Biomedical subjects

D Braby

Publications and source records attributed to D Braby.

3 recordsLinked to original sources

PubMed1996

Transesophageal atrial pacing in anesthetized patients with coronary artery disease. Hemodynamic benefits versus risk of myocardial ischemia.

BACKGROUND: Transesophageal atrial pacing (TEAP) provides prompt and precise control of heart rate and improves hemodynamics in anesthetized patients with bradycardia and hypotension. The authors' purpose in this study was to examine the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in patients about to undergo coronary artery bypass surgery. METHODS: Hemodynamics, ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-systolic, and fractional area change of the left ventricle, determined by transesophageal echocardiography (TEE), were measured after anesthesia induction with 30 micrograms/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90 beats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was accomplished with 12-lead electrocardiograms and biplane TEE assessment of left ventricular regional wall motion. Hemodynamics, electrocardiograms, and TEE measurements at each TEAP rate were compared with baseline awake measurements (except TEE) and with measurements obtained after anesthesia induction before TEAP. RESULTS: Sinus bradycardia occurred in 15 patients after anesthesia induction and was associated with a hypotensive response and a decrease in cardiac output in 10 patients. In these patients, TEAP restored diastolic blood pressure and cardiac output to baseline values at TEAP rates of 65 and 80 bpm, respectively. Stroke volume was similar to baseline measurements after anesthesia induction and at TEAP rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90 bpm. Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and 90 bpm, respectively. CONCLUSIONS: Control of heart rate with TEAP restores intraoperative hemodynamics to baseline in patients in whom bradycardia and a hypotensive response develop before coronary artery bypass surgery. When using TEAP for patients with severe coronary artery disease, these results support using the lowest TEAP rate titrated to achieve optimal hemodynamics, while closely monitoring for myocardial ischemia, especially at TEAP rates > 80 bpm.

Adult↗

PubMed1994

Sinonasal polyposis: investigation by direct coronal CT.

To demonstrate the typical clinical and CT features of sinonasal polyposis, we reviewed the clinical records and preoperative direct coronal CT scans of 35 patients with surgically proven disease. Symptoms included progressive nasal stuffiness (100%), rhinorrhea (69%), facial pain (60%), headache (43%) and anosmia (17%). We found associations with rhinitis (46%), asthma (29%) and aspirin sensitivity (9%). Coronal CT features included polypoid masses in the nasal cavity (91%), partial or complete pansinus opacification (90%), enlargement of infundibula (89%), bony attenuation of the ethmoid trabeculae (63%) and nasal septum (37%), opacified ethmoid sinuses with convex lateral walls (51%) and air-fluid levels (43%). The latter feature correlated with symptoms and signs of acute sinusitis in only 40% of patients. Recognition of sinonasal polyposis is important to the endoscopic surgeon since it can be the most troubling sinonasal inflammatory disease to manage due to its aggressive nature and tendency to recur despite appropriate treatment.

Diagnosis, Differential↗

PubMed1991

Sinonasal polyposis.

The SSCT findings of the SNP pattern are nearly diagnostic for this entity. SNP is characterized by the major findings of nasal polypoid masses and infundibular enlargement. Patients may also show individual sinus involvement with polypoid masses and/or opacification of the paranasal sinuses without visualization of polypoid masses. The presence of polypoid masses within the sinuses also can be inferred if the major findings are present, especially if there are the minor findings of nasal septal and sinus trabeculae attenuation and bulging of the lateral ethmoid sinus walls. Air/fluid levels are frequent in SNP but do not always indicate acute sinusitis. Patients typically present with nasal stuffiness and rhinorrhea. They often have facial pain and less often headaches. Common associations exist between SNP and atopy (either allergic or nonallergic), asthma, infection, cystic fibrosis, and aspirin intolerance. Therapy may be either medical or surgical, with steroids being the mainstay of the medical treatment. FESS provides a relatively atraumatic means of removing polyps and creating better sinus drainage. Regardless of the type of therapy, recurrences are common, requiring repeated bursts of systemic steroids, nasal steroid maintenance, and frequent additional surgical procedures. Identification of the SNP pattern on SSCT helps the otolaryngologist to institute an appropriate therapy aimed at alleviating symptoms. The SSCT is adequate for evaluation of SNP in the vast majority of cases and serves as a detailed road map for the treating endoscopic surgeon.

Acute Disease↗