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At least 127 records · Page 7Linked to original sources

PubMed1975

Influence of lung resection on pulmonary circulation and lung function at rest and on exercise.

Since June 1972, preoperative evaluation of the pulmonary hemodynamics and lung function tests at rest and on exercise were done in patients undergoing thoracotomy with lung resection. 49 patients have been investigated postoperatively, 28 patients had pre- and postoperative rightsided heart catheterization. 80% of the patients were feeling well and more than 50% were working again. The pulmonary hemodynamics showed postoperatively already at rest an increase of the pulmonary artery pressures, the cardiac index reached on exercise no longer the preoperative values and there was an increase of PCV pressures on exercise compared to preoperative. Stroke volume, heart rate, AV difference for oxygen, oxygen uptake, PaO2, V, VD/VT, AadO2, and diffusing capacity for CO steady state on exercise showed no statistical significant changes. The extent of lung resection showed no different influence on the pulmonary circulation for the time period investigated.

Adult↗

PubMed1989

Exercise tolerance and cardiorespiratory response to exercise before and after the Fontan operation.

To determine the effect of the Fontan operation on exercise tolerance and cardiorespiratory response to exercise, we compared the preoperative and postoperative responses to graded exercise to maximal effort in 20 patients who underwent a modified Fontan procedure. The mean interval between preoperative and postoperative exercise testing was 1.8 years. Postoperatively, total work performed, duration of exercise, and maximal oxygen uptake were significantly increased. Although cardiac output increased during exercise, the response was subnormal, and stroke volume was unchanged. The heart rate and systolic blood pressure during maximal exercise were not significantly changed from preoperative values, but the diastolic blood pressures during rest and maximal exercise were significantly increased postoperatively. Systemic arterial blood oxygen saturation increased after the modified Fontan operation, but during exercise, a mild but significant desaturation occurred (93% compared with 90%). The ventilatory equivalent for oxygen decreased toward normal during exercise. The respiratory rate and oxygen consumption during resting remained unchanged from preoperative values. For this subset of patients, these data indicate that exercise tolerance improves, cardiac output and stroke volume responses to exercise are subnormal, and ventilatory response to exercise decreases toward normal after the modified Fontan operation.

Adolescent↗

PubMed1979

Effect of exercise upon locomotor balance modification after peripheral vestibular lesions (unilateral utricular neurotomy) in squirrel monkeys.

In this study, we placed unilateral utricular nerve section and measured the locomotor equilibrium function (deviation counts of the animal's trotting gait) by the squirrel monkey platform runway test. We applied physical exercise, both preoperatively (3 weeks) and postoperatively. 21 young adult squirrel monkeys were randomly assigned to three groups (7 each): rotating cage exercise (continuous trotting in the motor-driven rotating cage) group, rail-traversing exercise (60 running shuttles on the rotating rail) group, and control nonexercise group. After the statistical analyses on data it was found that the physical exercise showed some effect; however, the type, daily amount, and number of days applied must be quite substantial.

Animals↗

PubMed1988

Transcutaneous oxygen tension exercise profile. A method for objectively assessing the results after reconstructive peripheral arterial surgery.

Transcutaneous oxygen tension during exercise (TcPo2 exercise profile) was measured on the foot in 10 patients before reconstructive vascular surgery and 9 and 18 months later. The preoperative TcPo2 exercise profiles were abnormal in all 10 patients. In 9 of the patients the reconstructions were successful. In these patients the TcPo2 exercise profiles reverted to normal. In a control group of six healthy persons no significant changes in TcPo2 were observed during the follow-up period of 18 months. The reproducibility determined as the total week-to-week variation of claudicants and controls was 8%. The TcPo2 exercise test is suitable for monitoring the patient after reconstructive surgery, because it is based exclusively on objective data is non-invasive and the measurements are reproducible.

Adult↗

PubMed1995

Effect of atrial fibrillation on exercise capacity in mitral stenosis.

