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G Edelist

Publications and source records attributed to G Edelist.

At least 19 recordsLinked to original sources
PubMed1999

Inhaled nitric oxide does not alter pulmonary or cardiac effects of fat embolism in dogs after cemented arthroplasty.

PURPOSE: We examined the effect of inhaled nitric oxide (NO) on the acute pulmonary hypertension and right ventricular (RV) dilation after fat embolism. METHODS: A bilateral cemented arthroplasty (BCA), created fat embolism in 20 dogs. In Part A, 12 dogs were randomized to an NO group (n=6, inhaled NO 40 ppm before BCA and throughout the study) or a control group (n=6). In Part B, a third group of dogs (n=8) were given NO 20-40 ppm 2-3 min after BCA when pulmonary artery pressure (PAP) increased. Transesophageal echocardiography (TEE) and invasive hemodynamic monitoring evaluated the hemodynamic response to BCA. Postmortem, quantitative morphometry was used to estimate the number of fat emboli and diameter of lung vessel occluded by fat. RESULTS: Part A: The increase in PAP in the NO group (16 +/- 1 to 34 +/- 9 mmHg) within three minutes of BCA was not different from that in the control group (14 +/- 4 to 35 +/- 9 mmHg). Within three minutes of BCA, TEE demonstrated RV dilation in all groups (P < 0.05) but there was no difference in the change in RV area in the NO and control groups. When NO was given after BCA, no difference in PAP or RV dilation was noted from that in the control group. There were no differences, at post mortem, between the groups in the diameter of lung vessel occluded by fat CONCLUSION: Whether given before the embolic insult or two to three minutes after the onset of pulmonary hypertension, inhaled NO did not attenuate the acute pulmonary hypertension or RV dilation after cemented arthroplasty.

Administration, Inhalation↗
PubMed1998

Large pulmonary embolus without systemic hemodynamic consequences during cemented hip arthroplasty.

A case is presented in which a large embolus was detected passing through the right side of the heart during total hip arthroplasty. Although tricuspid regurgitation and an elevated right ventricular pressure resulted, there was no perturbation in systemic hemodynamics or gas exchange. The emboli detected during total hip arthroplasty are most likely composed of fat. No specific treatment is required, although heightened vigilance for disturbances in systemic hemodynamics is important.

Aged↗
PubMed1997

Relationship of fat embolism to haemodynamic and echocardiographic changes during cemented arthroplasty.

PURPOSE: Pressurisation of the medullary cavity during cemented arthroplasty causes "intravasation" of marrow fat. The purpose of this study was to examine the relationship between the amount of pulmonary intravascular fat and the haemodynamic and echocardiographic changes. METHODS: Anaesthetised mongrel dogs (n = 16) underwent bilateral cemented arthroplasty (BCA) to create a large embolic load. Haemodynamic measurements included blood pressure (BP), pulmonary artery pressure (PAP), right atrial pressure and cardiac output as well as transoesophageal echocardiographic (TEE) assessment of right ventricular (RV) and left ventricular (LV) areas. Using quantitative morphometry on postmortem lung specimens, the proportion of lung tissue occluded by fat was measured. RESULTS: Mean BP decreased within one minute of BCA, coinciding with the appearance of echogenic material in the RV. The RV area increased by 56% (P < 0.05) and LV area decreased by 34% (P < 0.05) while PAP increased from 15 +/- 3 mmHg to 39 +/- 10 mmHg within one minute (P < 0.001). The PAP remained elevated throughout the study (30 min). Stroke volume decreased in 14/15 dogs, yet cardiac output was maintained by increased heart rate. There was a curvilinear relationship (r = 0.87) between the maximum increase in PAP and the proportion of lung occupied by fat. CONCLUSION: In this model, stroke volume decreased within one minute of BCA when fat embolism accompanied prosthesis insertion. The TEE detected an increased RV area and reduced LV area associated with decreased stroke volume. The maintenance of cardiac output after intraoperative fat embolism depends primarily on the ability to increase heart rate.

Animals↗
PubMed1996

An introduction to transoesophageal echocardiography: II. Clinical applications.

PURPOSE: As progress has been made in the acquisition of cardiac images with transoesophageal echocardiography, the technique has moved from the confines of the cardiology laboratory into the operating room, the intensive care unit, and the emergency department. This has afforded anaesthetists the opportunity to become familiar with, and develop expertise in its practice. The purpose of this article is to present a review of transoesophageal echocardiography with reference to anaesthetic practice. SOURCE: The principle source of material was a computerized MedlineTM search of the English language literature from 1986 to 1995. PRINCIPLE FINDINGS: After discussing the technique of probe insertion, and describing some of the standard images, transoesophageal echocardiography's clinical utility is critically assessed. Comparisons with available monitoring techniques are made with reference to ventricular function, valvular heart disease, pericardial, aortic and congenital heart disease, and the management of the multiple traumatized patient. Issues of certification and maintenance of competence are also discussed. CONCLUSION: Although the benefit of transoesophageal echocardiography is intuitive in many clinical situations, in others, it has not been shown to improve upon presently existing monitoring techniques. The need for adequate training and collaboration with cardiology colleagues is emphasized.

Anesthesiology↗
PubMed1996

Echocardiographic assessment of left ventricular filling during isoflurane anaesthesia.

