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Biomedical subjects

S E Ricksten

Publications and source records attributed to S E Ricksten.

At least 37 records · Page 2Linked to original sources
PubMed1997

Quality of life after cardiac surgery complicated by multiple organ failure.

OBJECTIVE: To evaluate quality of life after prolonged multiple system intensive care treatment in cardiac surgical patients. DESIGN: A case-control study. SETTING: Adult 12-bed thoracic intensive care unit (ICU) at a university teaching hospital. PATIENTS: Forty-seven patients surviving multiple organ failure requiring intensive care treatment for > or = 5 days (ICU group). Patients with a completely uncomplicated postoperative course were matched to the study group with respect to gender, age, and type and date of surgery. The Nottingham Health Profile was used to assess quality of life at least 1 yr after complicated cardiac surgery. INTERVENTIONS: Quality of life measures were collected at least 1 yr after discharge from the ICU. MEASUREMENTS AND MAIN RESULTS: Seventy-five percent of the patients in the ICU group suffered from multiple organ failure involving at least three organ systems, with a mean stay in the ICU of 9.0 +/- 1.2 (SEM) days. Quality of life was considerably reduced in the ICU group, with a higher total mean score of all dimensions of quality of life (22.7 +/- 2.6) compared with the control group (13.2 +/- 2.4 [SEM])(p < .01). The Nottingham Health Profile score was higher in three of six dimensions of health--i.e., energy (p < .05), physical mobility (p < .05), and emotional reactions (p < .05)--compared with the control group. A higher percentage of patients reported problems in three of six important activities of daily life--housework (p < .05), hobbies (p < .01), and sex life (p < .01)--compared with the control group. CONCLUSION: Patients treated with prolonged multiple system intensive care after heart surgery have a poor outcome with respect to quality of life measured at least 1 yr after discharge from the ICU.

Adult↗
PubMed1997

Effects of dopamine, dopexamine and dobutamine on renal excretory function during experimental sepsis in conscious rats.

BACKGROUND: Acute renal failure is a frequent complication in human sepsis. Various inotropic drugs are often used to improve central haemodynamics and renal function. The differential preservative role of the most commonly used inotropic drugs on renal function, in this condition, has previously not been extensively studied. The aim of this experimental animal study was therefore to compare the preserving effects of dopamine, dopexamine, dobutamine and saline on renal excretory function, after induction of sepsis in conscious rats. METHOD: The effects of dopamine (DA) (2.5 micrograms.kg-1.min-1; n = 11), dopexamine (DX) (1 microgram.kg-1.min-1; n = 10), dobutamine (DB) (5 micrograms.kg-1.min-1; n = 10) and saline (n = 13) on the glomerular filtration rate (GFR), urine flow (UF), sodium excretion (SE) and fractional urinary excretion of sodium (FUENa) were studied and compared in conscious rats subjected to a 1-h infusion of live E. coli bacteria (10(9)/h). RESULTS: In the saline-treated control group, bacteria infusion decreased GFR, UF, SE and FUENa by 31%, 53%, 51% and 36% respectively, associated with a 16% decrease in mean arterial pressure (MAP), and a 10% increase in heart rate (HR). In the post-E. coli treatment period, the fall in MAP was less pronounced with DX compared to both DB and control, while there was no difference between DX and DA. The increase in HR was most pronounced with DB. GFR decreased to a lesser extent with DX compared to DA, DB and control. UF and SE were better maintained with DX compared to DB and control, while there was no difference in FUENa between the groups. CONCLUSION: We conclude that dopexamine, to a greater extent than dopamine and dobutamine, improves renal excretory function in experimental septic shock.

Adrenergic beta-Agonists↗
PubMed1997

Effects of halothane and isoflurane on left ventricular diastolic function during surgical stress in patients with coronary artery disease.