To determine the preoperative and postoperative effect of atrial fibrillation (AF) on exercise capacity in mitral stenosis, 12 digitalized patients in AF (7 women and 5 men, age 52 +/- 6.1 years) and 10 in sinus rhythm (5 women and 5 men, age 46 +/- 5 years) underwent maximal cardiopulmonary exercise testing according to Weber's protocol and Doppler echocardiographic examination before and at 3 and 6 months after mitral valve replacement. The ratio of right ventricular acceleration to ejection time was used as an estimate of mean pulmonary artery pressure. Preoperative exercise duration (6.8 +/- 1 vs 8 +/- 2 minutes), peak oxygen consumption (9.7 +/- 3 vs 12.3 +/- 3 ml/kg/min), and right ventricular acceleration to ejection time ratio (0.34 +/- 0.07 vs 0.34 +/- 0.08) were not significantly different between patients with AF and those in sinus rhythm. Postoperative improvement in these parameters was lower in patients with AF than in those in sinus rhythm: exercise duration at 3 months, 7.5 +/- 2 vs 11.9 +/- 2 minutes (p < 0.001); at 6 months, 9 +/- 2 vs 12 +/- 2 minutes (p < 0.001); peak oxygen consumption at 3 months, 10.8 +/- 3 vs 17.5 +/- 3 ml/kg/min (p < 0.001); and at 6 months, 11.9 +/- 3 vs 17.8 +/- 3 ml/kg/min (p < 0.001); right ventricular acceleration to ejection time ratio at 3 months, 0.35 +/- 0.08 vs 0.42 +/- 0.05 (p < 0.05); and at 6 months, 0.38 +/- 0.05 vs 0.44 +/- 0.05 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗

PubMed2002

Preoperative physical activity, anesthesia, and analgesia: effects on early postoperative walking after total hip replacement.

This study explored whether preoperative activity, anesthesia, or analgesia influence early postoperative walking after total hip replacement (THR). Data were collected as part of a randomized intervention study of standard or augmented postoperative activity and its influence on wound healing. More than half of all subjects did not exercise regularly. Subjects who performed strength activities preoperatively walked significantly greater distances. Anesthesia or analgesia did not affect walking distances. Upper arm strength is needed after THR because walking is dependent on the use of assistive devices. These results suggest: (1) preoperative exercise may promote recovery of mobility after THR, and (2) a need to evaluate preoperative exercise programs for effect on mobility and independence after THR.

Aged↗

PubMed1981

[Examination of the effect of aorto-coronary revascularisation by means of exercise tests (author's transl)].

The purpose of this study was to determine the value of exercise tests in the examination of the effect of aorto-coronary revascularisation. 48 patients (mean age 52 +/- 6 years) were examined 5.0 +/- 1.9 months before and 4.9 +/- 3.0 months after coronary revascularisation by means of coronary and left ventricular angiography. Left ventricular function at rest was unchanged. 122 grafts were constructed, the patency rate was 86%. Preoperatively two exercise tests with a bicycle ergometer were performed, some days before angiography and some days before operation, respectively. A third test was performed postoperatively (again some days before angiography). During exercise at identical work load, heart rate and systolic blood pressure did not change significantly pre- and postoperatively. At the second preoperative examination, pulmonary artery pressure (31.6 +/- 11.3 mm Hg) was significantly lower than at the first examination (36.3 +/- 10.8 mm Hg). Postoperatively there was a further decrease of mean pulmonary artery pressure (27.6 +/- 6.5 mm Hg). At the highest work load, mean pulmonary artery pressure was significantly lower at the second preoperative and at the postoperative examination (34.4 +/- 11.6 and 31.3 +/- 8.1 mm Hg versus 39.6 +/- 9.8 mm Hg). The explanation of the preoperative reduction of pulmonary artery pressure is not clear. The pressure decrease must be considered in the examination of the effect of aorto-coronary revascularisation by means of exercise tests.

