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Biomedical subjects

I Garutti

Publications and source records attributed to I Garutti.

At least 19 recordsLinked to original sources
PubMed2005

Radial to femoral arterial blood pressure differences during liver transplantation.

This observational study compared femoral and radial arterial blood pressure in 72 patients undergoing liver transplant surgery. Simultaneous femoral and radial arterial blood pressures, cardiac index, core temperature and vasoconstrictor therapy were recorded at seven time points during the operation. No significant differences between radial and femoral pressures were found at the start of surgery. Femoral and radial systolic arterial blood pressures were statistically significantly different during liver reperfusion (mean (SD) arterial pressure = 92 (22) mmHg vs. 76 (22) mmHg, p < 0.01). Mean arterial blood pressures showed no statistically significant differences throughout the study. Vasoconstrictor drug administration was associated with a larger systolic pressure difference between femoral and radial arteries (28 (24) mmHg in patients being given vasoconstrictor drugs vs. 9 (19) mmHg in patients not needing vasoconstrictors during reperfusion, p < 0.001). In conclusion, differences in systolic arterial blood pressure occur between femoral and radial arterial monitoring sites during liver reperfusion, and in particular in patients being given vasoconstrictor therapy. Thus, if femoral arterial monitoring is not available, clinicians should rely on mean rather than systolic arterial pressure measurements from a radial artery catheter during liver transplantation.

Adult↗
PubMed2005

[Perioperative use of beta-blockers in noncardiac surgery].

A variety of strategies have been used to reduce the high prevalence and mortality rates of cardiac complications in patients undergoing noncardiac surgery. One approach taken is to prescribe agents that block beta-adrenergic receptors. The effect of beta-blockers on myocardial ischemia is multifactorial: they correct myocardial oxygen imbalance, prevent rupture of atheromatous plaque, and reduce coronary vasoconstriction. We summarize the results of several recently published studies that confirm the beneficial effects and the low incidence of side effects.

Adrenergic beta-Antagonists↗
PubMed2004

[Recombinant activated factor VII used in a man with refractory bleeding from a stab wound injuring the liver and kidney].

A 30-year-old man bled massively from a stab wound that injured his liver and right kidney and entered a life-threatening cycle of transfusion, hypothermia, coagulopathy, and rebleeding in spite of surgery and aggressive resuscitation. He was given a single dose of recombinant activated factor VII (rVIIa; NovoSeven, Novo Nordisk, Denmark) in a final attempt to save his life. The patient responded favorably, as bleeding stopped almost immediately and coagulation markers became normal. Clinical course following rVIIa administration was good. Severe bleeding in the trauma patient needing massive transfusion can become complicated by dilutional coagulopathy and hypothermia. Therapy with rVIIa is a promising aid to controlling bleeding in the repeatedly transfused patient who does not respond to standard replacement of blood products.

Adult↗
PubMed2004

[Paravertebral analgesia in thoracic surgery].

Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. The thoracic paravertebral block, following its rediscovery, is being used with increasing frequency and success for both surgery and recovery from thoracotomy, challenging the supremacy of thoracic epidural analgesia, which to date has been considered the gold standard. We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.

Analgesia↗
PubMed2003

Autonomic neuropathy in end-stage cirrhotic patients and evolution after liver transplantation.

Autonomic neuropathy (AN), which is frequently observed in cirrhosis patients, has been associated with a higher mortality. We have prospectively evaluated the prevalence of AN, its relationship with the degree of liver dysfunction and circulatory disturbances, and the evolution of AN after liver transplantation (LT) in 62 end-stage liver cirrhosis patients. AN was evaluated by seven cardiovascular tests assessing sympathetic or parasympathetic function before and 6 months after LT. Patients were classified as showing absent (A), early (E), or definite dysfunction (D). AN appeared in 67.7% of cases (E: 24.2%, D: 43.5%) without relation to liver disease etiology. Parasympathetic dysfunction was more prevalent than sympathetic dysfunction (59.7% vs. 20.9%). AN was significantly related to Child-Pugh score. Hyperdynamic circulation was more marked in the D than the A group as shown by a greater cardiac output (CO)(9 vs. 7.3 L/min) and a lower peripheral resistance (SVR)(666 vs. 866 dyn.s.cm(-5)). Moreover, AN scores significantly correlated with CO and SVR. Overall the prevalence of AN decreased 6 months after LT (67.7% vs 48%) due to a significant reduction in definite AN (43.5 vs. 14.8%; P<.05). AN improved in 70% of cases after LT. Sympathetic dysfunction remained in only one patient. We conclude that AN is frequent in liver transplant candidates; its severity is associated with the degree of liver failure. Systemic circulatory disturbances seem to correlate with the severity of AN. AN is clearly improved by LT. The evaluation of AN may contribute to a better selection of LT recipients.

