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At least 721 records · Page 40Linked to original sources
PubMed1991

Lung glutamine flux following open heart surgery.

Despite the attenuated skeletal muscle proteolysis that occurs following hypothermic anesthesia and open heart surgery, blood amino acid levels are maintained, suggesting enhanced amino acid release by another organ. To investigate the role of the lung in this response, we determined the release of glutamine (Gln) and alanine by the lung, since these two amino acids transport two-thirds of circulating amino acid nitrogen. Three groups of patients were studied: (a) preoperative non-stressed controls; (b) postoperative general surgical patients; and (c) postoperative cardiac surgical patients studied on Postoperative Day 1 following open heart surgery requiring cardiopulmonary bypass and hypothermic anesthesia. In preoperative controls the lung was an organ of glutamine and alanine balance. These exchange rates were unaffected by the stress of an abdominal surgical procedure despite a mild increase in pulmonary blood flow. However, lung Gln release in the cardiac surgical patients was significantly increased (-0.6 +/- 1.2 mumole/kg/min in controls vs -6.5 +/- 1.3 mumole/kg/min in postoperative hearts, P less than 0.05) and was due exclusively to an increase in the pulmonary artery-systemic arterial concentration difference. Alanine release by the lungs was also increased in the postoperative cardiac surgical patients. The mechanism by which this augmented pulmonary glutamine release occurs following open heart surgery is unclear, but the lungs appear to play a central role in maintaining amino acid homeostasis. This metabolic role of the lungs following hypothermic anesthesia and cardiopulmonary bypass has not been previously described.

Amino Acids↗
PubMed2002

Effect of arterial baroreceptor denervation on sodium balance.

During chronic increased dietary sodium intake, arterial baroreceptors buffer against sustained increases in arterial pressure, and renal sympathoinhibition contributes importantly to the maintenance of sodium balance by decreasing renal tubular sodium reabsorption and increasing urinary sodium excretion. The present study examined the effect of arterial baroreceptor denervation on sodium balance in conscious rats during low, normal, and high dietary sodium intake. Compared with measurements made before arterial baroreceptor denervation, arterial baroreceptor-denervated rats had similar sodium balance during normal dietary sodium intake but significantly more negative sodium balance during low dietary sodium intake and significantly more positive sodium balance during high dietary sodium intake. At the end of the high dietary sodium intake period, arterial pressure (under anesthesia) was 159+/-5 mm Hg after arterial baroreceptor denervation and 115+/-1 mm Hg before arterial baroreceptor denervation. Sham arterial baroreceptor denervation in time control rats had no effect on sodium balance or arterial pressure during the different dietary sodium intakes. These studies indicate that (1) arterial baroreceptor denervation impairs the ability to establish sodium balance during both low and high dietary sodium intake, and (2) arterial baroreceptor denervation leads to the development of increased arterial pressure during high dietary sodium intake in association with increased renal sodium retention.

Animals↗
PubMed2001

GDNF improves cerebellar Purkinje neuron function in aged F344 rats.

Aging is associated with a decline in the function of beta-adrenergic receptor responses in the cerebellum. This decline in noradrenergic receptor sensitivity may underlie some of the accompanying age-related declines in motoric learning behaviors. Glial cell line-derived neurotrophic factor (GDNF) has been reported to prevent the degeneration of noradrenergic neurons following neurotoxic lesions. Thus, it was of interest to examine if GDNF would have a beneficial effect on age-related declines in noradrenergic function. Eighteen-month-old F344 rats were injected with 500 microg GDNF in 20 microl into the cisterna magna. Three weeks following GDNF or vehicle treatment, rats were tested on a motor coordination task and then examined electrophysiologically under urethane anesthesia. GDNF did not produce an improvement in performance on an inclined balance beam or an accelerating rotorod. In young (3-month-old) F344 rats isoproterenol (ISO) will increase GABAergic inhibitions in the majority of cells examined; however, in aged rats only about 30% of neurons demonstrate this phenotype. In the aged rats treated with GDNF, ISO was able to increase GABAergic inhibitions in greater than 75% of the neurons tested, thus returning the neurons to a young phenotype. We examined the brains for expression of bcl-2, which has been shown to be increased in the aged cerebellum. GDNF was able to down-regulate this neuronal signal. Thus, intra-cisterna magna delivery of GDNF to aged rats improved beta-adrenergic receptor function and reduced stress related signaling of bcl-2 in the aged F344 rats to a level similar to that observed in young rats.

Aging↗
PubMed2001

Arterial blood gas and pH analysis. Clinical approach and interpretation.