BACKGROUND: The effects of inhalation anesthetics on left ventricular (LV) systolic function are well documented, while the effects of these agents on LV diastolic function have mainly been evaluated in animal studies, with conflicting results. METHODS: We investigated the effects of halothane and isoflurane, when used to control the stress response to sternotomy in 33 patients with coronary artery disease (CAD). LV early diastolic relaxation and end-diastolic stiffness were evaluated from mitral Doppler flow profiles, transesophageal two-dimensional echocardiography, and central hemodynamic measurements. Measurements were performed a) after induction of anesthesia, b) after volume loading, c) prior to surgery and d) during surgery, 10 min after introduction of the inhalation anesthetic. The effects of the anesthetics on Doppler indices reflecting early diastolic relaxation, and on the left ventricular end-diastolic pressure-area (LVED P/A) relationship, were studied. RESULTS: When data obtained during surgical stress were compared to the control situation, we found an increase in the LV filling pressures in both groups, while only the isoflurane group showed an increase in heart rate. An increase in end-systolic LV area and decreased fractional area change was present in the halothane group, while an increase in LV end-diastolic area, and similar changes in the mitral Doppler indices (decreases of deceleration rate and time of early diastolic filling), indicating an impairment of early diastolic relaxation, was present in both groups. Isoflurane induced a displacement of the LVED P/A relationship leftwards from the baseline LVED P/A curve. CONCLUSION: Both halothane and isoflurane impair early diastolic relaxation in patients with CAD, when used to control intraoperative surgical stress. In contrast to halothane, isoflurane induced a change in the LVED P/A relationship, suggestive of an increased LVED stiffness.

Adult↗
PubMed1996

Effects of atrial natriuretic peptide on acute renal impairment in patients with heart failure after cardiac surgery.

OBJECTIVE: To investigate the effects of IV infusion of atrial natriuretic peptide (human ANP 1-28) on renal function in patients with acute heart failure and renal impairment after cardiac surgery. DESIGN: Pharmocodynamic dose-effect investigation. SETTING: Cardiothoracic Intensive Care Unit of a university hospital. PATIENTS: Twelve patients (mean age 68 years, range 44-78 years) treated with inotropic drugs and an intra-aortic balloon pump (n = 8) were studied 1-3 days after cardiac surgery. Patients had acute renal impairment, defined as a rise in serum creatinine of more than 50% compared to preoperative values. Patients were receiving dopamine and furosemide infusion to increase urine flow. INTERVENTIONS: Baseline measurements of glomerular filtration rate (GFR) and renal blood flow (51Cr-EDTA and PAH clearance) were first performed during two 30-min periods. ANP was then administered for two consecutive 30-min periods (25 and 50 ng/kg per min), followed by two control periods. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure decreased by 6% at the highest ANP dose. Urine flow, GFR and RBF increased 62%, 43% and 38%, respectively, while renal vascular resistance decreased 30%. At this dose level, circulating ANP concentrations were on the average eight fold higher than preinfusion levels. CONCLUSIONS: ANP improved renal function and decreased elevated renal vascular resistance in patients with renal dysfunction after cardiac surgery. The improvement in renal blood flow and glomerular filtration rate may be of potential therapeutic value to prevent or treat exaggerated renal vasoconstriction in patients with acute renal impairment following cardiac surgery.

Acute Kidney Injury↗
PubMed1996

Inhaled prostacyclin for treatment of pulmonary hypertension after cardiac surgery or heart transplantation: a pharmacodynamic study.

OBJECTIVE: To study the effects of incremental concentrations of inhaled aerosolized prostacyclin (PGI2) on pulmonary and systemic hemodynamics after cardiac surgery or heart transplantation. DESIGN: Pharmacodynamic dose-response study. SETTING: Cardiothoracic intensive care unit (ICU) at a university hospital. PARTICIPANTS: Nine patients with pulmonary hypertension after cardiac surgery or heart transplantation and an elevated pulmonary vascular resistance (PVR) (> 20 dynes.sec.cm-5) treated in the ICU with inotropic support were studied. INTERVENTIONS: Inhaled prostacyclin was administered at concentrations of 2.5, 5.0, and 10.0 micrograms/mL using conventional systems for nebulization. MEASUREMENTS AND MAIN RESULTS: Pulmonary and systemic hemodynamics as well as right ventricular (RV) function variables (n = 3) were measured before, during, and 10 and 20 minutes after inhalation of PGI2. Inhaled PGI2 induced a dose-dependent decrease in PVR and the transpulmonary gradient (which decreased by -29% and -26%, respectively) at an inhaled concentration of 10 micrograms/mL. Inhaled PGI2 caused no changes in systemic vascular resistance. Central venous pressure decreased during PGI2 inhalation with no change in stroke volume, indicating an improvement in RV performance, which was particularly obvious in one patient with RV failure after heart transplantation. Twenty minutes after discontinuation of inhaled PGI2, hemodynamic variables returned to baseline. CONCLUSIONS: Inhaled PGI2 induces a dose-dependent selective pulmonary vasodilation and may improve RV performance after cardiac surgery complicated by pulmonary hypertension and RV failure.

