recorded continuously using Holter monitoring in 25 patients undergoing elective cesarean section under either spinal or epidural anesthesia. In addition, in 13 of the patients, two-dimensional precordial echocardiography was carried out before and during cesarean section. ST segment depression suggestive of myocardial ischemia occurred in 16 patients including 8 of the 13 with echocardiograms. Wall motion remained entirely normal during episodes of ST segment depression. Patients in whom ST depression developed had significantly more rapid heart rates at delivery than those who did not experience ST depression. We conclude that ST segment depression is a common feature of the electrocardiogram during cesarean section under regional anesthesia and is not the result of myocardial ischemia.

Anesthesia, Conduction↗

Effect of adrenaline on extradural anaesthesia, plasma lignocaine concentrations and the feto-placental unit during elective caesarean section.

Extradural anaesthesia was induced with either 2% lignocaine or 2% lignocaine with adrenaline 1:200,000 in 20 patients undergoing elective Caesarean section. With the adrenaline-containing solution, a smaller dose of lignocaine was required to produce an adequate block and the lignocaine concentrations in both mother and neonate were significantly smaller compared with the plain solution. Arterial pressures were less in the adrenaline group, but there was no difference in umbilical flow velocity waveform, fetal heart rate or fetal outcome. Neither feto-placental circulation nor fetal outcome were affected adversely by episodes of hypotension or the ephedrine used for treatment.

Adolescent↗