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Biomedical subjects

C Coccia

Publications and source records attributed to C Coccia.

At least 19 recordsLinked to original sources
PubMed2001

Pediatric renal transplantation: anesthesia and perioperative complications.

The appropriate choice of anesthesia for patients (pts) undergoing renal transplantation (Ktx) requires minimal toxicity and accurate monitoring for pts at high risk for metabolic, cardiovascular, and respiratory perioperative complications. We evaluated the anesthetic management and postoperative follow-up in pediatric Ktx performed in the last 12 years in our institution. From 1988 to 1999, 75 ASA class II-III pts (45 males, 22 females) younger than 18 years scheduled for Ktx were studied: 49 received a graft from a cadaveric donor (CD) and 26 from a living donor (LD). All pts were treated with dialysis within 24 h before the procedure. Standard monitoring consisted of an electrocardiogram, central venous pressure, non-invasive arterial pressure, pulse oximetry, and inspiratory and expiratory gas analysis. If necessary, an arterial cannula and pediatric pulmonary catheter were introduced. Anesthesia was induced with sodium thiopental, propofol, halothane, or sevoflurane and maintained with isoflurane and/or fentanyl and droperidol in O2:N2O (FiO2 0.4%). As muscle relaxants atracurium or cisatracurium besilate were used, except in allergic pts, in whom vecuronium or rocuronium bromide was administered. Dopamine, 20% mannitol, and furosemide were used to increase diuresis. Continuous morphine and ketoralac infusions were used for postoperative pain relief. The surgical technique was the same in all cases. Complications and renal-function (RF) recovery were evaluated relating to CD and LD using the chi-square test; differences in mean anesthesia and surgical time were evaluated by Student's t-test; survival curves were calculated from the day of Ktx to death or last follow-up and estimated by the Kaplan-Meier method. Values of P below 0.05 were considered significant. Postoperative immunosuppressive therapy was based on cyclosporine together with other conventional drugs. Mean anesthesia time was 228 +/- 65 min. Mean kidney ischemia time for CD was 16.5 +/- 4 h. Four pts (3 CD, 1 LD) died within 72 h postoperatively: 3 due to cardiac failure and 1 to metabolic coma. Six pts showed cardiovascular and 3 had infective complications, all successfully treated. Three pts (2 CD, 1 LD) died within 2 to 12 months after, surgery; 10 (6 CD, 4 LD) had graft failure and are still alive on dialysis; 58 (38 CD, 20 LD) are alive in good health after a mean follow-up of 57.6 +/- 36.6 months (range 12-120 months). Fifteen of 26 pts younger than 12 years (21 CD and 5 LD) recovered RF intraoperatively (10 CD, 5 LD); 1 with CD and 1 with LD showed postoperative graft failure and 2 with CD died within 72 h postoperatively, 22 (18 CD and 4 LD) are alive in good health. This group showed no statistical difference compared to pts older than 12 years. Of 16 pts (15 CD and 1 LD) with body weight (BW) less than 25 kg, 6 showed intraoperative (5 CD, 1 LD) recovery of RF. The 3 deaths were all in CD pts, 2 within 72 h and one 2 months after surgery; only 1 LD had postoperative graft failure. Twelve pts (75%) (12 CD, 80%) are alive in good health. Compared to pts with BW of 25 kg or more, this group showed lower intraoperative recovery of RF (P < or = 0.05). No peri- and postoperative complications occurred in all 26 LD pts (100%). Recent advances in surgery, anesthesia, immunosuppression, and antimicrobial prophylaxis have made Ktx a more predictable procedure even in pediatric pts. For high-risk pts, mortality and morbidity can be controlled by accurate surgical, anesthetic, and postoperative management. Pts younger than 12 years and with BW less than 25 kg are more likely to develop peri- and postoperative complications.

Adolescent↗
PubMed2001

Inhaled nitric oxide administration during one-lung ventilation in patients undergoing thoracic surgery.