Coronary Angiography↗

PubMed1982

Left ventricular performance before and after aortocoronary artery bypass surgery.

Left ventricular performance was studied before and late (mean 12-17 months) after aortocoronary artery bypass surgery by quantitative, computer-based videoangiography. We measured total function (left ventricular ejection fraction, volumes and end-diastolic pressure) at rest (in 60 patients) and before and after exercise (abnormal exercise hemodynamics preoperatively in 32 patients) and regional function (peak rate of systolic wall thickening) at rest (in 60 patients) and before and after administration of nitroglycerin (in 19 patients). Total left ventricular function at rest is usually unchanged postoperatively. Exercise hemodynamics are more sensitive indexes of performance and, if abnormal, usually improve postoperatively if revascularization has been complete and extensive myocardial infarction has not occurred. Regional myocardial function usually improves postoperatively if the bypass graft to the region is patent and has a blood flow of more than 60 ml/min (measured late postoperatively by videodensitometry) and if no previous infarction was present in the region. Myocardial infarction and graft blood flow of 40 ml/min or less are the two main factors that prevent improvement in abnormal regions defined by the regional wall thickening method when bypass grafts are patent. Regions supplied by occluded grafts show decreases in regional function. The preoperative wall-thickening response to administration of nitroglycerin can be used to distinguish ischemia and significant myocardial infarction and to predict the successful response to aortocoronary bypass graft surgery.

Blood Pressure↗

PubMed1981

Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease.

Electrocardiographically monitored arterial stress testing was performed before surgery in 130 patients with peripheral vascular disease. When limitations of claudication or pain at rest precluded treadmill exercise, arm ergometry was employed. The electrocardiographically monitored arterial stress test proved a cost-effective, easily applicable means of screening for coronary artery disease in this group of patients. Unlike statistical analyses of historical risk factors, the electrocardiographically monitored arterial stress test evaluates the current functional state of the myocardium. We believe that preoperative electrocardiographic exercise testing should be employed more widely and should be considered in any patient facing major surgery in whom coronary artery disease is suspected on the basis of past history or known risk factors. In patients who have an ischemic response to exercise, particularly at less than 75 percent of the maximum predicted heart rate, coronary angiography and possibly coronary revascularization should be considered before elective major surgery is performed.

Aged↗

PubMed1986

Pulmonary atresia with ventricular septal defect: preoperative and postoperative responses to exercise.

Between April 1982 and June 1984, maximal exercise testing was performed 35 times in 34 consecutive patients with pulmonary atresia and ventricular septal defect (14 studies in patients without repair, 11 studies in patients with partial repair [insertion of a right ventricle to pulmonary artery conduit without ventricular septal defect closure] and 10 studies in patients with complete repair [insertion of a conduit with septal defect closure]). Total work performed, maximal power achieved, exercise time and maximal oxygen uptake were significantly greater in patients after partial or complete repair than in patients without repair. Systemic arterial blood oxygen saturations at rest and during exercise were directly related to the degree of repair. Although heart rate at rest in the three study groups was similar to that in a separate group of normal control subjects, patients in all three study groups had a blunted heart rate response to exercise. The ventilatory equivalent for oxygen was increased both at rest and during exercise for patients without conduit repair and those with a right ventricle to pulmonary artery conduit without ventricular septal defect closure but was similar to that of control subjects in the group with conduit insertion and septal defect closure. This study indicates that patients with pulmonary atresia and ventricular septal defect have decreased exercise tolerance both before and after corrective surgery. Exercise tolerance improves significantly after placement of a conduit from the right ventricle to the pulmonary artery with or without ventricular septal defect closure. Although no further improvement in exercise tolerance occurs with closure of the septal defect, ventilatory function and systemic arterial blood oxygen saturation are improved.

Adolescent↗

PubMed2000

Exercise capacity of thoracotomy patients in the early postoperative period.

