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J Coddens

Publications and source records attributed to J Coddens.

25 records · Page 2Linked to original sources
PubMed1994

Use of ketanserin in the treatment of hypertension following coronary artery surgery.

Ketanserin, a selective S2-serotonin receptor blocker with alpha 1-adrenergic blocking effects, may be a suitable antihypertensive medication after coronary artery surgery and lacks side effects seen with other vasodilators. Fifty patients with systolic blood pressures greater than 150 mmHg after coronary artery surgery were given, in a randomized double-blind fashion, either ketanserin (K) or saline (S). Each patient received six successive boluses of 1 mL of S or 1 mL of K (5 mg) at 2-minute intervals. After the last injection, sodium nitroprusside was started whenever the systolic blood pressure exceeded 150 mmHg. In the K group, the following significant (P < 0.05) changes occurred: systolic and diastolic arterial pressure -12% and -11%, respectively; heart rate -3%; systolic and diastolic pulmonary artery pressure -5% and -6%; central venous pressure -5%; pulmonary capillary wedge pressure -5%; systemic vascular resistance -16%; pulmonary vascular resistance -8%; stroke index +6%. None of these parameters changed significantly in the S group. There was no change in pulmonary shunt fraction in either group. In the K group, five patients did not require any further antihypertensive therapy during the 120 minutes following the last bolus injection. Twenty patients needed sodium nitroprusside during this period. This occurred 37 minutes (+/- 17 min) after the last bolus. In conclusion, after coronary artery bypass surgery, K is an effective antihypertensive medication, which does not cause reflex tachycardia or an increase in pulmonary shunt fraction. Exceeding the recommended dose of 10 (or 20) mg, as done in this study, does not seem to improve effectiveness or prolong the duration of action.

Aged↗
PubMed1993

Effects of dobutamine and/or nitroprusside on the pulmonary circulation in patients with pulmonary hypertension secondary to end-stage heart failure.

Nine NYHA class III-IV patients awaiting heart transplantation (HTx) were studied with a right ventricular ejection fraction (RVEF) catheter. The first aim of the study was to explore the pulmonary and systemic circulatory effects of dobutamine (D) and/or nitroprusside (N) in these patients. The second aim was to search for the parameter(s) among those usually measured that best predicted RVEF. Baseline data were recorded after 30 minutes of stabilization. Then, three drug regimens were administered in a randomized order for 30 minutes each: D, 4 micrograms/kg/min; N, 0.25 to 1.0 micrograms/kg/min; and their combination. Significant changes in RV loading and function were observed with all three therapies. The combination of both drugs was superior to either drug alone. The best predictor of RVEF was pulmonary arterial elastance. The second best was pulmonary capillary wedge pressure (PCWP). Pulmonary artery pressures, pulmonary vascular resistances, and transpulmonary gradient (TPG) were of less predictive value, as shown by a multiple regression analysis. None of the drugs showed any selectivity for the pulmonary vasculature, because the ratio PVRI/SVRI was never changed significantly. Selective pulmonary arterial vascular smooth muscle relaxation is probably not the most important mechanism to explain the unloading and improvement in function of the RV with D and/or N. Improved myocardial pump function appears to be the major factor in unloading the RV via reduction of PCWP and mean pulmonary artery pressure with essentially no change in TPG. The RVEF catheter provides valuable additional information in the screening of HTx candidates for pulmonary hypertension.

Blood Pressure↗
PubMed1992

Reliability of auscultation in positioning of double-lumen endobronchial tubes.

Auscultation is a well-established technique to confirm the position of double-lumen endobronchial tubes (DLTs). However, some authors have recommended that fibreoptic bronchoscopy (FOB) is also indicated. The aims of this study were to determine first if bronchoscopy after blind placement of DLTs improved positioning; and second if preoperative bronchoscopy could detect difficult intubation. Twenty-four patients undergoing aortic or lung surgery were studied. After intubation with a single-lumen tube, an initial FOB was performed by an independent observer to check the airway anatomy. Then, the single-lumen tube was replaced by a DLT using a classical "blind" intubation method. Subsequent FOB was performed first by the independent observer to record the DLT position and next by the investigators for improvement or correction of their positioning under visual control. Fibreoptic bronchoscopy after blind placement of DLTs resulted in repositioning 78% left-sided DLTs and 83% right-sided DLTs. Preoperative bronchoscopy did not always detect an airway abnormality which might lead to difficult positioning of the DLTs. In conclusion, auscultation is an unreliable method of confirming the position of DLTs and should be followed by fibreoptic bronchoscopy.

Adult↗
PubMedDate not supplied

Endovascular treatment of an acute type B dissection: a case report.

The case of a young man with acute type B dissection is reported. Inserting an endovascular stentgraft was the treatment of choice, with a good short-term result. We do believe that this is a promising strategy in the management of this serious pathology in which the classical surgical treatment is still associated with an important mortality and morbidity.

Acute Disease↗
PubMedDate not supplied

Heart transplantation.

From September 1988 until March 1990, 22 orthotopic heart transplantations (HTX) were performed in 20 patients (18 male and 2 female). Median age was 56.5 years (23-66). The indication for HTX was an end-stage ischemic disease in 7 pts. a dilated cardiomyopathy in 13 pts, and a retransplantation in 2 pts. The mean waiting time was 58 days. Immunosuppressive therapy included OKT3, prednisone and azathioprine. Cyclosporine was introduced at day 10. Donor hearts were obtained from our institution in 5 cases, from other hospitals in Belgium in 9 cases, and from other European countries in 8 cases. The mean ischemic time was 129 +/- 28 min. No patient died in the operating room. During the first postoperative month, weekly endomyocardial biopsies were performed to detect early rejection. Five patients died in the early postoperative period, mainly from rejection. After a mean hospital stay of 23 days, 15 patients (75%) were discharged. During the late follow-up, 3 patients died: 1 from chronic mediasdinitis, 1 from hypoglycemia, and 1 from cardiac arrest following non-compliance with the medical treatment. In conclusion, early acute rejection after HTX still remains a major cause of death.

Adult↗