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Biomedical subjects

T M Fuhrman

Publications and source records attributed to T M Fuhrman.

31 records · Page 2Linked to original sources
PubMed1981

Combined use of dopamine and nitroprusside therapy in conjunction with intra-aortic balloon pumping for the treatment of postcardiotomy low-output syndrome.

Intra-aortic balloon pumping (IABP) has been utilized in our institution in over 600 patients for the treatment of postcardiotomy low-output syndrome, with a 59% survival rate. Volume loading and pharmacologic treatment have played integral roles in the overall treatment of this syndrome. This investigation documents the hemodynamic effectivenss of combined nitroprusside/dopamine therapy in patients who required IABP for weaning from cardiopulmonary bypass. Serial hemodynamic measurements were made before and during infusion of nitroprusside (0.5 to 5.0 microgram/kg/min) and after combined nitroprusside/dopamine (7.5 micrograms/kg/min) therapy in 10 patients during IABP. Prior to pharmacologic therapy, cardiac index was 1.6 +/- 0.4 L/min/m2 and systemic vascular resistance (SVR) was 2,774 +/- 932 dynes sec cm-5. After nitroprusside infusion, cardiac index increased to 1.8 +/- 0.5 L/min/m2 (NS) and SVR decreased to 1,957 +/- 791 dynes sec cm-5 (p less than 0.01). The simultaneous infusion of nitroprusside and dopamine resulted in further augmentation of cardiac index to 2.5 +/- 0.5 L/min/m2 (p less than 0.01) and an additional reduction of SVR to 1,439 +/- 358 dynes sec cm-5 (p less than 0.02). In addition, pressure-rate-product, an index of myocardial oxygen demand, was decreased by nitroprusside (p less than 0.02) but was not significantly altered by both agents. This study provides a rationale for the combined use of nitroprusside/dopamine in postcardiotomy low-output syndrome necessitating IABP when SVR is greater than 2,000 dynes sec cm-5 and cardiac index is less than 2.0 L/min/m2.

Assisted Circulation↗
PubMed1980

Quantitative indices of intra-aortic balloon pump (IABP) dependence during post-infarction cardiogenic shock.

This study attempts to quantitate post-infarction cardiogenic shock IABP dependence in instances of massive myocardial infarction with the use of hemodynamic indices plotted over time-course trajectories. Mortality is predicted when age and hemodynamic performance are also considered. It appears that post-infarction IABP dependence can be quantitated and that such information can be useful in considering diagnostic and therapeutic alternatives during the course of IABP support and cardiogenic shock. The analysis suggests that such IABP-dependent patients could be considered for therapeutic alternatives. They do not expire during the first 50 hours of IABP support and neither improve nor deteriorate during the second 50 hours of support. They remain in Class B without the occurrence of life-threatening ventricular dysrhythmias for a sufficient time for cardiac catheterization to determine the appropriateness of corrective procedures.

Adult↗
PubMed1979

RIGHT AND LEFT VENTRICULAR HEMODYNAMIC INDICES AS PREDICTORS OF THE NEED FOR AND OUTCOME OF POST-CARDIOTOMY MECHANICAL INTRAAORTIC BALLOON PUMP SUPPORT.

Preoperative cardiac catheterization data of 21 patients requiring intraaortic balloon pumping (IABP) for weaning from cardiopulmonary bypass were analyzed and compared with similar data in 28 patients who underwent nearly similar operative procedures, but did not require IABP for weaning. Cardiac index (CI) and systemic vascular resistance (SVR) were found to have predictive value for the need of IABP for weaning from cardiopulmonary bypass and differentiated survival from non-survival. Left ventricular end diastolic pressure (LVEDP) was not found to be predictive. Ejection fraction (EF) was significantly lower in those who required IABP than those who did not; EF did not predict the outcome. Pulmonary capillary wedge pressure ([unk]), pulmonary artery pressure ([unk]) and pulmonary vascular resistance (PVR) were predictive of the need for IABP, but not the outcome. Left ventricular minute work index (LVMWI) was significantly lower in those requiring IABP, right ventricular minute work index (RVMWI) was predictive of survival with IABP. Together, LVMWI and RVMWI were predictive of the need for and outcome of IABP following cardiopulmonary bypass. Twenty-seven of 28 control RVMWI's were normal. No patient requiring IABP had depressed RVMWI's preoperatively. Elevated preoperative RVMWI's were associated with 80% survival with postcardiotomy IABP; normal RVMWI's were associated with a 56% survival with post-cardiotomy IABP. Elevated preoperative RVMWI's reflected moderate to maximal right ventricular compensatory capacity in response to depressed left ventricular function. Normal preoperative RVMWI's in the presence of depressed LVMWI's were indicative of decreased right ventricular compensatory capacity in post-cardiotomy IABP-support settings. Right ventricular function is as important as left ventricular function as a prognosticator for the need and outcome of IABP support of the failing post-cardiotomy circulation.

Journal Article↗
PubMed1979

CLINICAL TRIALS OF THE ABDOMINAL LEFT VENTRICULAR ASSIST DEVICE (ALVAD): PROGRESS REPORT.