OBJECTIVE: We investigated the mechanism involved with the initial drop and subsequent recovery of exercise capacity in the early postoperative period of thoracotomy patients. METHODS: Sixteen patients (13 who had undergone lobectomy, 3 who had undergone pneumonectomy) underwent a routine pulmonary function test (PFT) and a cardiopulmonary exercise test preoperatively, within 14 postoperative days (POD; post-1; mean +/- SD, 9 +/- 2 POD), and after 14 POD (post-2; mean, 26 +/- 12 POD). RESULTS: After surgery on post-1, PFT results of FVC, FEV(1), and maximum ventilatory volume (MVV) significantly decreased. Oxygen uptake (VO(2)) at a venous blood lactate level of 2.2 mmol/L (La-2. 2), which was adopted as the empirical anaerobic threshold, and maximum V O(2) (VO(2)max) decreased significantly to 88.2 +/- 7.9% and 73.1 +/- 15.4% of the preoperative values, respectively. La-2.2 min ventilation (VE)/ MVV and maximum VEmax)/MVV increased significantly from 0.36 +/- 0.08 to 0. 66 +/- 0.20 and from 0.58 +/- 0.14 to 0.80 +/- 0.09, respectively. On post-2, though La-2.2 VO(2) did not change, VO(2)max improved significantly to 81.5 +/- 19.7% of the preoperative values, in association with significant increases in maximal tidal volume and VEmax, which were produced by significant increases in the PFT results. La-2.2 VE/MVV also decreased significantly to 0.49 +/- 0.13, which indicated a sufficient recovery of respiratory reserve at submaximal exercise. CONCLUSIONS: The initial drop of exercise capacity after lung resection seems to be derived from both circulatory and ventilatory limitations. Further, the subsequent recovery within 1 month seems to be produced by an improvement in ventilatory limitation, which was caused by the surgical injury to the chest wall.

Adaptation, Physiological↗

PubMed1984

Changes in cardiac functional capacity after coronary bypass surgery in relation to adequacy of revascularization.

Seventy patients having aortocoronary vein bypass grafting surgery for angina pectoris underwent preoperative invasive exercise testing to symptom limits and again 6 to 14 months postoperatively. Cardiac output was measured using the direct Fick principle. Postoperatively at maximal exercise, there was a 3.11 liters/min (p less than 0.0001) increase in cardiac output in men (n = 61) and a 2.04 liters/min (p less than 0.01) increase in women (n = 9). Patients with complete revascularization showed a significantly greater improvement in cardiac output postoperatively than did those with incomplete revascularization (26 versus 6%, p less than 0.0001). The major reason for the increased maximal cardiac output was a marked increase in heart rate while stroke volume was maintained at the same preoperative level. These findings were true irrespective of preoperative use of beta-adrenergic blocking drugs.

Adrenergic beta-Antagonists↗

PubMed2002

Recovery after uncomplicated laparoscopic cholecystectomy.

BACKGROUND: After laparoscopic cholecystectomy, the duration of convalescence is 2 to 3 weeks with an unclear pathogenesis. This study was undertaken to analyze postoperative recovery after uncomplicated elective laparoscopic cholecystectomy. METHODS: Twenty-four consecutive unselected employed patients were followed up prospectively from 1 week before to 1 week after outpatient laparoscopic cholecystectomy. Daily computerized monitoring of physical motor activity and sleep duration and night sleep fragmentation (actigraphy), subjective sleep quality, pulmonary function, pain, and fatigue were registered. Treadmill exercise performance (preoperatively and at postoperative days 2 and 8) and nocturnal pulse oximetry at the patients' homes (preoperatively and postoperative nights 1-3) were completed. RESULTS: Median age was 41 years (range, 21-56). Compared with preoperatively, levels of physical motor activity, fatigue, and pain scores were normalized 2 days after operation. Subjective sleep quality was significantly worsened on the first postoperative night, and sleep duration was significantly increased on the first 2 postoperative nights. There were no significant perioperative changes in actigraphy night sleep fragmentation, incidence of self-reported awakenings or nightmares/distressing dreams, exercise performance, or nocturnal oxygenation. Pulmonary peak flow measurements were normalized the day after operation. CONCLUSION: After uncomplicated outpatient laparoscopic cholecystectomy, there is no pathophysiologic basis for recommending a postoperative convalescence of more than 2 to 3 days in otherwise healthy younger patients.

