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Biomedical subjects

S N Glisson

Publications and source records attributed to S N Glisson.

12 recordsLinked to original sources
PubMed1991

Atrial natriuretic peptide responses during anaesthesia in patients with refractory cardiomyopathies.

In patients with congestive heart failure, the release of atrial natriuretic peptide (ANP) is decreased. This study sought to determine the extent of ANP, sympathetic and haemodynamic responses to acutely increased atrial pressure in patients with cardiomyopathies undergoing orthotopic cardiac transplantation. Haemodynamic variables, plasma ANP, norepinephrine, and epinephrine concentrations were measured in 17 patients at five times before and after induction of anaesthesia using either ketamine 1.5 micrograms.kg-1 or sufentanil 3.6 +/- 0.3 micrograms.kg-1. Preinduction values in the ketamine and sufentanil groups were not significantly different. Compared with preinduction values, increases in mean arterial pressure (26%), pulmonary capillary wedge pressure (90%), right atrial pressure (107%), and heart rate (24%) occurred in the ketamine group while cardiac index decreased by 19% (P less than 0.05). Haemodynamic variables in the sufentanil group did not change at any of the times studied. Plasma concentrations of atrial natriuretic peptide were not different within or between treatment groups. Following tracheal intubation plasma norepinephrine levels increased by 116% in the ketamine group (P less than 0.05), but did not change in the sufentanil group. Plasma norepinephrine concentrations differed significantly between the ketamine and sufentanil groups. There were no differences in epinephrine concentrations in either group. Despite the anticipated haemodynamic and catecholamine differences found between the ketamine and sufentanil groups, the levels of plasma ANP were similar. Based upon these results, it is concluded that ANP exerts little influence in the control of fluid volume or blood pressure in patients with refractory cardiomyopathy.

Adult↗
PubMed1989

Cardiac transplantation: a prospective comparison of ketamine and sufentanil for anesthetic induction.

The hemodynamic effects of ketamine, 1.5 mg/kg, or sufentanil, 3.4 +/- 0.3 micrograms/kg, were studied prospectively for the anesthetic induction of 20 patients with cardiomyopathies undergoing cardiac transplantation. Plasma epinephrine (EPI), norepinephrine (NE), and sufentanil levels were also obtained. Measurements were taken at various times before induction and following intubation. Following ketamine, progressive increases (P less than 0.05) in mean arterial pressure (28%, MAP), mean pulmonary artery pressure (56%, PAP), central venous pressure (109%, CVP), and pulmonary capillary wedge pressure (84%, PCWP) occurred over time, whereas the cardiac index (CI), stroke volume index (SVI), and stroke work index (SWI) remained unchanged or decreased. The use of sufentanil was associated with no significant changes in MAP, PAP, CVP, PCWP, CI, SVI, or SWI. The heart rate (HR) did not significantly change in either group. Plasma NE significantly increased (31%) in the ketamine group, peaking at 10 minutes; whereas EPI levels did not significantly change in either group. Plasma sufentanil did not reflect the microgram/kg or microgram/BSA administered dose, suggesting individualized distribution kinetics. Since perioperative morbidity and mortality did not differ between groups, both ketamine and sufentanil are acceptable drugs for the anesthetic induction for cardiac transplantation. However, the dissimilar hemodynamic effects caused by ketamine and sufentanil suggest that this conclusion may not be applicable to the patient with a cardiomyopathy undergoing noncardiac surgery.

Adolescent↗
PubMed1987

Investigation of midazolam's influence on physiological and hormonal responses to hypotension.

Midazolam differs from diazepam in that midazolam is water-soluble, more potent and has a shorter elimination half-life (t1/2). To date, it has been used primarily for induction of anesthesia and as an anesthetic supplement. Diazepam has been shown to decrease the catecholamine response to perioperative stress. This study determined the extent to which midazolam influences the physiological and hormonal responses that are evoked by a nitroprusside-induced hypotensive challenge. Plasma levels of epinephrine, norepinephrine (NE), cortisol, and renin activity, as well as hemodynamic performance were measured in dogs anesthetized with enflurane-nitrous oxide-oxygen. Midazolam 0.2 mg/kg i.v. administered prior to a 30% decrease in mean blood pressure statistically attentuates the increase in plasma catecholamines. The cortisol and renin increases that occurred in response to the hypotension were not affected appreciably by midazolam. Hemodynamic changes due to midazolam were minimal, with only a transient 8-10% decrease in mean blood pressure observed. The findings of this study demonstrate that midazolam, like diazepam and fentanyl, can reduce the physiological and hormonal response to hypotensive episodes that occurred during the course of anesthesia and surgery.

Animals↗
PubMed1979

Prolongation of pancuronium-induced neuromuscular blockade by intravenous infusion of nitroglycerin.