Administration, Inhalation↗
PubMed1996

Early effects of coronary artery bypass surgery and cold cardioplegic ischemia on left ventricular diastolic function: evaluation by computer-assisted transesophageal echocardiography.

OBJECTIVE: Although left ventricular (LV) systolic function undergoes a temporary decrease after cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG), data on the effects of CABG and cardioplegic arrest on LV diastolic function are contradictory. The objective of the present study was to further evaluate the effects of CABG and CPB on LV diastolic function. DESIGN: A prospective study. SETTING: A multi-institutional investigation at a university hospital. PARTICIPANTS: 20 patients on beta-receptor antagonists, scheduled for CABG and with a preoperative ejection fraction over 0.5. INTERVENTIONS: Central hemodynamic measurements, transesophageal LV short-axis images, and mitral Doppler flow profiles were obtained before and after volume loading that in turn was performed both before surgical incision and after weaning from CPB. MEASUREMENTS AND MAIN RESULTS: Heart rate, cardiac output, and peak atrial filling velocity increased; systemic vascular resistance decreased; whereas stroke volume, LV area ejection fraction, deceleration rate and slope of early diastolic filling, time-velocity integral of early diastolic filling, and the ratio between early and atrial peak filling velocity were unchanged post-CPB compared with pre-CPB. LV end-diastolic stiffness that was calculated for each patient pre-CPB and post-CPB using the formula: P = B*eS*A), where P is the LV filling pressure and A is the end-diastolic short-axis area, was unchanged post-CPB compared with pre-CPB. CONCLUSIONS: Both the active and passive components of LV diastolic function are well maintained shortly after CABG and cardioplegic arrest in patients with a good preoperative systolic LV function.

Coronary Artery Bypass↗
PubMed1996

Effects of prostacyclin on myocardial hemodynamics and metabolism after coronary artery bypass grafting.

OBJECTIVE: To study the effects of incremental infusion rates of prostacyclin on myocardial blood flow and metabolism and central hemodynamics shortly after coronary artery bypass grafting. DESIGN: A pharmacodynamic dose-response study. SETTING: A multi-institutional university hospital. PARTICIPANTS: Twelve patients with two- or three-vessel coronary artery disease and with an ejection fraction greater than 0.5 were studied in the operating room after sternal closure and elective coronary artery bypass grafting. INTERVENTIONS: Prostacyclin was administered at infusion rates of 2.5, 5, 10, and 20 ng/kg/min. Systemic and pulmonary hemodynamics and global (coronary sinus) as well as regional (great cardiac vein) myocardial blood flow and metabolic variables were measured. MEASUREMENTS AND MAIN RESULTS: Infusion rates of 10 and 20 ng/kg/min decreased mean arterial blood pressure (13% and 21%, respectively), systemic vascular resistance (31% and 42%), and pulmonary vascular resistance (11% and 33%), increased cardiac output (28% and 37%), heart rate (9% and 13%), and stroke volume (15% and 20%), but had no effect on central filling pressures. Prostacyclin caused no changes in great cardiac vein flow or coronary sinus flow. Furthermore, prostacyclin caused no changes in regional myocardial oxygen extraction, indicating that prostacyclin did not induce direct coronary vasodilation. There were no electrocardiographic or obvious metabolic signs of myocardial ischemia during prostacyclin infusion. CONCLUSION: Prostacyclin may be a useful afterload-reducing compound after coronary artery bypass grafting because it has no direct coronary vasodilatory effect, which minimizes the risk of myocardial ischemia.