An abdominal left ventricular assist device (ALVAD) is undergoing controlled clinical trials in our institution. The ALVAD is pneumatically-actuated, synchronously or asynchronously with an external console and is interposed between the apex of the left ventricle and the infrarenal abdominal aorta. It is an order of magnitude more effective than conventional intraaortic balloon pumping. Thus far, we have implanted this pump in 21 patients (15 males and six females). The average age has been 50. The duration of cardiopulmonary bypass with intensive pharmacologic support and IABP until ALVAD implantation has been nearly 4 hours. The plasma hemoglobins prior to ALVAD implantation have averaged 168 mg%. The platelet counts at implantation have averaged 68,000 mm(3). The average duration of ALVAD support has been in excess of one day and the longest trial extended for one week. We have been able to remove the pump after ventricular recovery in two instances and effected cardiac allografting in one instance of ALVAD dependency. We have found that (1) the profoundly depressed left (and right) ventricles can recover if totally supported with this device; (2) the device can function in the presence of ventricular fibrillation and/or standstill; (3) the device can effectively replace both left and right ventricular function in the presence of normal pulmonary vascular resistance and microcirculatory hemodynamics; and (4) in the presence of impending multiple organ failure, procrastination in use is to be avoided.

Journal Article↗
PubMed1979

Efficacy of nitroprusside therapy in postcardiotomy low-output syndrome necessitating intra-aortic balloon counterpulsation.

Serial hemodynamic measurements were obtained before, during, and after nitroprusside therapy over a 24 hour period in 19 patients requiring intra-aortic balloon pumping (IABP) for successful weaning from cardiopulmonary bypass. Nitroprusside, administered in doses ranging from 0.5 to 5 micrograms/kg/min, effected significant reductions in mean aortic pressure and systemic vascular resistance within 20 to 30 minutes. Mean aortic pressure decreased from 108 +/- 22 mm Hg to 85 +/- 27 mm Hg (p less than 0.005). Systemic vascular resistance decreased from 2,705 +/- 1,072 to 1,942 +/- 823 dynes sec cm-5 (p less than 0.005). 2n response to nitroprusside-induced decreases in left venticular afterload, cardiac indes increased from 1.83 +/- 0.58 to 2.04 +/- 0.54 L/min/m2 (p less than 0.025). Pulmonary capillary wedge pressure (PCW), right atrial pressure, right and left ventricular minute work indices, and the rate-pressure products did not change, indicating that nitroprusside administration during IABP further increased cardiac output without increasing ventricular filling pressure, ventricular work, or indices of myocardial oxygen consumption. The data suggest that nitroprusside, in conjunction with volume loading to optimal preload levels (PCW = 15 to 18 mm Hg), augments ventricular performance in postcardiotomy low-output syndrome by lowering impedance to left ventricular ejection through a direct dilator effect on vascular smooth muscle, without a direct effect on cardiac muscle. Thus it is a valuable pharmacologic adjunct during mechanical (IABP) support of the failing circulation.

Blood Pressure↗
PubMed1977

Danazol therapy in hormone-sensitive mammary carcinoma.

The effect of Danazol, a synthetic gonadotropin inhibitor, on two groups of Sprague-Dawley rats with dimethylbenze (a) anthracine (DMBA) induced mammary carcinoma was studied. Twenty-four (83%) of 29 control animals developed mammary tumors. Forty-four rats in one treatment group received Danazol after tumor reached 0.5 cm in diameter. Twenty-nine (66%) demonstrated tumor regression (p less than 0.005) and in 16 (36%) tumor disappeared (p less than 0.005). In a second treatment group (given Danazol daily after administration of DMBA), only seven of 50 rats (14%) developed palpable mammary carcinoma (p less than 0.0005). Danazol therapy resulted in regression of established mammary carcinoma in rats, and produced a striking inhibition of carcinogenesis in those animals treated from the time DMBA was administered. Danazol is clinically safe; studies using it in the treatment of breast cancer in women who are candidates for hormonal ablative therapy seem warranted.

9,10-Dimethyl-1,2-benzanthracene↗
PubMedDate not supplied

Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic responses to emergence and extubation.

STUDY OBJECTIVE: To define the ability of esmolol and alfentanil to control the hemodynamic changes associated with extubation and emergence. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: General surgery operating rooms at a university hospital. PATIENTS: Forty-two ASA physical status I and II patients without history of cardiac or pulmonary disease undergoing surgery not involving the cranium or thorax. INTERVENTIONS: Patients were given either a bolus dose of normal saline followed by an infusion of normal saline, a bolus dose of alfentanil 5 micrograms/kg followed by an infusion of normal saline, or a bolus dose of esmolol 500 micrograms/kg followed by an infusion of esmolol 300 micrograms/kg/min. MEASUREMENTS AND MAIN RESULTS: Emergency and extubation resulted in significant increases in heart rate (HR) and blood pressure (BP) in the placebo group. Alfentanil controlled the responses to emergence but prolonged the time to extubation (p < 0.05). Esmolol significantly controlled the responses to emergence and extubation (p < 0.05). CONCLUSIONS: Emergence and extubation after inhalation general anesthesia result in significant increases in BP and HR in healthy patients. An esmolol bolus dose and subsequent infusion significantly attenuated these responses. A small bolus dose of alfentanil minimized the responses to emergence but prolonged the time to extubation and was no longer protective at that point.

Adrenergic beta-Antagonists↗