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Biomedical subjects

T Pedersen

Publications and source records attributed to T Pedersen.

At least 109 records · Page 6Linked to original sources
PubMed1987

Mucopolysaccharidoses and anaesthetic risks.

The purpose of this review is to asses the current knowledge of mucopolysaccharidosis (MPS), with reference to the serious complications which may arise in connection with anaesthesia and operation. MPS consists of a heterogeneous group of hereditary diseases which are characterized by an abnormal accumulation of mucopolysaccharides, especially in cartilaginous and bone tissue. Because of their progressive and disabling nature, frequent surgical intervention is common, and is associated with a high degree of per- and postoperative risk. The clinical manifestations of MPS are frequently dwarfism, scaphocephaly, grotesque facial features with snub nose, hypertelorism, macroglossia and dental anomalies. The chest is deformed by pectus carinatum or excavatum, club-formed ribs and kyphosis with gibbus. Furthermore, cardiomegaly, abdomen pendens, hepatosplenomegaly, umbilical hernia, corneal clouding, conductive deafness and subnormal intelligence are common findings. Prior to operation, patients should be thoroughly evaluated through clinical examination and laboratory investigations. In particular, lung function should be optimized by lung physiotherapy and treatment of airway infections. When inducing general anaesthesia, spontaneous respiration is recommended until the patient has been intubated, as airway anomalies, bleeding and salivation may make intubation extremely difficult. Local or regional anaesthesia is often preferable, though age and mental status are relative contraindications. When used in combination with careful sedation, many problems may be overcome. Postoperatively, it is important to treat stagnation of secretions and airway infections with lung physiotherapy positive end-expiratory pressure, and antibiotics. In connection with anesthesia, it is vital to monitor the patient carefully before, during and after anaesthesia.

Anesthesia↗
PubMed1986

Effect of timolol on mortality and reinfarction after acute myocardial infarction: prognostic importance of heart rate at rest.

Long-term timolol treatment after acute myocardial infarction is associated with a significant reduction in mortality and nonfatal reinfarction. To evaluate whether the reduction in mortality and morbidity is exclusively or partly dependent on a reduction in heart rate (HR), cardiac events in the Norwegian Timolol Multicenter Study were analyzed according to resting HR at baseline and at 1 month of follow-up Resting HR at baseline was a significant predictor of total death and all events (total death plus nonfatal reinfarction) both in placebo- and in timolol-treated patients. In the placebo group the median resting HR was unchanged from baseline to 1 month control (72 beats/min), but was reduced from 72 beats/min to 56 beats/min in the timolol group. Resting HR during follow-up remained a significant predictor of total death. Further, mortality at a given HR during treatment was not markedly different whether the HR was spontaneous or caused by timolol. Timolol treatment was related to a significant reduction in mortality, and this study suggests that the major effect of timolol treatment on mortality after acute myocardial infarction may be attributed to the reduction in HR. Timolol treatment was also associated with an overall reduction in nonfatal reinfarction. However, nonfatal reinfarction was inversely related to resting HR during follow-up, indicating that although coronary artery occlusion in low-risk patients may cause nonfatal reinfarction, the outcome in high-risk patients is more likely to be death. When analyzing mortality and nonfatal reinfarction combined, timolol treatment was related to a reduction in cardiac events at any given HR, suggesting that factors in addition to HR reduction are important in the protective effects of timolol.

Clinical Trials as Topic↗
PubMed1986

Anaesthetic problems in Hurler-Scheie syndrome. Report of two cases.

Hurler-Scheie syndrome is an intermediate form of mucopolysaccharidosis. Affected patients characteristically present in infancy with serious abnormalities including the upper airways and the lungs. We present two patients with Hurler-Scheie syndrome and describe their anaesthetic management. One case was complicated by difficult endotracheal intubation and postoperative pneumonia. The second case was successfully managed using spinal anaesthesia and mild sedation.

Adolescent↗
PubMed1986

Effect of cimetidine on gastric mucosal cell proliferation in man.

Seven duodenal ulcer patients were treated for 3 months with cimetidine. Before and after treatment endoscopic biopsy specimens were taken for autoradiographic estimation of cell proliferation in the gastric mucosa in the antral and fundic part of the stomach and from the duodenum. In all three areas the estimated labeling index was increased during medication with cimetidine. The increase in epithelial cell renewal may participate in the ulcer healing effect of cimetidine.

Adult↗
PubMed1986

Effects of acetate and bicarbonate dialysis on cardiac performance, transmural myocardial perfusion and acid-base balance.

The effects of acetate and bicarbonate dialysis on cardiac performance, myocardial oxygen balance and acid-base balance were evaluated in 7 patients with end-stage renal failure. During acetate dialysis cardiac output increased and was significantly higher than during bicarbonate dialysis (p less than 0.05). Systemic vascular resistance was significantly lower during acetate than during bicarbonate dialysis (p less than 0.05). The myocardial oxygen balance estimated from the supply/demand ratio (DPTI/SPTI) was significantly reduced after acetate dialysis and significantly lower than during bicarbonate dialysis (p less than 0.05). After 90 min acetate dialysis DPTI/SPTI dropped to its lowest value as a result of an excess of myocardial oxygen demand (SPTI) over myocardial oxygen supply (DPTI), signifying transient hypoperfusion of the subendocardium which did not occur during bicarbonate dialysis. Acidosis was more adequately corrected with bicarbonate dialysis, and there was no change in pCO2 which was significantly higher than during acetate dialysis (p less than 0.05). During bicarbonate dialysis a stable hemodynamic circulation and well balanced acid-base values were seen. Acetate dialysis leads to improvement in left ventricular performance, but at the expense of myocardial oxygen balance, which falls to marginal safety levels in uremic patients.