Based upon clinical observation of undue prolongation of pancuronium-induced blockade in the presence of intravenous infusion of nitroglycerin, neuromuscular blockades produced by pancuronium, succinylcholine and d-tubocurarine were studied in 51 cats using the sciatic-gastrocnemius nerve-muscle preparation. Pancuronium-induced blockade was found to be significantly prolonged (P less than 0.1) in the presence of a nitroglycerin infusion of 1 microgram/kg/min (65 vs. 127 min). Less, but still significant, prolongation occurred when nitroglycerin, 0.5 microgram/kg/min, was infused. The intravenous infusion of nitroglycerin must be started prior to the pancuronium injection for the block to be prolonged. Neuromuscular blocks produced by succinylcholine and d-tubocurarine were not altered by nitroglycerin. In experiments using the isolated rat diaphragm preparation, the depth of pancuronium-induced block was found not to be changed by nitroglycerin, suggesting an effect of nitroglycerin on the process of recovery from blockade. These findings indicate a selective pancuronium-nitroglycerin interaction.

Animals↗
PubMed1978

Serum epinephrine and norepinephrine during valve replacement and aorta-coronary bypass.

A comparison of the levels of serum epinephrine, norepinephrine and blood pressure was made in 25 patients undergoing aorta-coronary bypass or valve replacement who were anaesthetized with a nitrous oxide-narcotic technique. Serum epinephrine and norepinephrine were measured in arterial samples drawn pre-induction, post-induction, before cardiopulmonary bypass, two and eight minutes after initiation of cardiopulmonary bypass, 20 minutes before termination and after termination of cardiopulmonary bypass. In both patient groups significant increases in epinephrine and norepinephrine occurred befored cardiopulmonary bypass, with accompanying increase of blood pressure in the valve replacement patients. During cardiopulmonary bypass an initial hypotensive response (p less than 0.001) was recorded, followed by a significant increase in blood pressure and epinephrine in both groups. After cardiopulmonary bypass, aorta-coronary bypass patients had epinephrine, norepinephrine and blood pressure equal to levels before cardiopulmonary bypass. In contrast, serum epinephrine continued to rise in the valve replacement patients, with a gradual recovery of blood pressure to pre-bypass levels. These findings demonstrate significant differences in blood pressure and catecholamine response in patients with valvular disease from patients with coronary artery disease.

Adult↗
PubMed1976

The effect of ketamine upon norepinephrine and dopamine levels in rabbit brain parts.

Ketamine (40 mg/kg, i.v.) significantly increased dopamine levels in the thalamus and hypothalamus brain areas, but not in the midbrain or caudate nucleus. The increase in dopamine occurred during the time when ketamine produced its maximal anesthetic action (10-30 min). Ketamine had no effect upon norepinephrine levels in whole brain or the select brain parts with the exception of caudate nucleus at any of the times studied. These results demonstrate an effect of ketamine upon dopamine levels in those brain regions previously suggested as the site of ketamine's anesthetic action.

Animals↗
PubMed1976

Levels of circulating norepinephrine and epinephrine before, during, and after cardiopulmonary bypass in man.

Little information is available on the levels of circulating catecholamines during cardiac surgery. A study was undertaken to measure the serum levels of epinephrine and norepinephrine before, during, and after cardiopulmonary bypass in 16 patients. Sampling were drawn before induction, after intubation, before bypass, 2 and 8 minutes after initiation of the bypass, and 20 minutes after bypass. The findings of this study show that the initiation of cardiopulmonary bypass was associated with a significant but transient fall in mean blood pressure accompanied by an increased secretion of adrenal epinephrine and norepinephrine. The cause of the observed hypotension may be due to an initial hemodilution of the circulating catecholamines by the 2 L. pump-priming solution. The secretion of adrenal catecholamines appears to be a compensatory response to the lowered blood pressure as indicated by the rapid return of the blood pressure in the ensuing minutes. Twenty minutes after bypass, both the blood pressure and serum catecholamine levels were observed to have returned to preinduction levels.

Anesthesia, Inhalation↗
PubMedDate not supplied

Enflurane anesthesia for surgical removal of pheochromocytoma.

Four cases describing the use of enflurane as the main anesthetic during surgical removal of pheochromocytoma (PCC) are presented and the preoperative preparation and intraoperative management of the patients are discussed. Serum levels of epinephrine and norepinephrine were measured in 3 of the reported cases. Intraoperative values were extremely elevated during tumor manipulation, but there was only 1 minor episode of arrhythmias. Criteria for choosing anesthetic agents for surgical removal of PCC are outlined. The authors conclude from their experience and that of others that enflurane is as safe and effective an anesthetic as any now available for PCC excision.

Adult↗
PubMedDate not supplied

Amitriptyline therapy increases electrocardiographic changes during reversal of neuromuscular blockade.

Induction of anesthesia is associated with an increased incidence of cardiac arrhythmias in patients maintained on amitriptyline medication. This study presents additional evidence showing that, in experimental animals (cats), amitriptyline treatment also produces significant ST-T wave and conduction abnormalities during neostigmine reversal of neuromuscular blockade.

Amitriptyline↗