Arterial blood gas and pH analysis are performed during anesthesia or critical care medicine for (1) assessment of acid-base balance, (2) assessment of pulmonary oxygenation of arterial blood, and (3) assessment of alveolar ventilation by measurement of arterial blood PCO2. Total physiologic and alveolar dead spaces are evaluated by comparing the alveolar PCO2 with the mixed expired and mixed alveolar PCO2, respectively. This article provides a clinical approach and interpretation of arterial blood gas and pH analysis.

Acid-Base Equilibrium↗
PubMed1999

Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: a prospective randomized study.

BACKGROUND: Several studies demonstrated the feasibility of minimally invasive parathyroidectomy as a treatment for primary hyperparathyroidism. We compared its results with those of traditional surgery in a prospective randomized study. METHODS: From March to November 1998, 38 patients eligible for video-assisted parathyroidectomy (VAP) were referred to us. They were randomly divided into 2 groups: patients of group A underwent a conventional cervicotomy with bilateral exploration and frozen section of the removed adenoma; patients of group B underwent VAP with intraoperative measurement of parathyroid hormone. Operative time, postoperative pain, fever and hypocalcemia, cosmetic result, and costs were compared. Two cases of VAP were performed with locoregional anesthesia. RESULTS: Groups A (18 patients) and B (20 patients) were statistically balanced. Operative time was significantly shorter in group B (57 vs 70 minutes). Cosmetic result was significantly better in group B, which also experienced less postoperative pain (P < .05). No cases of persistent primary hyperparathyroidism were present in either group, but recurrent laryngeal nerve palsy occurred in 1 patient in group B. CONCLUSIONS: Compared with conventional surgery, VAP is associated with a shorter operative time, a better cosmetic result, and a less painful postoperative course.

Adult↗
PubMed1993

An alternative method of increasing PCO2 using apnoea and continuous positive airway pressure.

We have examined the use of continuous positive airway pressure (CPAP) and apnoeic oxygenation for restoration of spontaneous breathing at the end of anaesthesia after controlled ventilation. We studied 45 adult patients without a history of acute or chronic respiratory disturbances. Anaesthesia was induced with thiopentone or propofol and maintained with nitrous oxide and enflurane in oxygen. The patients were normocapnic during artificial ventilation. At the end of surgery, the lungs were ventilated for 5 min with oxygen and then given a CPAP of 8 cm H2O. Spontaneous ventilation was regained after a mean of 5 min and an arterial blood sample was obtained at the third breath. All patients were well oxygenated (PO2 mean 43.5 kPa, range 21-76 kPa) when spontaneous ventilation started. The pH was close to 7.28 in most cases (mean 7.28, range 7.21-7.32), and PCO2 varied in the range 6.6-9.9 kPa (mean 7.9 kPa). It is concluded that the method is safe with regard to oxygenation and acid-base balance.

Adolescent↗
PubMed1975

Epidural anaesthesia as an alternative to caesarean section in the treatment of prolonged, exhaustive labour.

Epidural anaesthesia was given to nine parturients who were considered candidates for delivery by caesarena section due to prolonged exhaustive labour. Upon pain relief and oxytocin infucion guided by cardiotocography, vaginal delivery took place. Delivery was spontaneous in seven cases, two were instrumentally delivered. It is concluded that an efficient epidural block tends to restore uterine contractility by reducing the inhibitory influences exerted by adrenergic mechanisms and unfavourable changes in the acid-base balance.

Adult↗
PubMed1978

Control of intracranial pressure during pediatric neurosurgery anesthesia.

Some of the important points of view of anesthesia in pediatric neurosurgery are: adequate alveolar exchange of oxygen and carbondioxide by means of artificial ventilation; stable cardiovascular function; fluid balance; monitoring, and attempts to keep intracranial pressure low. This last point is achieved by various anesthesiological procedures, e.g., hyperventilation, positive-negative pressure ventilation, rapid induction of anesthesia and choice of suitable anesthetics. Enflurane (Ethrane) increases intracranial pressure less than halothane. The new intravenous anesthetic etomidate lowers intracranial pressure in a favorable manner quite similar to thiopental (Pentothal-Sodium).

Anesthesia↗
PubMed2005

Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery.

Fluid therapy is one of the most controversial topics in perioperative management. There is continuing debate with regard to the quantity and the type of fluid resuscitation during elective major surgery. However, there are increasing reports of perioperative excessive intravascular volume leading to increased postoperative morbidity and mortality. Recent evidence suggests that judicious perioperative fluid therapy improves outcome after major elective gastrointestinal surgery. The observed benefits may not be solely attributable to crystalloid restriction but also to the use of colloids instead. Some clinically useful guidelines based on the studies discussed in this review include avoidance of deep general anesthesia and elimination of preload for patients who receive epidural analgesia. A balanced approach to fluid management is recommended, with colloids administered to provide hemodynamic stability and maintain urine output of 0.5 mL x kg(-1) x h(-1) and crystalloids administered only for maintenance. In addition, blood loss may be replaced with colloid on a volume-to-volume basis. Furthermore, predetermined algorithms that suggest replacement of third space losses and losses through diuresis are unnecessary. Significant reduction in crystalloid volume can be achieved without encountering intraoperative hemodynamic instability or reduced (i.e., < 0.5 mL x kg(-1) x h(-1)) urinary output just by avoiding replacement of third space losses and preloading. Finally, there is a need for well-controlled studies in a well-defined patient population using clear criteria or end-points for perioperative fluid therapy.