OBJECTIVE: To evaluate the effects of inhaled nitric oxide (iNO) on hemodynamics and oxygenation during one-lung ventilation (OLV) in the lateral decubitus position in patients undergoing elective thoracic surgery. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Thirty consecutive patients scheduled for thoracotomy. INTERVENTIONS: Anesthesia consisted of thoracic epidural analgesia combined with general anesthesia (isoflurane, fentanyl, and vecuronium bromide). Systemic and pulmonary circulations were monitored with a radial artery catheter and a pulmonary artery catheter. Inhaled NO, 40 ppm, was administered during OLV, and the inhaled gas mixture was monitored for NO and nitrogen dioxide (NO2). Hemodynamic and oxygenation data were collected before and during inhaled NO administration. MEASUREMENTS AND MAIN RESULTS: Inhaled NO caused a reduction of pulmonary vascular resistance index from 249 +/- 97.6 dyne. sec. cm(-5) to 199.3 +/- 68.9 dyne. sec. cm(-5) (p < 0.05), without effects on systemic hemodynamics or impairment of oxygenation. A stratification of the patients according to values of QS/QT (< 30%, 30% to 44%, > or = 45%), PaO(2)/fraction of inspired oxygen (> or = 200, 100 to 199, < 100), and pulmonary hypertension (mean pulmonary arterial pressure < 24 or > or = 24 mmHg) showed that inhaled NO causes a significant reduction of mean pulmonary artery pressure in patients with pulmonary hypertension, mainly as a result of a reduction of pulmonary vascular resistance index, and improves oxygenation by reducing intrapulmonary shunt in patients with severe hypoxemia during OLV. CONCLUSIONS: Inhaled NO administration neither significantly decreased mean pulmonary arterial pressure in patients with normal pulmonary artery pressure nor improved oxygenation in nonhypoxic patients. Nevertheless, inhaled NO is effective in patients with pulmonary hypertension and hypoxemia during OLV.

Aged↗
PubMed2001

Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled aerosolized prostacyclin.

OBJECTIVE: To evaluate hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide (iNO) and inhaled aerosolized prostcyclin (IAP) during lung transplantation. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Ten patients scheduled for lung transplantation. INTERVENTIONS: Ten patients, with a mean age of 38 years (range, 24 to 56 years), were scheduled for lung transplantation (2 single-lung transplantations and 8 double-lung transplantations). During first lung implantation with single-lung perfusion and ventilation, hemodynamic and oxygenation data were analyzed in 3 phases: (1) baseline, 5 minutes after pulmonary artery clamping; (2) inhaled NO phase, 15 minutes after inhaled NO administration (20 ppm) in 100% oxygen; and (3) IAP-inhaled NO phase, 15 minutes after combined administration of inhaled NO (20 ppm) and IAP (10 ng/kg/min) in 100% oxygen. MEASUREMENTS AND MAIN RESULTS: During the inhaled NO phase, reductions of mean pulmonary arterial pressure (p < 0.05) and intrapulmonary shunt (p < 0.05) were noted. After the start of prostacyclin inhalation, a further decrease in mean pulmonary arterial pressure (p < 0.05) was observed. PaO2/FIO2 increased during the IAP-inhaled NO phase (p < 0.05), whereas intrapulmonary shunt decreased (p < 0.05). CONCLUSION: This study confirms the action of inhaled NO as a selective pulmonary vasodilator during lung transplantation. Combined therapy with IAP and inhaled NO increases the effects on pulmonary arterial pressure and oxygenation compared with inhaled NO administered alone without any systemic changes.

Administration, Inhalation↗
PubMed2001

[Anesthesia for lung volume reduction surgery].