Aged↗
PubMed1996

Myocardial circulatory and metabolic effects of atrial natriuretic peptide after coronary artery bypass grafting.

The purpose of this study was to examine the effects of incremental infusion rates of human atrial natriuretic peptide (ANP), 25, 50, 100 ng.kg-1. min-1, on myocardial blood flow and metabolism (n = 10), and to compare the effects of ANP on these variables with those of equipotent infusion rates of sodium nitroprusside (SNP) (n = 9) 1-3 h after coronary artery bypass grafting (CABG). ANP induced a dose-dependent decrease in mean arterial blood pressure and systemic vascular resistance. There were no changes in cardiac index, heart rate, or cardiac filling pressures. ANP caused no changes in myocardial blood flow or its distribution, and caused no changes in myocardial oxygen extraction. Regional myocardial lactate uptake (RMLU) and extraction (RMLE) increased significantly (P < 0.05) at 50 ng.kg-1.min-1 (10.2 +/- 3.8 mumol/min and 8.2% +/- 3.0%, respectively) as compared to control (-1.1 +/- 3.0 mumol/min and -1.3% +/- 3.3%, respectively). RMLE and RMLU were significantly (P < 0.05) higher with ANP (5.7% +/- 2.5% and 6.8 +/- 3.7 mumol/min, respectively) compared to SNP (-1.5% +/- 2.1% and -0.1 +/- 3.7 mumol/min, respectively). We conclude that ANP has no dilatory effects on coronary vascular resistance vessels and thus lacks the potential to maldistribute flow, and that ANP improves myocardial lactate metabolism after CABG.

Atrial Natriuretic Factor↗
PubMed1995

A comparison of prostacyclin and sodium nitroprusside for the treatment of heart failure after cardiac surgery.

OBJECTIVE: To study the effects of the two vasodilators, prostacyclin and sodium nitroprusside, on central hemodynamics in heart failure after cardiac surgery. DESIGN: Randomized cross-over study. SETTING: Multi-institutional university hospital. PARTICIPANTS: Ten patients. INCLUSION CRITERIA: cardiac index less than 2.5 L/min/m2; pulmonary capillary wedge pressure greater than 15 mmHg, systemic vascular resistance index greater than 2,500 dynes.s.cm-5/m2, and treatment with inotropic support. Five patients were treated with intra-aortic balloon counterpulsation. INTERVENTIONS: After control measurements, mean arterial pressure was decreased by 10% to 20% with each vasodilator in each patient. MEASUREMENTS AND RESULTS: Sodium nitroprusside induced decreases in mean pulmonary arterial pressure (-21%), pulmonary capillary wedge pressure (-29%), central venous pressure (-17%), and systemic vascular resistance (-25%), and increases in cardiac output (+7%) and stroke volume (+6%) compared with control. Prostacyclin decreased mean pulmonary arterial pressure (-14%), pulmonary capillary wedge pressure (-19%), central venous pressure (-7%), and systemic (-40%) and pulmonary (-25%) vascular resistances, whereas cardiac output (+25%) and stroke volume (+22%) increased compared with control. Prostacyclin, compared with sodium nitroprusside, induced a more pronounced increase in cardiac output and stroke volume, associated with less pronounced decreases in cardiac filling pressures and more profound decreases in systemic and pulmonary vascular resistances. CONCLUSION: Prostacyclin appears to be a useful agent, superior to sodium nitroprusside, in the treatment of postoperative heart failure in patients with normal or mildly elevated cardiac filling pressures, where vasodilator treatment is indicated.

Aged↗
PubMed1995

Effects of adenosine infusion on systolic and diastolic left ventricular function after coronary artery bypass surgery: evaluation by computer-assisted quantitative 2-D and Doppler echocardiography.

