PubMed Health⌕ Search

Biomedical subjects

D Mangar

Publications and source records attributed to D Mangar.

At least 37 records · Page 2Linked to original sources
PubMed1993

Unusual complication of retrograde coronary sinus perfusion with pulmonary artery catheter.

A balloon-tipped catheter placed in the coronary sinus is used during cardiac surgery for retrograde cardioplegia and is secured by a purse string suture placed proximal to the atrioventricular groove in the lower right atrium. We report a complication of this procedure where a pulmonary artery catheter was sutured to the wall of the right atrium by the purse string suture in a patient scheduled for aortocoronary bypass grafting. Pulsatile resistance was noted when we attempted to withdraw the catheter indicating an attachment to the heart. The pulmonary artery catheter within the vascular space after atrial cannulation should be checked since the sheath-protected cannula will enable free mobility.

Aged↗
PubMed1993

Hyskon-induced pulmonary edema.

Hyskon (32 percent dextran-70) (Hyskon Division, Pharmacia) is used during hysteroscopy to help visualization of the uterine surfaces. Pulmonary edema of an uncertain cause has occurred in many patients. Because this study could not be conducted in humans, we determined if Hyskon caused cardiogenic or non-cardiogenic pulmonary edema in a dog model. Dogs were randomly assigned to receive an infusion of Hyskon or whole blood to sustain left ventricular end-diastolic pressure between 20 and 23 millimeters of mercury for 60 minutes. In dogs receiving blood, there was no protein in the bronchoalveolar lavage before or after blood was given. In the Hyskon group, there was no protein in the bronchoalveolar lavage before Hyskon and 0.6 +/- 1.4 milligrams per deciliter (range of 0.1 to 3.7 milligram per deciliter) after Hyskon. The ratio of bronchoalveolar lavage protein to plasma protein after Hyskon was 8.0 +/- 18.0 percent compared with zero percent in the blood group. Hyskon altered pulmonary microvascular membrane permeability, causing alveolar flooding with plasma proteins and possibly accounting for the deterioration of oxygenation and pulmonary compliance seen in patients. These results suggest a significant noncardiogenic component of Hyskon induced pulmonary edema.

Animals↗
PubMed1993

Isoflurane and mivacurium chloride neuromuscular blockade in patients with myasthenia gravis.

The relaxograph findings are presented in two patients. In the first, isoflurane alone is administered, and mivacurium with isoflurane is administered to the second patient with myasthenia gravis. A significantly lower dose of mivacurium is required. It was noticed that the T4:T1 ratio was 100% after mivacurium and reversal agent, but T1 did not return to normal. In the patient that only received isoflurane, T1 was 60% to 70% of the baseline, indicating the neuromuscular blocking effects of isoflurane. These cases illustrate that inhalation anesthetics are adequate for muscle relaxant effects, and if neuromuscular blockers are necessary, then a lower dose of nondepolarizer should be administered, and the patient carefully monitored. Mivacurium appears to be an ideal agent for neuromuscular blockade in myasthenia gravis as long as careful neuromuscular blockade is performed.

Adult↗
PubMed1993

Intraoperative awareness and recall during total hip arthroplasty.

A case of intraoperative recall and awareness in a patient with sickle cell disease who had received midazolam, 10 mg at induction of anesthesia, is reported. The patient was on opioids which may also have caused tolerance. Although the use of midazolam may have been judged to provide adequate amnesia, this was clearly not the case. Upon analysis of the reasons for recall, we predicted from a two-compartment model that the estimated blood level was 88 ng/mL-1; this level would have provided no amnesia. This case illustrates that recall can occur with the use of midazolam, especially if levels become subtherapeutic, and other measures should be taken to provide adequate anesthesia and amnesia.

Adult↗
PubMed1993

Direct or modified Seldinger guide wire-directed technique for arterial catheter insertion.

Percutaneous radial artery cannulation is widely used for direct continuous arterial blood pressure measurement and sampling of arterial blood. We compared the success rate of arterial catheter placement in patients undergoing aortocoronary bypass operations using the direct and the modified Seldinger techniques. The effects of gender and quality of the pulse were also investigated. Our study group consisted of 42 female and 96 male patients. The overall success rate with the guide wire was 82% compared with that of the direct method of 65% (P = 0.02). The success rate for arterial cannulation in male patients was high whether direct cannulation or a guide wire was used. In female patients, on the other hand, the failure rate with the direct technique was high (57%) and was significantly lower (14%) when the guide wire was used (P < 0.001). We conclude that the success rate for cannulation is high in male patients, and patients with a bounding pulse regardless of the use of the direct or guide-wire techniques. The guide wire is recommended as the initial technique for cannulating the radial artery of female patients. In patients with a thready pulse, no significant advantage could be obtained by using a guide wire, but in salvaging an arterial line the guide wire is efficacious.

Adult↗
PubMed1992

Anaesthetic implications of 32% Dextran-70 (Hyskon) during hysteroscopy: hysteroscopy syndrome.

