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Biomedical subjects

M J Boscoe

Publications and source records attributed to M J Boscoe.

29 records · Page 2Linked to original sources
PubMed1982

The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease.

We measured the dose of sufentanil required for unconsciousness as well as the entire operation in 44 patients (22 taking propranolol and 22 not taking propranolol) undergoing coronary artery bypass grafting (CABG) operations. The incidence of hypertension during operation, requirements for supplements to treat hypertension and recovery times were also determined. The data indicate that patients undergoing CABG operations taking propranolol require significantly less sufentanil for unconsciousness and the entire operation than patients not taking this drug. In spite of requiring less sufentanil, patients taking propranolol had less hypertension during operation and thus required less supplements. However recovery times in both groups were the same. The results of this study may partially explain the varying incidence of hypertension reported during high dose fentanyl and other narcotic-oxygen anaesthetic techniques.

Anesthesia, General↗
PubMed1982

Antidiuretic and growth hormone responses during coronary artery surgery with sufentanil-oxygen and alfentanil-oxygen anesthesia in man.

Antidiuretic hormone (ADH), growth hormone (GH), and cardiovascular responses to large (anesthetic) doses of alfentanil (1.2 +/- 0.02 mg/kg) and oxygen and sufentanil (13.1 +/- 0.4 microgram/kg) and oxygen were measured before and during surgery (including cardiopulmonary bypass) and at the end of surgery in 29 patients undergoing coronary artery bypass surgery. The data demonstrate that alfentanil-O2 and sufentanil-O2 result in little change in cardiovascular dynamics throughout anesthesia and surgery, and also prevent changes in plasma levels of ADH and GH at all times during the study. Our findings contrast with previous studies with other anesthetics, including fentanyl, in which plasma levels of ADH and GH become markedly elevated during bypass. The results suggest that alfentanil and sufentanil may block hormonal stress responses to surgical stimulus better than fentanyl does. The clinical significance of the difference in ADH and GH responses during fentanyl and during alfentanil or sulfentanil anesthesia remains to be determined. However, this difference may provide part of the explanation why alfentanil and sufentanil-O2 anesthesia require less frequent employment of other anesthetic adjuvants and are easier to use than fentanyl during coronary artery surgery.

Alfentanil↗
PubMed1981

Percutaneous pulmonary artery catheterization via the arm before anaesthesia: success rate, frequency of complications and arterial pressure and heart rate responses.

The success rate, frequency of complications and changes in systolic arterial pressure and heart rate during percutaneous pulmonary artery catheterization via an antecubital vein were evaluated before induction of anaesthesia in 84 patients about to undergo cardiac surgery. Serious complications were angina (2%) and a small tear in the tricuspid valve (one patient). If one of the basilic veins was used, the success rate was 93%. When it was necessary to use a cephalic vein, the success rate decreased to 60%. Overall success rate was 75%. Placing the catheter in the pulmonary artery resulted in an immediate increase in systolic arterial pressure in all patients and a significant increase in heart rate in patients not taking beta-adrenergic blocking drugs. This study demonstrates that percutaneous catheterization of the pulmonary artery via the basilic vein is a simple, safe, effective technique associated with few complications.

Arm↗
PubMed1981

Alfentanil-oxygen anaesthesia for coronary artery surgery.

The anaesthétic properties of alfentanil were evaluated in 15 patients undergoing coronary artery bypass grafting operations. Alfentanil was infused at a rate of 3.0mg min-1 until the patients (breathing pure oxygen) became unconscious. Additional alfentanil 2.5-5.0mg i.v. was given if systolic arterial pressure increased by 15% or more from control values. Alfentanil produced unconsciousness in 75 +/- 18s, but muscle rigidity occurred in 27% of patients. Cardiovascular dynamics were minimally altered during the induction of anaesthesia and throughout most of the operation, although 60% of patients became hypertensive during sternotomy and 73% during sternal spread. Recovery from anaesthesia was rapid with patients regaining consciousness after 1.4 +/- 0.6h and fulfilling out criteria for extubation of the trachea 4.1 +/- 1.2h after operation. No patient was aware of laryngoscopy, endotracheal intubation or any aspect of the operation.

Adult↗
PubMedDate not supplied

Anaesthetic assessment and management of cardiac patients for non-cardiac surgery. Part 2: Management.

In an earlier article in this journal (June 1999) we discussed the risk that the presence of cardiac disease poses to patients undergoing non-cardiac surgery. We outlined factors in the patient's medical history, examination findings and the value of various tests in arriving at an overall assessment of risk for any given patient. In this article we concentrate on the management of these patients as they undergo surgery itself. We shall consider what measures may usefully be employed in order to minimise the risk of an adverse cardiac event occurring in the perioperative period.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Inhaled nitric oxide for right ventricular dysfunction following cardiac transplantation.

A 55-year-old man developed postoperative hypotension following orthotopic cardiac transplantation, unresponsive to support with inotropes and counterpulsation. Acute right ventricular failure was confirmed by transoesophageal echocardiography, and the introduction of inhaled nitric oxide resulted in immediate improvement. A beneficial effect persisted for 11 days, with hospital discharge two months postoperatively.

Administration, Inhalation↗