The effects of adenosine on central hemodynamics, ST-segment changes, and left ventricular (LV) systolic and diastolic function, determined by transesophageal 2-D and Doppler echocardiography, were investigated in 20 patients shortly after coronary surgery. After control measurements, adenosine was infused at incremental infusion rates (30, 60, and 120 micrograms.kg-1.min-1). Adenosine caused dose-dependent increases in heart rate (68.0 +/- 11.2-74.0 +/- 15.7 bpm), cardiac output (3.23 +/- 0.76-4.17 +/- 0.67 L/min), and stroke volume (48.8 +/- 12.5-56.7 L/min), and stroke volume (48.8 +/- 12.5-56.7 mL), decreases in arterial pressure (84.8 +/- 16.6-63.3 +/- 15.2 mm Hg), and systemic and pulmonary vascular resistances (1994 +/- 510-1106 +/- 309 and 209 +/- 54-116 +/- 58 dyne.s.cm-5, respectively), but no changes in cardiac filling pressures. The mean ST segment was slightly but significantly depressed by adenosine (from 0.003 to 0.019 mV). Analysis of LV wall motion showed that adenosine caused no changes in the global area ejection fraction (GAEF), the segmental area ejection fraction (SAEF), or in the SAEF/GAEF ratio, indicating that no regional wall motion abnormalities appeared. Maximum early and late diastolic flow rates (Emax, Amax), determined by mitral Doppler analysis, increased (from 30.1 +/- 14.8 to 40.1 +/- 24.1 and from 37.8 +/- 15.7 to 46.4 +/- 31.3 cm/s, respectively), as did the deceleration slope of the early diastolic filling (from -151 +/- 67 to -210 +/- 107 cm/s-2), whereas no changes were found in the ratio between Emax and Amax, the deceleration time of early diastolic filling, or the velocity time integrals of early or late diastolic filling.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1995

The effects of nitrous oxide on left ventricular systolic and diastolic performance before and after cardiopulmonary bypass: evaluation by computer-assisted two-dimensional and Doppler echocardiography in patients undergoing coronary artery surgery.

We investigated the effects of nitrous oxide (N2O) on central hemodynamics and left ventricular systolic and diastolic function in 25 patients undergoing coronary artery bypass surgery. All patients were receiving beta-blockers and had good left ventricular function. Global and regional systolic left ventricular performance and diastolic function were determined by computer-assisted analysis of transesophageal echocardiographic (TEE) images, and mitral Doppler flow profiles, respectively. The patients were anesthetized with fentanyl and ventilated with oxygen in air. Hemodynamic and TEE measurements were obtained before and after the introduction of N2O in oxygen (60%/40%), before and after cardiopulmonary bypass (CPB). N2O reduced mean arterial pressure, heart rate, stroke volume, and cardiac output both before and after CPB. Left ventricular global area ejection fraction (GAEF) was not changed by the introduction of N2O, either before or after CPB. N2O induced a significant change in regional wall motion after, but not before CPB, as assessed by the relationship between segmental area ejection fraction (SAEF) and GAEF. Analysis of the mitral flow profile indicated an increase in early diastolic relaxation in the pre-CPB period after introduction of N2O, that was absent in the post-CPB period. We conclude that N2O induces regional wall motion abnormalities and possibly diastolic dysfunction post-CPB.

Blood Pressure↗
PubMed1995

Effects of hypertonic saline on myocardial function and metabolism in nonischemic and ischemic isolated working rat hearts.

OBJECTIVE: To study the direct effects of hypertonic saline on the function of non-ischemic and ischemic myocardium by the use of an isolated working rat heart model. DESIGN: A prospective, randomized, controlled study. SETTING: Animal laboratory at a university medical center. SUBJECTS: Adult Wistar rats (n = 32) of both sexes. INTERVENTIONS: The heart was excised via thoracotomy in anesthetized rats and prepared for antegrade perfusion at a constant heart rate in an antegrade perfusion apparatus at predetermined preloads and afterloads. Hearts were exposed to ischemia, ischemia followed by repeated hypertonic saline treatment, or repeated hypertonic saline without preceding ischemia. Myocardial ischemia was induced by decreasing the mean aortic pressure to 25 mm Hg. MEASUREMENTS AND MAIN RESULTS: Variables that were measured or calculated included the following: left atrial pressure; mean aortic pressure; heart rate; coronary flow; aortic flow; cardiac output; stroke volume; PO2, electrolyte content, osmolality, and lactate concentration of the perfusate and/or venous effluent; myocardial oxygen extraction; myocardial oxygen consumption; and myocardial lactate efflux. Ischemia resulted in pronounced impairment of myocardial function and metabolism. Hypertonic saline administration during ischemia induced an additional transient myocardial depression. In the nonischemic heart, a transient myocardial-depressant effect after hypertonic saline administration was also seen. CONCLUSIONS: The present results from an isolated working heart preparation show that hypertonic saline exerts myocardial-depressive effects in the ischemic as well as in the nonischemic heart. Systemic rather than direct myocardial effects may therefore be responsible for the previously reported beneficial hemodynamic effects of hypertonic saline in shock treatment.