This review describes the properties and side effects of Hyskon and the implications for the patient and anaesthetist during hysteroscopy. The amount of Hyskon absorbed is dependent on the injection pressure, the extent of tissue trauma, the seal of the hysteroscope around the cervix, and the duration of infusion. The mechanism of pulmonary oedema after absorbtion of Hyskon is fluid overload, and not injury to pulmonary capillary endothelium. The haematological effects are primarily due to haemodilution. However, case reports suggest that Dextran 70 may cause a syndrome resembling disseminated intravascular coagulation. The allergic response to Hyskon consists of both an anaphylactic and an anaphylactoid component. It is recommended that hysteroscopy with Hyskon be limited to 45 min, and that all possible measures be taken to minimize tissue trauma and bleeding. The volume of Hyskon should be limited to less than 500 ml, since pulmonary oedema and coagulopathy have been described with even lesser amounts. The cumulative volume of Hyskon should be monitored frequently and the patient should be closely monitored for signs of impending pulmonary oedema.

Anesthesia, Local↗
PubMed1992

Tourniquet at 50 mm Hg followed by intravenous lidocaine diminishes hand pain associated with propofol injection.

We evaluated the efficacy of intravenous lidocaine, with and without a tourniquet, to decrease the intensity of pain during intravenous propofol injection in 82 patients undergoing general anesthesia. Patients in group A (n = 20) received propofol (2 mg/kg IV); patients in group B (n = 22) received 2% lidocaine (100 mg IV) followed 1 min later by propofol (2 mg/kg). Patients in group C (n = 21, saline placebo) and D (n = 19, 2% lidocaine) had an arm tourniquet inflated to 50 mm Hg applied for 1 min after gravity drainage of venous blood. The intensity of pain along the forearm was marked on a 0-100-mm visual analogue scale. Pain intensity was less in group B (21 +/- 19 mm) than in group A (75 +/- 28 mm; P less than 0.05). Pain intensity was significantly less in group D (1 +/- 2 mm) compared with group B (21 +/- 19 mm; P less than 0.001). We conclude that intravenous lidocaine before propofol injection attenuates the painful response; whereas, lidocaine administered after a tourniquet inflated to 50 mm Hg for 1 min virtually abolishes the pain associated with intravenous propofol.

Adult↗
PubMed1992

Comparison of low-dose sufentanil and fentanyl in balanced intravenous anesthesia for orthotopic cardiac transplantation.

A retrospective review was made of the records of 118 patients who received orthotopic heart transplant. Anesthetic techniques, drugs, dosage, hemodynamic profiles, intubation time, and intensive care unit stay were evaluated. The efficacy of sufentanil was compared to fentanyl in a balanced anesthetic when given in lower doses. Patients were given adequate anesthesia with total opioid doses of sufentanil, 6.5 +/- 2.9 micrograms.kg-1, or fentanyl, 58.9 +/- 24.9 micrograms.kg-1. Midazolam was used in all patients (mean dose 7.6 +/- 3.8 mg). There were no differences between the groups in complications, requirements for inotropic support, or time to extubation. A significantly higher pulmonary artery pressure was noted in patients who received sufentanil, but not fentanyl, pretransplant. The pulmonary artery pressures were not significantly elevated posttransplant. This review indicated that patients can be safely anesthetized with either combination of drug in lower doses than previously recommended.

Adolescent↗
PubMed1992

Incidence of arterial oxygen desaturation in cardiac patients premedicated with intramuscular scopolamine and morphine.

The effect of a standard preoperative medication combination, morphine and scopolamine, on arterial oxyhemoglobin saturation was measured continuously in 29 patients scheduled for elective coronary artery bypass grafting procedures. On the morning of operation, both before and after administration of preoperative medication, each patient was monitored continuously with a pulse oximeter (SpO2). Patients received 0.05 to 0.11 mg/kg of morphine (mean = 6.0 +/- 2.1 mg) intramuscularly (IM) and 0.2 to 0.4 mg of scopolamine (mean = 0.30 +/- 0.07 mg) IM. The mean arterial blood oxyhemoglobin saturation decreased from 92.0 +/- 1.8% before preoperative medication to 89.0 +/- 3.8% (P greater than .001) after preoperative medication. Forty-five percent of the patients had SpO2 less than 90% for at least 2 minutes, and 21% below 85%. In conclusion, significant arterial oxyhemoglobin desaturation occurred in this group of cardiac surgical patients after preoperative medication with morphine and scopolamine. Prophylactic administration of oxygen with preoperative medication might reduce the incidence of hypoxemia in this group of patients at risk for myocardial ischemia.

Aged↗
PubMed1991

Electrocautery-induced pacemaker malfunction during surgery.

We report a case of electrocautery-induced pacemaker failure that resulted in asystole in a 15-year-old girl scheduled for cardiac surgery. Her pacemaker was converted to the asynchronous mode the night before surgery. Electromagnetic interference from the unipolar electrocautery caused a reduction in the battery voltage, which allowed the digital circuitry, but not the voltage control oscillator (VCO), to work properly. Eventually the battery current drain caused VCO "lock-out," and pacemaker and battery failure. This report demonstrates that electrocautery-induced pacemaker failure can occur, even after conversion to asynchronous mode.

Adolescent↗