Blood Volume↗
PubMed1989

[Influence of tooth extraction on postural stability].

A study was conducted to analyze how tooth extraction procedure would affect patient's physical equilibrium sensation, using the positional centric equilibrium measuring device. Forty-five health subjects, between the ages of 20 to 30, with no systemic nor equilibrium abnormalities were selected for this study. The results obtained were as follows. 1. No noticeable changes in the centric movement were observed during the postural change from a sitting to a standing position. 2. Centric movement was transiently increased immediately after the movement from a horizontal to standing position. The average arterial pressure was decreased immediately after the alteration in body posture, suggesting that changes in body posture may influence the controlling mechanism of BP. 3. Increases in the area and velocity of the centric movement were found immediately after and up to 10 minutes after, respectively, topical administration of the anesthetic. During this time span, no correlation found between centric movement changes and circulatory changes suggested that topical anesthesia might influence the recovery reflex via central nervous system. 4. The effect of the extraction procedure on the centric movement area and the anteroposterior centric movement speed lasted for 10 minutes after extraction. On the other hand, the increase in the velocity of bilateral centric movement as well as whole body centric movement was found up to a point immediately after extraction. No correlation was found between circulatory changes and centric movement changes. It therefore was assumed that the topical anesthesia affected the recovery reflex via central nervous system.

Adolescent↗
PubMed1985

Adrenalectomy in the ferret.

A simple adrenalectomy technique is presented for the ferret (Mustela putorius furo). The adrenal glands were removed in two operations with an interim recovery period of approximately 1 week. The right adrenal should be removed first, as the surgery is complicated on that side by fascia which binds the adrenal to the inferior vena cava. Salt solution (1% NaCl) in place of water will maintain sodium balance.

Adrenalectomy↗
PubMed1998

Surgical treatment of atherosclerotic lesions of subclavian artery: carotid-subclavian bypass versus subclavian-carotid transposition.

BACKGROUND: The aim of this retrospective study is to analyze the short and long term results of two different surgical treatments in patients with subclavian lesions: common carotid-subclavian artery bypass (CSB) versus transposition of subclavian artery on the common carotid artery (SCT). METHODS: From 1981 until 1995, 40 non randomized patients with symptomatic subclavian steal underwent 20 CSBs and 20 SCTs. Risk factor rates were equally balanced in the two groups. Surgery was carried out routinely under general anesthesia, with electroencephalic continuous monitoring. Patency of revascularization was assessed by physical examination, brachial blood pressure determinations, ultrasound sonography and angiography whenever recurrence of symptoms developed or when the function of repair was in doubt. Patients were examined every year. In Spring 1996 (range 9-189 mos, average 7 years) a general clinical-instrumental follow-up was performed. RESULTS: In the short term (<30 days) mortality was 5%: one death (5%) for pulmonary embolism in a patient with CSB and one for myocardial infarction in a patient with SCT. The early thrombosis rate was 5% (1 CSB and 1 common carotid artery distal to a patent SCT). During follow-up 10 patients (25%) died and 6 were lost. The six-year actuarial patency rate was 100% for SCT and 66% for CSB. Moreover there were 3 thromboses of the vertebral artery homolateral to patent CSBs. CONCLUSIONS: In conclusions SCT should be considered the surgical technical choice for the treatment of proximal subclavian artery lesions.

Adult↗
PubMed1979

[Sympathetic-adrenal and enterochromaffin systems and homeostatic indices in open-heart surgical operations under morphine anesthesia].

Catecholamine, serotonin and histamine metabolism and the level of acid metabolites and the activity of the enzymes lactate dehydrogenase and catalse in blood were studied in patients with congenital heart disease who were operated on under conditions of extracorporeal circulation and morphine anesthesia. The results obtained were compared with the values of acid-base balance, haemodynamics and volume of diuresis. It wwas found that the period of morphine induction was marked by a significant increase in the blood plasma noradrenalin content in the absence of essential changes in the other biochemical and hemodynamic indices studied. No significant changes were noted in the systems of neurohumoral and tissue regulation, indices of the redox processes and renal excretion in the most traumatic periods of the operation. The data obtained allow morphine to be accepted as an anesthetic which provides adequate protection of the organism from operative trauma.

Adolescent↗