BACKGROUND: Lung volume reduction surgery (LVRS) has become a novel palliative procedure for a subgroup of patients with advanced non-bullous emphysema. METHODS: Seventy-six patients with severe emphysema were evaluated: ten patients were considered for lung transplantation and only 24 underwent LVRS. In all patients an epidural catheter was inserted between the T5-T9 space. During one lung ventilation (OLV), ventilatory setting was adjusted to avoid air trapping and/or dynamic hyperinflation and high frequency jet ventilation was used when PaO2/ FiO2 was lower than 60 mmHg in 5 patients. Permissive hypercapnia (PaCO2=53 mmHg) was allowed to avoid hyperinflation and reach hemodynamic stability. RESULTS: During OLV PaO2/FiO2 was 148+/-80 mmHg, PaCO2 53+/-11 mmHg, mPA 27+/-2 mmHg and Qsp/Qt was 38+/-6%. Although the high risk patients, there were no complications due to hypercapnia during surgery. Twenty-three patients were extubated successfully at the end of the surgery (PaO2/FiO2 179+/-34 mmHg and PaCO2 59+/-11 mmHg) and only one patient was not extubated because of air leakage and died for postoperative respiratory failure after 20 days. Another patient died because of sepsis after 15 days. Numeric Ordinal Verbal Scale (by Keele modified) was used for postoperative pain degree at 0, 12th and 24th hours. No patients had pain>2. CONCLUSIONS: In conclusion, a careful anesthesia technique with an accurate intraop monitoring associated with thoracic epidural analgesia even in Video Assisted Thoracic Surgery is suggested in LVRS patients; 12 months postoperative data confirm the validity of the procedure (FEV1 24 AE 36%, FVC 53 AE 70%, RV 265 AE 199% and 6MWT 213 AE 330 m).

Adult↗
PubMed2000

TGFbeta trophic factors differentially modulate motor axon outgrowth and protection from excitotoxicity.

Transforming growth factor (TGF) beta-like trophic factors have been shown to be protective in acute neuronal injury paradigms. In the current study, we analyzed and compared members of this growing family, including glial cell line-derived neurotrophic factor (GDNF), neurturin, nodal, persephin, and TGFbeta1, for protection against chronic glutamate toxicity. In parallel, we developed a organotypic spinal cord culture system to study the ability of these factors to promote motor axon outgrowth across white matter. Using these systems, we were able to differentiate the neuroprotective effect of the TGFbeta-like factors from their motor axon outgrowth-promoting activity. GDNF, neurturin, persephin, nodal, and TGFbeta1 all protected against excitotoxic motor neuron degeneration. Low amounts of GDNF (1 ng/ml) and high concentrations of neurturin induced vigorous motor axon outgrowth. In contrast, nodal, persephin, and TGFbeta1 did not induce motor axon outgrowth. Both GDNF and neurturin bind to Ret receptor complexes and were capable of activating the MAP kinase pathway. A specific inhibitor of MAP kinase kinase, PD98059, inhibited the motor axon outgrowth-promoting activity of the GDNF but not the neuroprotective activity. Similarly, the specific PI3K inhibitors, LY294002 and wortmannin, were able to inhibit the promotion of motor axon outgrowth by GDNF, but did not affect neuroprotective activity. Our results suggest that the neurite outgrowth-promoting effect of GDNF is mediated through the PI3K and MAP kinase pathways. The neuroprotective effect of GDNF appears to be through a separate pathway.

Androstadienes↗
PubMed2000

[Anesthesia in single and bilateral sequential lung transplantation. Lung Transplantation Group].