Animals↗
PubMed1995

Protective effects of halothane but not isoflurane against global ischaemic injury in the isolated working rat heart.

The effects of equi-anaesthetic concentrations of halothane (HAL) and isoflurane (ISO) on myocardial performance, perfusion, oxygenation and lactate release were studied before, during and after a low-flow, global ischaemic insult in isolated, paced rat left heart preparations. An antegrade perfusion technique was used, where left atrial pressure (LAP) and mean aortic pressure (MAP) could be altered independently of each other. Aortic flow, coronary flow (CF) and PO2 in venous coronary effluent were continuously recorded and stroke volume, myocardial oxygen consumption (MVO2) and myocardial oxygen extraction as well as lactate release were calculated. The hearts were exposed for at least ten minutes to the perfusate without (control, n = 10) or with HAL (n = 10) or ISO (n = 10) at a MAP of 80 mmHg (10.4 kPa) and a LAP of 7.5 mmHg (1.0 kPa). After baseline measurements, MAP was reduced to 25 mmHg (3,2 kPa) for a total of nine minutes. Thereafter MAP was increased to 80 mmHg (10.4 kPa) for another nine minute period. During the whole experimental procedure, LAP was maintained at 7.5 mmHg (1.0 kPa) and heart rate at 325 beats per minute. In the pre-ischaemic control period, MVO2 was lower with HAL compared to ISO (P < 0.05) and control (P < 0.05). Stroke volume was also lower with HAL compared to control (P < 0.05). During hypoperfusion, lactate release was twice as high in the control group (P < 0.01) and with ISO (P < 0.01) compared to HAL.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Effects of atrial natriuretic peptide on renal function after cardiac surgery and in cyclosporine-treated heart transplant recipients.

The study investigated the effects of intravenous infusion of atrial natriuretic peptide (human ANP 99-126) on renal function and central hemodynamics after coronary artery bypass grafting (CABG), and the ability of ANP to reverse the acute nephrotoxic effects of cyclosporine after heart transplantation. Ten patients with an EF > 0.5 and normal renal function were studied 2 to 4 hours after CABG surgery. Furthermore, six heart transplant recipients receiving cyclosporine for immunosuppression who developed renal dysfunction 2 to 4 days after transplantation were studied. Standard urinary clearance of 51Cr-EDTA and PAH was used to study the effects of ANP on glomerular filtration rate (GFR) and renal blood flow (RBF). Baseline measurements were first performed during two 30-minute periods. Incremental infusion rates of ANP were then administered for three consecutive 30-minute periods (25, 50, and 100 ng/kg/min), followed by two 30-minute post-ANP control periods. Marked increases in urinary flow (UF), GFR, filtration fraction (FF), and fractional urinary excretion of Na+ were observed in the CABG patients with increasing doses of ANP, while RBF was unchanged. Mean arterial pressure decreased by around 15% at the highest ANP dose. In the heart transplant recipients, baseline GFR was markedly reduced compared to pretransplantation values (-65%). UF, GFR, and RBF increased 240%, 69%, and 53%, respectively, while renal vascular resistance decreased 45% during the highest dose of ANP infused. At this ANP dose level, circulating ANP concentrations were sixfold to eightfold higher than the preinfusion control level.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Thoracic epidural anesthesia during coronary artery bypass surgery: effects on cardiac sympathetic activity, myocardial blood flow and metabolism, and central hemodynamics.

