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Biomedical subjects

R F Cucchiara

Publications and source records attributed to R F Cucchiara.

At least 37 records · Page 2Linked to original sources
PubMed1990

Labetalol and esmolol in the control of hypertension after intracranial surgery.

The postoperative course of patients emerging from general anesthesia after intracranial surgery is frequently complicated by hypertension. This study examined the comparative efficacy of esmolol and labetalol in treating increases in blood pressure during emergence and recovery from anesthesia after intracranial surgery. Both esmolol and labetalol were equally effective in controlling systolic blood pressure on emergence and in the recovery room in patients undergoing intracranial surgery. However, decreases in heart rate were significantly more frequent in the immediate postoperative period in patients given labetalol. An increase in blood pressure after intracranial surgery appears to be a transitory phenomenon adequately treated with a short-acting antihypertensive agent such as esmolol.

Adrenergic beta-Antagonists↗
PubMed1989

Parameters affecting occurrence of paradoxical air embolism.

The effects of different patterns of ventilation and intravascular volume infusion on the occurrence of paradoxical air embolism (PAE) were evaluated in 15 pigs with a surgically created atrial septal defect (ASD). A balloon atrial septostomy was created transvenously in anesthetized pigs (mean diameter 8.6 mm +/- 1 mm). Monitoring included transesophageal echocardiography (TEE) of the right and left heart, ECG, EEG, direct arterial pressure, right and left atrial pressures (RAP and LAP), pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP). With the animal in a head up tilt, air was infused into the superior vena cava at a rate of 0.27 ml.kg-1.min-1 for 6 min or until PAE was identified on the TEE. Four situations were studied--intermittent positive pressure ventilation (IPPV), intermittent positive pressure ventilation with 10 cm H2O positive end-expiratory pressure (PEEP), spontaneous ventilation, and IPPV following infusion of 500 ml hetastarch. The incidence of PAE was not different in any of the four situations. Release of PEEP resulted in an increase in the amount of PAE or new PAE in nine of 14 animals. PAE occurred both with and without mean RAP exceeding mean LAP and the incidence of PAE was not significantly different based on the atrial pressure gradient. In situations during which the mean LAP remained greater than mean RAP throughout the venous air infusion and PAE occurred, transient reversal of the right to left atrial pressure gradient during a portion of each cardiac cycle was demonstrated.

Animals↗
PubMed1988

Esmolol for the control of hypertension after neurologic surgery.

We sought to evaluate the effectiveness of esmolol vs placebo in 40 patients emerging from general anesthesia for neurosurgery. Efficacy was defined as a decrease in systolic blood pressure to within 20% above average ward pressure. The need for additional antihypertensive agents to control blood pressure was also used to define efficacy. During the infusion period 20 of 21 (95%) of the esmolol-treated patients and two of 19 (11%) of the patients receiving placebo had return of systolic blood pressure to within 20% of average ward pressure (p less than 0.001). One out of 21 (5%) esmolol-treated patients and 14 of 19 (74%) of the placebo group required intervention with additional antihypertensive medications (p less than 0.001). Esmolol was found to be effective in controlling hypertension that develops on emergence from general anesthesia in patients undergoing neurosurgery.

Adrenergic beta-Antagonists↗
PubMed1988

Outcome following posterior fossa craniectomy in patients in the sitting or horizontal positions.

Controversy continues to surround the use of the sitting position for neurosurgical procedures. This retrospective review of 579 posterior fossa craniectomies performed over a 4-yr period from 1981 through 1984 examines outcome following these procedures performed with the patients in either the sitting (n = 333) or horizontal (supine, prone, lateral, park bench) (n = 246) position. Multiple preoperative, intraoperative, and postoperative variables were analyzed. Venous air embolism occurred significantly more often in patients in the sitting position (45% versus 12%). However, no morbidity or mortality was attributed to venous air embolism. The incidence of hypotension with positioning was not different by position (19% in the sitting patients and 24% in the horizontal patients). Average blood replacement was significantly lower in the sitting patients (359 ml versus 507 ml), and the incidence of transfusion of greater than two units of blood was significantly higher in the horizontal patients (13% versus 3%). Postoperative cranial nerve function was significantly better in patients in the sitting group as compared to those in the horizontal group. The incidence of perioperative cardiopulmonary complications was not different between groups. These outcome data suggest that there are potential advantages and disadvantages of both the sitting and horizontal positions without supporting a significantly increased morbidity or mortality associated with either position.

Brain Diseases↗
PubMed1987

Monitoring of cortical evoked potentials during surgical procedures on the cervical spine.