BACKGROUND: Anesthesia for lung transplantation: intraoperative complications and long term results. METHODS: 52 patients were scheduled for 16 single lung transplantations (SLT) (9 fibrosis and 7 emphysema) and 36 bilateral sequential lung transplantations (DLT) (4 bronchiectasis, 6 emphysema, 3 fibrosis, 22 cystic fibrosis and 1 pulmonary hypertension). Anesthesia was induced with propofol or midazolam, and fentanyl or alfentanil. As muscle relaxant vecuronium bromide was used. Anesthesia was maintained with isoflurane, fentanyl in boluses or sufentanil continuous infusion in O2 100%. Prostaglandin E1 (20-300 ng/kg/min), inhaled nitric oxide (10-40 ppm), dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-3 mcg/kg/min) and ephedrine (5-10 mg per bolus) were used for hemodynamic management. In 2 patients inhaled areosolized prostacyclin were administered. RESULTS: Mean pulmonary arterial pressure (mPA) and pulmonary vascular resistance (PVRI) increased after pulmonary artery clamping during first lung (mPA: 3347 nel DLT, 3643 nel SLT; PVRI; 375488 nel DLT, 377420 nel SLT) and second lung implantation (mPA: 3746; PVRI: 263553) and decreased after reperfusion of the first (mPA: 4737 nel DLT, 4329 nel SLT; PVRI: 488263 nel DLT, 420233 nel SLT) and the second lung (mPA: 4629; PVRI: 553260). Only in 9 cases (7 DLT and 2 SLT) C-P bypass was used. CONCLUSIONS: With a strong drug support with pulmonary vasodilators, positive inotropic and systemic vasoconstrictor drugs, in most patients we transplanted C-P bypass can be avoided. Intraoperative deaths were not observed. Two years actuarial survival is 65% for DLT and 60% for SLT.

Adolescent↗
PubMed1999

Preimplantation retrograde pneumoplegia in clinical lung transplantation.

OBJECTIVE: Retrograde pneumoplegia seems to improve early graft function in experimental and clinical lung transplantation. We evaluated the role of retrograde flushing in addition to antegrade pneumoplegia in clinical lung transplantation. METHODS: Fourteen patients undergoing lung transplantation were randomized into 2 groups: in group I we performed antegrade pulmonary artery flushing with alprostadil (prostaglandin E1) and modified Euro-Collins solution at the time of retrieval. In group II additional retrograde flushing through the pulmonary veins was performed at the back table, before reimplantation. Hemodynamic variables, mean airway pressure, and blood gas analysis were monitored at different time points. Postoperative volumetric monitoring was performed to assess extravascular lung water. The reimplantation response was assessed by a radiographic score; extubation time and intensive care unit stay were recorded. RESULTS: During retrograde flushing, blood and clots coming out from the pulmonary artery were observed; 2 lungs harvested from a donor with multiple bone fractures had fat emboli in the retrograde perfusate. Hemodynamic monitoring did not demonstrate any difference between the 2 groups. The ratio of arterial oxygen tension to inspired oxygen fraction, extravascular lung water, duration of intubation, and length of stay in the intensive care unit were improved in group II, but the differences did not reach statistical significance. Intrapulmonary shunt fraction was significantly improved in group II at each time point ( P =.02), as well as indexed alveolar-arterial oxygen tension gradient (P =.04), mean airway pressure (P =.04), and chest x-ray score ( P =.03). CONCLUSIONS: Preimplantation retrograde flushing is not detrimental and helps to improve early graft function.

Adult↗
PubMed1999

[Hemodynamic changes during continuous infusion with dobutamine in candidates for lung transplantation. Lung Transplantation Group].

BACKGROUND: The aim of this study is to analyze the effects of dobutamine (DBT) on pulmonary and systemic hemodynamics and oxygenation in lung transplant candidates. METHODS: Forty-five patients (21M, 24F) to be introduced in waiting list for lung transplantation were studied (14 pulmonary fibrosis, 15 COPD, and 16 cystic fibrosis). They were studied awake, while spontaneously breathing in two different phases: baseline--O2 100%; DBT phase--O2 100% after 10 minutes of DBT continuous infusion (10 mcg/Kg/min). Blood gas samples and hemodynamic data were collected during right heart catheterization. Data were statistically analyzed with Student's "t" test and values for p < 0.05 were considered as significant. RESULTS: During DBT phase, a significant increase of cardiac output with a decreasing in systemic and pulmonary vascular resistance was observed. Since the fall in pulmonary vascular resistance (PVRI) was not proportional to the increase of cardiac output, mean pulmonary artery pressure and transpulmonary gradient increased. The prevalent role of vascular recruitment as mechanism in PVRI reduction during DBT is supported by the concomitant fall in PaO2/FiO2. This strongly suggests a worsening of regional Va/Qc due to an increased perfusion of poorly ventilated areas. CONCLUSIONS: DBT reduces PVRI through a recruitment of vessels due to an increase of pulmonary flow. Dobutamine has a favorable hemodynamic effect in mild-to-moderate pulmonary hypertension in lung transplant candidates.

