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Biomedical subjects

G Dahlgren

Publications and source records attributed to G Dahlgren.

7 recordsLinked to original sources
PubMed1991

Left ventricular end-systolic pressure estimated from measurements in a peripheral artery.

Aortic and radial arterial pressure measurements were compared after cannulation and before cardiopulmonary bypass in 26 patients scheduled for coronary artery bypass grafting. The radial artery blood pressure range was 89 to 147 mm Hg systolic and 44 to 75 mm Hg diastolic. A difference was found between the central and peripheral dicrotic notch pressures, the former being 7.9 +/- 2.7 (SD) mm Hg higher than the latter. When 8 mm Hg was added to the notch pressure measured in the radial artery to construct a calculated end-systolic pressure, there was good agreement with the centrally measured notch pressure. The mean difference was -0.15 mm Hg with a 95% confidence interval of -1.2 to 0.9 mm Hg. It was not possible to calculate peak systolic aortic pressure with the same accuracy from the systolic and diastolic pressure measurements in the radial artery. It is concluded that left ventricular end-systolic pressure measured as the aortic dicrotic notch pressure can be calculated from the dicrotic notch pressure in the radial artery with reasonable accuracy.

Aorta↗
PubMed1991

A comparative study of five different techniques to reduce left ventricular dysfunction during endotracheal intubation.

Thirty-five non-selected, consenting patients were studied during induction of anesthesia before coronary artery bypass grafting. Anesthesia was induced with diazepam, thiopentone and fentanyl, followed by pancuronium. Before induction, 200 MBq Tc 99 m - HSA was given i.v. and ejection fraction (EF) of the left ventricle was measured with a collimated single-crystal probe. The patients were allocated to five groups (seven patients in each) treated with: Group A: nitroglycerin i.v. bolus 4 micrograms x kg-1 given 30-60 s before laryngoscopy; Group B: nitroglycerin i.v. in continuous infusion, 1 micrograms x kg-1 x min-1 started before induction; Group C: two-stage topical anesthesia of the vallecula region and larynx with lidocain; Group D: a combination of nitroglycerin and topical anesthesia (as in Group B and C); and Group E: propranolol i.v. 0.01 mg x kg-1 given 5 min before intubation. All groups reacted in the same way during induction of anesthesia up to the point of laryngoscopy. End-diastolic volume and systemic arterial pressure decreased while cardiac index remained unchanged and EF increased. During laryngoscopy and intubation, however, differences between the groups were evident. Nitroglycerin i.v. as a bolus effectively prevented a reduction in EF and an increase in left ventricular volume. In addition to these beneficial hemodynamic effects, there was a moderate increase in heart rate and a reduction of stroke index. Continuous infusion of nitroglycerin and propranolol i.v. had no effect, since EF fell and left ventricular volume increased. Patients receiving topical anesthesia demonstrated a blunted response to endotracheal intubation with a moderate decrease in EF and an unchanged (Group C) or slightly increased (Group D) left ventricular volume.

Adult↗
PubMed1991

Strategies for health financing in Kenya--the difficult birth of a new policy.

The Kenyan Government has recently introduced a new strategy for health financing. The roles of the World Bank and US-AID in developing this strategy are reviewed in this article. Particular attention is paid to the fact that the government--under heavy pressure from the World Bank-partly had to accept a strategy generating less revenue and greater inequities than alternative strategies considered. At the same time the policy options assessed illustrate how the Kenyan Government managed to avoid public health services being transformed into semi private services primarily for middle and high income groups.

Decision Making, Organizational↗
PubMed1989

Isoflurane and intravenous anesthesia used for induction before coronary artery bypass grafting.

Induction of anesthesia with isoflurane in combination with fentanyl, thiopentone, nitrous oxide and pancuronium was studied in nine patients scheduled for coronary artery bypass grafting. Ejection fraction (EF) of the left ventricle was monitored with a single crystal probe linked to a microcomputer, after injection of 200 MBq Tc 99m-HSA. Stroke volume index determined by thermodilution and EF were used to calculate left ventricular end-diastolic volume index (LVEDVI). The degree of ischemia was numerically scored as evaluated from the ECG (modified V5 lead). The study protocol covered seven periods from awake before induction to 5 min after intubation. EF decreased moderately during intubation (P less than 0.05). Systemic vascular resistance index (SVRI) was decreased (P less than 0.05) at all times except during intubation when it was unchanged compared to control. LVEDVI decreased during induction (P less than 0.05), while left ventricular filing pressure remained unchanged. Heart rate did not change. Systolic arterial pressure decreased from 147 mmHg (19.6 kPa) to about 100 mmHg (13.3 kPa) during induction (P less than 0.05). Two patients were given vasoconstrictors because of low arterial pressure. The mean ischemic score did not change. One patient, however, had signs of progressive ischemia. In this patient isoflurane administration was stopped after the last recording and the ECG normalized within 20 min.

Aged↗
PubMed1988

Changes in ejection fraction during induction of anesthesia with two different i.v. techniques.

Two intravenous induction techniques were compared with respect to changes in ejection fraction (EF) and central hemodynamics in 30 patients scheduled for coronary artery surgery. Left ventricular EF was measured with a collimated single crystal probe linked to a microcomputer, after injection of 200 MBq Tc 99 m HSA. Stroke volume index (SI) determined by thermodilution and EF were used to calculate left ventricular volume in end-systole and end-diastole. In 20 patients (Group I), anesthesia was induced with diazepam (94 micrograms x kg-1), thiopentone (3 mg x kg-1) and fentanyl (3 micrograms x kg-1). In 10 patients (Group II), fentanyl (30 micrograms x kg-1) was used for induction. In Group I, EF decreased from 0.43 to 0.26 at intubation, while systemic vascular resistance index (SVRI) showed an increase. Left ventricular volume decreased during induction of anesthesia except during intubation. In Group II, EF and left ventricular volume remained unchanged during the study period. SVRI showed no increase at intubation. No change in contractility was indicated from the relation between the end-systolic pressure and volume, in any of the groups.

Anesthesia, Inhalation↗