We reviewed the results of intraoperative monitoring of short-latency cortical evoked potentials in 81 patients who underwent surgical procedures of the cervical spine. Of these patients, 43 had baseline somatosensory evoked potentials from stimulation of the upper and lower extremities, intraoperative monitoring for at least 3 hours, and absence of an intrinsic lesion of the spinal cord. Major reductions in amplitude of the ulnar and tibial cortical evoked potentials occurred shortly after induction of anesthesia in 12% of patients. Latencies gradually increased during the operation as the concentration of volatile anesthetic agents increased. In patients with preoperative evidence of cervical cord damage, the cortical responses showed more fluctuations and could be lost without major changes in the concentration of the anesthetic agent or surgical manipulation. In one patient, intraoperative monitoring of the cervical cord function prevented a postoperative neurologic deficit. Ulnar and tibial cortical evoked potentials were successfully monitored throughout operation in all patients in whom baseline scalp responses could be obtained, but careful monitoring of anesthetic effect is necessary for proper interpretation.

Adult↗
PubMed1987

Sedation for stereotactic headframe application: a randomized comparison of two techniques.

A prospective, randomized study was performed in 87 patients to compare the safety, efficacy and dose requirements of two sedation techniques for stereotactic headframe application. Sedation administration and headframe application averaged 30 min. Fifty patients weighing 76 +/- 13 kg (mean +/- SD) received mean doses of 154 micrograms fentanyl plus 5.5 mg droperidol i.v. (FD group). An additional 37 patients weighing 76 +/- 19 kg received mean doses of 127 micrograms fentanyl plus 6.7 mg Valium (diazepam; FV group). Both treatments provided excellent hemodynamic stability and a low incidence of adverse side effects while providing adequate analgesia and sedation. The incidence of anesthetist-assessed patient anxiety and discomfort was more favorable in the FD group.

Adolescent↗
PubMed1986

Transesophageal echocardiography and transcutaneous O2 and CO2 monitoring for detection of venous air embolism.

The sensitivities of current monitoring methods for detection of air embolism were compared in eight anesthetized dogs. Air was infused at controlled rates of 0.001 and 0.005 ml X kg-1 X min-1 for 1 min; 0.01, 0.05, 0.1, 0.2, and 0.4 ml X kg-1 X min-1 for 6 min; and 5 ml X kg-1 bolus injection. Based on the mean quantity of air infused to elicit a positive response, the monitors could be placed into three significantly different sensitivity groups. Transesophageal echocardiography (TEE) and precordial Doppler ultrasound were the most sensitive monitoring methods detecting 0.19 and 0.24 ml X kg-1 of air, respectively. TEE detected air during six infusions in which the Doppler failed to do so. The next most sensitive group of monitoring methods included pulmonary artery pressure (PAP), end-tidal CO2 (PETCO2), arterial oxygen tension (PaO2), and transcutaneous oxygen tension (PtcO2). The mean quantity of air infused to elicit a positive response in this group of monitors ranged from 0.61 to 0.76 ml X kg-1. The response of PtcO2, PaO2, PETCO2, and PAP equally reflected the quantity of air infused. The least-sensitive group of methods included arterial and transcutaneous carbon dioxide tension and systemic arterial blood pressure. These data indicate that TEE is more sensitive than Doppler ultrasound and that PAP, PETCO2, and PtcO2 are equally sensitive in detecting venous air embolism in the dog.

Animals↗
PubMed1986

Transcutaneous O2 and CO2 monitoring of neurosurgical patients: detection of air embolism.

Transcutaneous oxygen tension (PtcO2) and transcutaneous carbon dioxide tension (PtcCO2) were monitored in 60 patients undergoing neurosurgical procedures. Twenty-six patients were in the sitting position and underwent routine monitoring for air embolism. Seventeen episodes of air embolism were diagnosed by precordial Doppler ultrasound or transesophageal echocardiography, and the PtcO2 decreased early during the course of each episode. The mean PtcO2 decrease was 48 +/- 35 mmHg. During ten episodes the end-tidal carbon dioxide tension (PETCO2) decreased but only after the PtcO2 had already begun to decrease. PtcCO2 increased during air embolism but PETCO2 changes preceded the change in PtcCO2 by 1-2 min. Transcutaneous values during air embolism were verified with simultaneous arterial blood gas values during six air embolism episodes. A strong positive correlation was found between transcutaneous and arterial oxygen and carbon dioxide tensions. Correcting the PtcCO2 by the patient's baseline PtcCO2/PaCO2 ratio, PtcCO2 monitoring correctly reflected hypocarbia, normocarbia, and hypercarbia in 92% of the cases. PtcO2 monitoring was useful in detecting venous air embolism and may respond sooner than PETCO2. PtcCO2 monitoring was not useful as an early detector of air embolism.

Adult↗