Adult↗
PubMed1998

Inhaled nitric oxide in patients with cystic fibrosis during preoperative evaluation and during anaesthesia for lung transplantation.

INTRODUCTION: Inhaled nitric oxide (iNO) has been recently used as pulmonary vasodilator without any systemic effects because of a rapid inactivation by haemoglobin. We studied haemodynamic and oxygenation effects during iNO administration in cystic fibrotic patients during preoperative evaluation and during anaesthesia for lung transplantation. METHODS: From March 1996 to November 1997, 35 patients received iNO (40 ppm) during preoperative evaluation in spontaneously breathing. 13 patients, who underwent double lung transplantation, received iNO (40 ppm) during the surgical procedures, after pulmonary artery clamping. RESULTS: In the preoperative evaluation a significant decrease of mean pulmonary artery pressure, pulmonary vascular resistance index and intrapulmonary shunt, with an increase of PaO2/FiO2, were observed during iNO administration, compared to baseline in 100% O2. During lung transplantation a significant decrease in intrapulmonary shunt was noted. All the transplants were successfully performed without cardio-pulmonary bypass. In all procedures, after iNO administration, we observed no modification of systemic haemodynamics. In conclusion, our study confirms the pulmonary effects of iNO without any systemic effects in patients affected by cystic fibrosis during preoperative evaluation and during anaesthesia for lung transplantation.

Administration, Inhalation↗
PubMed1998

Anaesthesia for liver transplantation in cystic fibrosis patients.

INTRODUCTION: Cystic fibrosis (CF) is a disease caused by an inherited genetic defect. While pulmonary and pancreatic abnormalities predominate the clinical spectrum, other organ involvement is common, including liver. The severity of liver disease does not appear to be related to the severity of exocrine pancreatic or lung function. We discuss anaesthesia in four CF patients undergoing liver transplantation. METHODS: We studied haemodynamic and oxygenation modifications during anaesthesia in four patients affected by CF with end-stage liver disease and mild to moderate pulmonary abnormalities. The patients received pancreatic enzyme prior to transplantation and two had insulin-dependent diabetes mellitus. All patients were treated with broad-spectrum antibiotic therapy. After a waiting time ranging one week to three months, all patients were successfully transplanted. General anaesthesia was induced with fentanyl, thiopental and pancuronium, and maintained with isoflurane supplemented by fentanyl in O2:air. Haemodynamic and oxygenation evaluations were made during the main phases of the transplant. After the intubation and at the end of the procedure all patients received a broncho-alveolar toilet through fiberoptic bronchoscopy. RESULTS: During anaesthesia for liver transplantation, PaO2 increased proportionally to the decreasing of Qs/Qt. In postoperative follow-up, Fev1 and FVC improved from preoperative time in all patients. In conclusion, even if cystic fibrosis is a multisystem disease, liver transplantation can be offered to CF patients with endstage liver disease and mild to moderate pulmonary function abnormalities. The four patients are still alive, enjoying good health. The improved respiratory function and quality of life of these children is remarkable.

Adolescent↗
PubMed1998

Inhaled nitric oxide during anesthesia for bilateral single lung transplantation. Case report.

Recently inhaled nitric oxide (iNO) has been used as pulmonary vasodilator without any effect on systemic hemodynamics. iNO has been also used in cardiac and thoracic surgery, involving lung transplantation. In this case report a patient, 41 years old female, affected by bronchiectasis, underwent bilateral sequential single lung transplantation and during one lung ventilation and pulmonary artery clamped iNO allowed to avoid cardiopulmonary bypass and to carry out the procedure successfully.

Adult↗
PubMed1998

Avoiding a "toxic" organization.

While there is certainly no perfect organization, some are more suited to one's personality traits than others. Taking the time to examine as many aspects of the organization as needed helps secure insight into the personality that dominates the organization. It can make the difference between an unhappy experience or a comfortable fit.