Adult↗

PubMed1978

Central haemodynamics during induction of neurolept anaesthesia in patients with arteriosclerotic heart disease.

The haemodynamic changes occurring during induction of neurolept anaesthesia and intubation in patients with reduced cardiac reserve were compared with the haemodynamic changes observed prior to operation during the stress of moderate physical exercise in the same patients. Anaesthesia consisted of droperidolum NFN (Dehydrobenzperidol), fentanyli citras NFN (Haldid) and nitrous oxide-oxygen with suxamethonium for intubation. The haemodynamic parameters measured were mean arterial blood pressure, central venous pressure, pulmonary artery mean pressure, pulmonary capillary wedge pressure and cardiac output. Blood volume was also measured, as were arterial blood-gas tensions and pH. The haemodynamic changes observed during induction with intubation were significantly smaller than those observed preoperatively during exercise.

Aged↗

PubMed2004

Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resection.

PURPOSE: As cardiopulmonary load increases with the amount of lung resected, to perform surgery safely it is important to be able to predict cardiopulmonary insufficiency. However, lung function testing with spirometry and blood gas analysis does not accurately measure cardiopulmonary reserve. We conducted this study to evaluate expired gas analysis during exercise testing for predicting postoperative complications after lung resection. METHODS: Expired gas analysis during exercise and spirometry were done 1 week preoperatively in 211 patients who underwent pulmonary resection for lung cancer. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B). RESULTS: In group B there were more men than women (P < 0.01), and the mean age was greater (P < 0.05). There was no difference in disease stage, but more patients underwent pneumonectomy in group B than in group A ( P < 0.005). The results of expired gas analysis during exercise testing and of spirometry showed that maximum oxygen uptake/m(2) (P < 0.0005), anaerobic threshold/m(2) (P < 0.01), vital capacity (VC)/m(2) (P < 0.005), %VC (P < 0.0001), forced expiratory volume in 1 s (FEV(1.0))/m(2) (P < 0.0001), and FEV(1.0%) (P < 0.05) were lower in group B than in group A. CONCLUSIONS: The combination of expired gas analysis during exercise and conventional pulmonary function tests identified patients at risk for postoperative cardiopulmonary complications following pulmonary resection.

Aged↗

PubMed2000

Exercise following heart transplantation.