Autonomic Nervous System Diseases↗
PubMed2003

Autonomic neuropathy is associated with hemodynamic instability during human liver transplantation.

INTRODUCTION: End-stage liver disease is frequently associated with autonomic neuropathy (AN). The hemodynamic changes during liver transplantation (LT) require an adequate autonomic response to maintain cardiovascular stability. PATIENTS AND METHODS: Forty-one patients undergoing LT were evaluated for the influence of AN on the evolution after LT. AN was previously evaluated by seven cardiovascular tests assessing sympathetic (Sy) or parasympathetic (P) function. Patients were classified as absent (A), early (E), or definite dysfunction (D). A hemodynamic study was performed before and after vascular clampings. The analysis included the duration of LT, transfusion requirements, intra-operative artenal hypotensive episodes, incidence of postreperfusion syndrome (PRS), cardiac arrhythmias and vasoactive drug requirements. RESULTS: The hyperdynamic circulation worsened during surgery in D patients, as shown by a significantly increased cardiac output and a significantly decreased systemic vascular resistance. The incidence of PRS was greater in the AN group. Arterial hypotension during the neohepatic period was more frequent among patients with AN, more frequently requiring vasoconstrictor and inotropic therapy. CONCLUSIONS: AN is associated with hemodynamic impairment and with increased vasoactive drug requirements during liver transplantation, probably associated with impaired reflex vasoconstrictor responses to surgical manipulations and changes of blood volume. AN may be associated with a greater surgical risk during LT. Preoperative evaluation of AN may select a high-risk population of LT recipients.

Adult↗
PubMed2002

[Metamizol versus propacetamol: comparative study of the hemodynamic and antipyretic effects in critically ill patients].

OBJECTIVE: To compare the antipyretic and hemodynamic effects of metamizol and propacetamol in critically ill patients with fever. PATIENTS AND METHODS: A prospective randomized trial enrolling 60 patients admitted to our postoperative intensive care unit with fever > 38 degrees C. Patients were assigned to group M to receive intravenous doses of 2 g of metamizol or group P to receive 2 g of propacetamol. Measures were central temperature (Ta), systolic (SBP), diastolic (DBP) and mean (MBP) blood pressures, mean pulmonary artery pressure, central venous pressure, pulmonary capillary pressure, pulmonary and systemic vascular resistance index, and mixed venous saturation. All measures were taken at four times: baseline and 30, 60 and 120 minutes after infusion of the medication. Patients whose SBP fell below 90 mm Hg were withdrawn from the study. RESULTS: Patient characteristics and baseline hemodynamics and Ta were similar in the two groups. We observed a significant decrease in temperature in both groups, the maximum decrease occurring 120 minutes after administration of the antipyretic (0.5 degree C and 0.6 degree in the metamizol and propacetamol groups, respectively). SBP, DBP, MBP, and the vascular resistance index decreased from baseline values in both groups 30, 60 and 120 minutes after dosing. Thirteen percent of the patients in group M and 6.67% in group P were withdrawn from the study because of hypotension. We observed no statistically significant differences between the groups in Ta or hemodynamic variables at any of the four moments of measurement. CONCLUSION: Both metamizol and propacetamol are effective antipyretics at the doses tested. However, both have adverse hemodynamic side effects that may be poorly tolerated by critically patients.

Acetaminophen↗
PubMed2002

[Blood reflux through the catheter when trying catheterization of the subclavian vein is not a reliable sign in case of hemothorax].