Humans↗
PubMed1996

Hemodynamic and metabolic effects of transjugular intrahepatic portosystemic shunt (TIPS) during anesthesia for orthotopic liver transplantation.

Recently, the transjugular intrahepatic portosystemic shunt (TIPS) has been advocated as a safe bridge to orthotopic liver transplantation (OLT). We retrospectively studied 53 consecutive cirrhotic patients who underwent OLT: 27 patients with TIPS were compared to 26 controls. Hemodynamic and oxyphoretic data (Fick method) were collected during six phases of OLT. There were no significant differences in demographic data and Child-Pugh class, nor in surgical time and blood product requirements before the anhepatic phase between TIPS patients and controls. In the TIPS group, we observed a marked hyperdynamic profile with a lower systemic vascular resistance index, higher cardiac index, and depressed oxygen consumption before native liver removal. During the same period, the TIPS group developed a greater acidosis and was treated with a larger amount of NaHCO3. Following the anhepatic phase, no differences between the two groups were detected. All transplantations were successful, and no complications related to TIPS were observed. These results seem to be the consequence of a reduced liver function reserve with a direct hemodynamic effect due to the TIPS.

Acidosis↗
PubMed1995

[Anesthesia in experimental single-lung transplantation: hemodynamic and respiratory changes during prostaglandin E1 and nitroglycerin infusion].

INTRODUCTION: The haemodynamic and oxyforetic modifications induced by continuous infusion (c.i.) of Prostaglandin E1 (PGE1) and Nitroglycerin (NG) during experimental lung transplantation have been studied. METHODS: Twenty lung transplants have been performed on pigs (Landrace). Haemodynamic monitoring consisted of ECG, femoral cannulation for arterial pressure and Swan Ganz catheter. Continuous infusion of drugs started during pneumonectomy. Data have been collected in phase 1: after the induction of anaesthesia; in phase 2: 30 min after the start of pulmonary vasodilation in one lung ventilation with left pulmonary artery clamped; in phase 3: 30 min after lung revascularization; in phase 4: at the end of the surgery. The animals have been divided in two groups. Group A consisted of 10 cases treated with 50 ng/kg/min in phase 2 and 25 ng/kg/min in phase 3 and 4 of PGE1; group B consisted of 10 cases treated with 1 ncg/kg/min in phase 2 and 0.5 ncg/kg/min in phase 3 and 4 of NG. RESULTS: In phase 2 and 4 PA, RVSWI, PRVI increased in group B more than in group A (p < 0.05); in phase 3 PA, PAWP increased in group B more than in group A (p < 0.05). DISCUSSION: In our experience PGE1 has shown to be a stronger pulmonary vasodilator than NG. PGE1 can be considered the drug of choice for pulmonary vasodilation in experimental single lung transplantation, even if more investigations are needed for reaching the real goal of this procedure.

Alprostadil↗
PubMed1992

Management of extremely low-birth-weight infants.

Better health care of women during pregnancy and delivery, improvement in neonatal intensive therapy and technology have led to a decrease in neonatal mortality and morbidity and to lower limits of birth weight and gestational age for survival. This paper refers to the management protocol used in the Department of Perinatal Pathology of the Provincial Maternity Hospital of Milan for extremely low-birth-weight (ELBW) infants (birth weight < 1000 g). In this hospital, all newborn infants presenting evidence of life, irrespective of birth weight and gestational age, are resuscitated and transferred to the Neonatal Intensive Care Unit (NICU) for clinical management. After the introduction of this protocol the mortality rate of ELBW infants dropped from 71.4% in 1977-78 to 48% in 1987-88. In a group of 72 ELBW infants with a mean birth weight of 850 g and a mean gestational age of 27 weeks, 80% presented a normal outcome, 12% presented a mild neurological impairment and 8% were affected by severe cerebral palsy at the age of two years. The intact survival of a newborn infant of 450 g at birth is also reported.

Clinical Protocols↗