The effects of high thoracic epidural anesthesia (TEA) on cardiac sympathetic nerve activity, myocardial blood flow and metabolism, and central hemodynamics were studied in 20 patients undergoing coronary artery bypass grafting (CABG). In 10 of the patients, TEA (T1-5 block) was used as an adjunct to a standardized fentanyl-nitrous oxide anesthesia. Hemodynamic measurements and blood sampling were performed after induction of anesthesia but prior to skin incision and after sternotomy. Assessment of total and cardiac sympathetic activity was performed by means of the norepinephrine kinetic approach. Prior to surgery, mean arterial pressure (MAP), great cardiac vein flow (GCVF), and regional myocardial oxygen consumption (Reg-MVO2) were lower in the TEA group compared to the control group. During sternotomy there was a pronounced increase in cardiac norepinephrine spillover, MAP, systemic vascular resistance index (SVRI), pulmonary capillary wedge pressure (PCWP), GCVF, and Reg-MVO2 in the control group. These changes were clearly attenuated in the TEA group. None of the patients in the TEA group had metabolic (lactate) or electrocardiographic signs of myocardial ischemia. Three patients in the control group had indices of myocardial ischemia prior to and/or during surgery. We conclude that TEA attenuates the surgically mediated sympathetic stress response to sternotomy, thereby preventing the increase in myocardial oxygen demand in the pre-bypass period without jeopardizing myocardial perfusion.

Anesthesia, Epidural↗
PubMed1993

Central hemodynamics and right ventricular function after coronary artery bypass surgery. A comparison of prostacyclin, sodium nitroprusside, and nitroglycerin for treatment of postcardiac surgical hypertension.

The aim of this study was to compare the effects of prostacyclin on central hemodynamics and right ventricular function to the more widely used vasodilators sodium nitroprusside (SNP) and nitroglycerin (NTG), and to investigate whether prostacyclin is more selective to the pulmonary vascular bed compared to SNP and NTG after coronary artery bypass surgery. Twelve patients with two-vessel or three-vessel coronary artery disease and an ejection fraction > 0.5 were included. Hemodynamic measurements were made postoperatively in the intensive care unit using a pulmonary artery fast-response ejection fraction/volumetric thermodilution catheter. The aim was to control and maintain mean arterial blood pressure around 75 to 80 mmHg with each drug. After a 10-minute infusion of each drug at a stable infusion rate, central hemodynamic variables as well as right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV) and ejection fraction (RVEF) were measured or derived in triplicate. The average infusion rates of SNP, NTG, and prostacyclin were 2.3 +/- 0.8 micrograms/kg/min, 12.6 +/- 6.0 micrograms/kg/min and 20.0 +/- 0.5 ng/kg/min, respectively. Cardiac output, stroke volume, RVEDV, and central filling pressures were highest for prostacyclin compared to both NTG and SNP. Systemic vascular resistance (SVR) was lowest for prostacyclin but the effects on pulmonary vascular resistance (PVR) were comparable to that of SNP. The PVR/SVR ratio was significantly lower with both SNP and NTG when compared to prostacyclin. RVEF did not differ among the three drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1993

Management of a giant intracranial aneurysm using surface-heparinized extracorporeal circulation and controlled deep hypothermic low flow perfusion. A case report.

Extracorporeal circulation with controlled hypothermic low flow perfusion was introduced during the surgical treatment of a patient with a giant intracranial aneurysm of the anterior communicating artery. Heparin-coated equipment (Carmeda Bio-Active Surface; CBAS) was utilized, thus reducing the need for systemic heparinization. Direct cannulation of the right atrium and aorta was established through thoracotomy. Blood flow through the circuit was kept at 4.5 l/min during normothermia. Core cooling, in combination with external surface cooling, was performed for 30 min to a temperature of 18 degrees C (nasopharynx). During a period of 25 min, the time for surgical repair of the aneurysm, blood flow was minimized to 0.4 l.min-1, equilibrating central and peripheral blood pressures to approximately 5-10 mmHg (0.65-1.3 kPa). Reperfusion was started immediately after the low flow period concomitantly with rewarming, aiming at a temperature of 36 degrees C following 150 min. The patient could be weaned off the extracorporeal circulation with minimal inotropic support. The postoperative course was uneventful apart from a left-sided hemiparesis, probably due to an infarction in the area of the right pericallosal artery (A2). The patient was weaned off the ventilator after 6 days. He recovered and the hemiparesis regressed slowly.

Aged↗