PURPOSE: To determine the effect of isoflurane on left ventricular diastolic function, as assessed by Doppler echocardiography. METHODS: Ten patients with normal cardiovascular function were enrolled. Doppler measurements of mitral inflow velocities, and pulmonary venous blood flow velocities were measured preoperatively (transthoracic echocardiography), and intraoperatively (transesophageal echocardiography) at isoflurane MAC 1 and MAC 1.5. Heart rate and blood pressure were measured concomitantly. Variables were compared with repeated measures ANOVA. RESULTS: Isoflurane at both doses caused equal decreases in mitral inflow A(atrial systole) velocity (control: 43 +/- 12.3 cm.sec-1 vs MAC 1: 31 +/- 6.0 cm.sec-1 and MAC 1.5: 31.3 +/- 7.9 cm.sec-1 P < 0.01), the deceleration time of the mitral inflow E (early) velocity (control: 178 +/- 31.7 msec versus MAC 1: 127 +/- 38.3 msec and MAC 1.5: 137 +/- 28.4 msec, P < 0.01), and mean blood pressure (control: 91.1 +/- 15.4 mmHg versus MAC 1: 76.1 +/- 8.8 mmHg and MAC 1.5: 71.9 +/- 6.2 mmHg, P < 0.002). Isoflurane at both doses caused an equal increase in the E/A ratio (control: 1.5 +/- 0.57 vs MAC 1: 2.0 +/- 0.6 and MAC 1.5: 2.2 +/- 0.78, P < 0.01). No changes in mitral inflow E or pulmonary venous velocities were seen. CONCLUSION: The changes in Doppler velocities of mitral inflow and pulmonary venous flow with isoflurane are not consistent with prolonged left ventricular relaxation nor increased myocardial restriction, but are more likely the result of alterations in left ventricular loading conditions and atrial systolic function.

Adolescent↗
PubMed1990

Comparative evaluation of propofol and thiopentone for total intravenous anaesthesia.

Sixty unpremedicated ASA physical status I or II patients scheduled for surgical procedures of intermediate duration (15 to 60 min) were studied to evaluate the safety and efficacy of propofol, to measure recovery times and to compare the return of psychomotor and cognitive function with thiopentone. Patients were randomly allocated into two groups. Anaesthesia was induced and maintained by either propofol (2.0-2.5 mg.kg-1 followed by a continuous infusion 0.1-0.2 mg.kg-1.min-1) or thiopentone (4.0-5.0 mg.kg-1, and infusion rate 0.16-0.32 mg.kg-1.min-1), titrated to patient response. Succinylcholine was administered to facilitate tracheal intubation and maintain neuromuscular blockade. Induction of anaesthesia was slightly longer with propofol than thiopentone (42.2 vs 29.8 sec) and was smooth with both drugs. Post-intubation increases in heart rate, and systolic and diastolic blood pressures were attenuated by propofol when compared with thiopentone. After the administration of propofol, times to eye opening (6.4 +/- 4.3 vs 13.9 +/- 15.9 min), response to verbal command (7.6 +/- 6.3 vs 15.4 +/- 16.6 min) and orientation (22.7 +/- 12.8 vs 36.2 +/- 23.1 min), were significantly shorter. Psychomotor and cognitive function returned earlier with propofol and fewer side effects were noted. At 24 hr there was no distinguishable difference between groups. Propofol is a safe anaesthetic agent with the potential for early patient discharge and street fitness after outpatient procedures.

Adult↗
PubMed1988

Comparison of alfentanil, fentanyl and enflurane as supplements to general anaesthesia for outpatient gynaecologic surgery.

We compared two narcotic/N2O anaesthetic techniques and an inhalational anaesthesia/N2O technique for outpatient surgery in 59 women undergoing short gynaecological procedures. All patients received droperidol 0.625 mg IV, thiopentone and 70 per cent N2O in O2 plus either alfentanil (15 micrograms.kg-1), fentanyl (1.5 microgram.kg-1) or enflurane. The narcotics were given in a double-blind fashion and all anaesthetic techniques were assigned randomly. Cardiorespiratory parameters remained stable in all groups, with few clinically important changes occurring. Recovery was significantly faster in the group receiving alfentanil, with the time to respond to verbal commands and the time to establish alertness significantly faster than with either fentanyl or enflurane. All techniques provided satisfactory anaesthesia; however, the patients receiving alfentanil had significantly more adverse events than those receiving fentanyl.

Adolescent↗
PubMed1988

Isoflurane and primary pulmonary hypertension.

Primary pulmonary hypertension is a rare and fatal disease. These patients represent an anaesthetic challenge because of the high mortality associated with the marked intra-operative increase in pulmonary vascular resistance and right ventricular decompensation. This is a first case report which demonstrates the safe and beneficial effects of isoflurane in lowering pulmonary arterial pressure and pulmonary vascular resistance in such a patient for a short surgical procedure. The anaesthetic considerations in these patients are discussed.

Adult↗
PubMed1987

A comparison of propofol and thiopentone as induction agents in outpatient surgery.

We studied 90 healthy ASA physical status I or II female patients scheduled for outpatient therapeutic abortions. Sixty patients received induction doses of propofol (2.5 mg X kg-1) and 30 patients received thiopentone (4 mg X kg-1). Anaesthesia was maintained with nitrous oxide plus additional doses of the agent used for induction. Comparisons were made regarding the efficacy of induction and maintenance, rapidity of recovery, haemodynamic and respiratory variables and side effects. The number of "excellent" inductions was significantly different (p = 0.02), with 97 per cent of the patients induced with propofol and 80 per cent of the patients induced with thiopentone receiving this rating. A larger number of patients receiving propofol exhibited minor extraneous muscular movement during induction (p = 0.01). Recovery for the propofol group was significantly more rapid than with the thiopentone group (p = 0.001). The respiratory effect of the two drugs was not significantly different. Propofol caused a decrease in pulse rate and a decrease in systolic, diastolic and mean pressure which were significantly greater than with thiopentone. From the observations made we conclude that propofol has the potential to be an excellent induction and maintenance agent for outpatient surgery in combination with nitrous oxide alone.

Abortion, Therapeutic↗