Acetates↗
PubMed1986

Risk factors, complications and outcome in anaesthesia. A pilot study.

In a screening study the strength of association between individual risk factors and post-operative outcome was examined using three-dimensional variate analyses. In a study of 1016 patients, the incidence of life-threatening complications during anaesthesia was low (0.2%), whereas minor complications were seen in about 6% of the patients. Opiate overdose or residual curarization occurred in almost 2% of the cases. One hundred and eleven variables were prospectively assessed and 35 pre-operative variables were evaluated for their possible relationship to one event: post-operative mechanical ventilation (MV). The statistical method suggested that seven of the pre-operative variables seemed to be associated with post-operative MV. Eleven out of 20 patients with respiratory failure who were treated with MV died after anaesthesia (55%) compared with the overall hospital mortality of 2.7%.

Anesthesia↗
PubMed1985

Timolol maleate and HDL cholesterol after myocardial infarction.

The influence of long-term timolol treatment on plasma lipids was analysed in cohorts of the Norwegian timolol multicentre study. The prognostic importance of high-density lipoprotein (HDL) cholesterol concentration after myocardial infarction was also examined. One year timolol treatment was related to a significant reduction in HDL cholesterol levels, from 1.32 mmol l-1 to 1.26 mmol l-1 (P less than 0.05). After one year the HDL cholesterol levels were significantly lower in the timolol treated patients (1.26 mmol l-1) than in the placebo treated patients (1.32 mmol l-1, P less than 0.01). However, the HDL cholesterol values after myocardial infarction had no prognostic importance, and in the placebo group total mortality was the same in patients with low HDL cholesterol (less than 1.25 mmol l-1) and high HDL cholesterol (greater than or equal to 1.25 mmol l-1), respectively 15.0% and 14.8%. Timolol treatment was related to a reduction in mortality both in patients with low (24%, NS) and with high (43%, P less than 0.05) HDL cholesterol levels. Thus, any deleterious effects of timolol on serum lipids did not attenuate its protective effect on the damaged myocardium.

Cholesterol↗
PubMed1985

Comparison of bubble release from various types of oxygenators.

A comparative study of microbubble release from various types of oxygenators was performed using ultrasonic Doppler techniques. Bubble count versus amplitude histograms were calculated to derive the statistical distribution of the relative microbubble sizes. To compare the different oxygenators with respect to differences in microbubble releases, several key parameters as, temperature, liquid flow rate, gas to flow relationship, liquid level within the oxygenator, were altered one at a time to indicate different and oxygenator related sensitivities with respect to variations of the key parameters.

Extracorporeal Circulation↗
PubMed1985

Effect of acetate and bicarbonate dialysis on cardiac performance and transmural myocardial perfusion in patients with renal failure.

The object of the present study was to assess the haemodynamic changes measured by impedance cardiography during acetate and bicarbonate dialysis in uraemic patients without cardiovascular diseases. It was demonstrated that the cardiac output increased significantly after 60 minutes during acetate dialysis compared with bicarbonate dialysis while the peripheral resistance decreased significantly during acetate dialysis. As estimated by the diastolic systolic pressure time index ratio myocardial perfusion fell significantly following acetate dialysis as compared to bicarbonate dialysis. It is concluded that the work of the heart increases during acetate dialysis. This involves risk of myocardial hypoperfusion. It is therefore recommended that bicarbonate dialysis is the choice for patients with unstable circulation and/or ischaemic heart disease.

Acetates↗
PubMed1984

Dose-response relationships and neuromuscular blocking effects of vecuronium pancuronium during ketamine anaesthesia.

The dose-response curves of vecuronium and pancuronium were compared during ketamine anaesthesia in 60 patients (ASA I). The relationship between the probit transformed depression of twitch height and the logarithm of the dose was analysed by linear regression. Vecuronium was found to be 1.2 times more potent than pancuronium. ED50 of vecuronium and pancuronium were 30.5 microgram kg-1 and 37.0 microgram kg-1, and the ED95 45.6 microgram kg-1 and 59.5 microgram kg-1, respectively. Using equipotent doses of vecuronium and pancuronium (1.6 ED95) indices of neuromuscular blockade were compared in a further 20 patients (ASA I). No statistically significant difference was found in onset time. The duration of action following vecuronium was significantly shorter than after pancuronium. The time to 25% recovery of twitch height following vecuronium 73 microgram kg-1 was 22.2 min compared with 66.6 min following pancuronium 99 microgram kg-1. Following supplementary doses of vecuronium, a statistically significant increase in duration of action was seen following the fourth and fifth doses. Reversal time of vecuronium to a train-of-four ratio of 0.7 was significantly shorter than that of pancuronium (8.3 min and 13.6 min, respectively).

Adult↗