A 36-year-old man suffered chest and neurovascular trauma, soft-tissue injury to the left arm, and trauma to facial bones and extremities. He was hemodynamically unstable and responded poorly to blood transfusion and vasoactive medication. Pneumothorax was suspected. When a tube was inserted into the left hemithorax, 1500 mL of blood was drained. A chest film revealed hemothorax and a contusion on the left lung, but no rib fractures. An attempt to catheterize the left subclavian vein yielded reflux, and blood was then transfused. The patient continued to be highly unstable and an additional 1000 mL of blood was drained. Exploratory thoracotomy revealed a ruptured subclavian vein, location of the venous catheter in the pleural cavity, and a fracture of the first left rib. After chest injury leading to hemothorax, reflux upon catheterization of the ipsilateral subclavian vein is not a sure sign of correct tip placement. Additional means for checking placement, such as assessing pressure wave morphology, should be used. A fracture of the first rib, which may not be evident on a chest x-ray, often causes a vascular lesion and thoracic hemorrhage. Incorrect insertion of a subclavian catheter may then follow.

Adult↗
PubMed1999

Presence of a nitric oxide synthase inhibitor in the graft efflux during reperfusion in human liver transplantation.

Involvement of the nitric oxide (NO) system in complications following human orthotopic liver transplants (OLT) has been reported, but the contribution of the graft to the modulation of the NO system during reperfusion in normal OLT has not been characterized. We have studied the contribution of the graft efflux to the modulation of the NO system in 20 consecutive OLT. We evaluated its effects on isolated vascular reactivity of the rabbit and on rat cultured macrophages stimulated with lipopolysaccharide (LPS). In none of the donor liver biopsies was expression of inducible NO synthase (iNOS) activity by Northern or Western blot analysis found. Graft efflux after the onset of liver reperfusion, but not pre-transplant patient plasma, reversibly inhibited the acetylcholine-induced relaxation of norepinephrine-contracted rabbit aortic rings. Moreover, graft efflux reversibly inhibited NO production in rat macrophages treated with LPS, as evidenced by both a decrease in nitrite plus nitrate formation and a decrease in the production of [14C]citrulline from [14C]arginine. Addition of a 10% dilution of graft efflux to cultured rat macrophages incubated with LPS increased iNOS mRNA levels, suggesting direct inhibition of the enzyme but not of its expression. These results cannot be ascribed to the depletion of arginine the iNOS substrate since they can be reproduced even in the presence of an excess (10 mM) of exogenously added arginine. No correlation was found between the iNOS inhibitory activity in each sample and the corresponding clinical parameters related to either the graft function after the OLT or the existence of post-reperfusion syndrome. Our results indicate the existence of a soluble factor in the graft efflux from human OLT that reversibly and unspecifically inhibits NOS activity. Its involvement in the physiology and/or pathology of human liver diseases deserves further study.

Acetylcholine↗
PubMed1999

Arterial oxygenation during one-lung ventilation: combined versus general anesthesia.

UNLABELLED: The optimal anesthetic management of patients undergoing thoracotomy for pulmonary resection has not been definitely determined. We evaluated whether general i.v. anesthesia (propofol-fentanyl) provides superior PaO2 during one-lung ventilation (OLV) compared with thoracic epidural anesthesia (TEA) with supplemental local and general anesthetics. We studied 60 patients who had prolonged periods of OLV for elective thoracic surgery for lung cancer and who were prospectively randomized into two groups. In 30 patients (GA group), fentanyl/propofol/rocuronium anesthesia was used. Another 30 patients (TEA group) were anesthetized with propofol/rocuronium/epidural thoracic bupivacaine 0.5%. A double-lumen endotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV (OLV + 15 and OLV + 30, respectively) in all patients. We measured PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture percentage (Qs/Qt%), and arterial and central venous oxygen content. The mean values for PaO2 during OLV in the GA group after 15 min (175 mm Hg) and 30 min (182 mm Hg) were significantly (P < 0.05) higher compared with the TEA group (120 and 118 mm Hg, respectively). Furthermore, Qs/Qt% was significantly (P < 0.05) increased in the TEA group during OLV. There were no other significant differences. We conclude that using the TEA regimen is associated with a lower PaO2 and a larger intrapulmonary shunt during OLV than with total i.v. anesthesia alone. IMPLICATIONS: Sixty patients undergoing elective lung surgery during a prolonged period of intraoperative one-lung ventilation were studied and randomized to receive general i.v. anesthesia or general i.v. anesthesia combined with thoracic epidural anesthesia. The arterial oxygenation in the first group was better than that in the second group during one-lung ventilation.

Aged↗