During the past 2 decades, heart transplantation has evolved from an experimental procedure to an accepted life-extending therapy for patients with endstage heart failure. However, with dramatic improvements in organ preservation, surgery and immunosuppressive drug management, short term survival is no longer the pivotal issue for most heart transplant recipients (HTR). Rather, a return to functional lifestyle with good quality of life is now the desired procedural outcome. To achieve this outcome, aggressive exercise rehabilitation is essential. HTR present unique exercise challenges. Preoperatively, most of these patients had chronic debilitating cardiac illness. Many HTR have had prolonged pretransplantation hospitalisation for inotropic support or a ventricular assist device. Decrements in peak oxygen consumption (VO2peak) and related cardiovascular parameters regress approximately 26% within the first 1 to 3 weeks of sustained bed rest. Consequently, extremely poor aerobic capacity and cardiac cachexia are not unusual occurrences in HTR who have required mechanical support or been confined to bed rest. Moreover, HTR must also contend with de novo exercise challenges conferred by chronic cardiac denervation and the multiple sequelae resulting from immunosuppression therapy. There is ample evidence that both endurance and resistance training are well tolerated in HTR. Moreover, there is growing clinical consensus that specific endurance and resistance training regimens in HTR can be efficacious adjunctive therapies in the prevention of immunosuppression-induced adverse effects and the reversal of pathophysiological consequences associated with cardiac denervation and antecedent heart failure. For example, some HTR who remain compliant during strenuous long term endurance training programmes achieve peak heart rate and VO2peak values late after transplantation that approach age-matched norms (up to approximately 95% of predicted). These benefits are not seen in HTR who do not participate in structured endurance exercise training. Rather, peak heart rate and VO2peak values in untrained HTR remain approximately 60 to 70% of predicted indefinitely. However, the mechanisms responsible for improved peak heart rate, VO2peak and total exercise time are not completely understood and require further investigation. Recent studies have also demonstrated that resistance exercise training may be an effective countermeasure for corticosteroid-induced osteoporosis and skeletal muscle myopathy. HTR who participate in specific resistance training programmes successfully restore bone mineral density (BMD) in both the axial and appendicular skeleton to pretransplantation levels, increase lean mass to levels greater than pretransplantation, and reduce body fat. In contrast, HTR who do not participate in resistance training lose approximately 15% BMD from the lumbar spine early in the postoperative period and experience further gradual reductions in BMD and muscle mass late after transplantation.

Adrenal Cortex Hormones↗

PubMed1992

Predictors of exercise benefit after operative relief of left ventricular outflow obstruction by the myotomy-myectomy procedure in hypertrophic cardiomyopathy.

To determine predictors of exercise benefit in patients with hypertrophic cardiomyopathy after operative relief of left ventricular (LV) outflow tract obstruction, 30 patients underwent catheterization and exercise testing before and 6 months after operation, and hemodynamic measurements were obtained. The increase in maximal oxygen consumption (VO2max) during treadmill exercise testing was chosen as an index of exercise benefit. Univariate analysis showed a significant positive correlation of operative change in VO2max with preoperative LV end-diastolic and pulmonary arterial wedge pressures, operative change in exercise duration, and operative reductions in LV end-diastolic and pulmonary arterial wedge pressures and resting LV outflow tract gradient, and a significant negative correlation with preoperative VO2max and percent predicted VO2max. Multivariate analysis by stepwise linear regression of only significant univariate variables selected only preoperative percent predicted VO2max, and operative reduction in LV end-diastolic pressure and resting LV outflow tract gradient as significant predictors of postoperative change in VO2max. Stepwise regression analysis, applied only to preoperative exercise and catheterization hemodynamic variables, selected only preoperative percent predicted VO2max and preoperative LV end-diastolic pressure as predictors of improvement in exercise capacity. Thus, patients with obstructive hypertrophic cardiomyopathy, after failing medical therapy, are most likely to demonstrate improvement in exercise capacity if preoperative exercise testing demonstrates limited exercise capacity and if surgery achieves reduction in elevated resting LV outflow tract gradients and LV filling pressures.

Adult↗

PubMed1980

Medicine in orthopaedics: a role for the rheumatologist?

In a seven-month period 102 patients admitted for elective orthopaedic surgery (total hip replacement for more than 50%) were referred for a medical opinion, and more than 70% were seen preoperatively. Twenty-nine patients were considered unfit for operation for a variety of different reasons, but after suitable treatment surgery was possible for most of this group. General practitioners and surgeons alike provided insufficient information prior to admission, and this resulted in postponement of operations. A wide variety of conditions was seen pre- and post-operatively, and a very high level of diagnostic criticism was maintained by orthopaedic junior staff but management of certain metabolic conditions was poor. As the number of elderly patients requiring joint replacement surgery increases, great care must be exercised in preoperative assessment in order to maintain an economic service. Combined orthopaedic and rheumatology consultation might be advantageous.

Adolescent↗