Prediction of adverse cardiac outcomes in high-risk Mexican patients with chest pain in the emergency department / Desenlaces adversos cardiovasculares en pacientes mexicanos de alto riesgo con dolor torácico en el servicio de urgencias

Abstract Objective: The aim of the study was to compare the discriminative power and accuracy for prediction of MACE of five commonly used scoring tools in Mexican patients with chest pain who present to the ED. Methods: A single-center, prospective, observational, and comparative study of patients admitted to the ED with chest pain as the chief complaint. Five chest pain scoring systems were calculated. The primary endpoint was the composite of cardiovascular death, myocardial infarction, coronary intervention, coronary artery bypass grafting, or readmission for cardiovascular causes within 30 days. Results: A total of 168 patients were studied. The score which provided the highest area under the curve of 0.76 (95% CI: 0.70-0.85) was history, ECG, age, risk factors, and troponin (HEART) score. In addition, the integrated discrimination index for the HEART score was 6% higher when compared to the other four scores. Conclusions: The HEART score provided the best classification tool for identifying those patients at highest risk for MACE, either alone or by adding their results to other classification scores, even in a comorbid population.

Resumen Objetivo: Comparar el poder discriminativo y precisión diagnóstica de Eventos Cardiovasculares Mayores (ECVM) de cinco escalas de clasificación de dolor torácico de uso común en pacientes mexicanos con dolor torácico que acuden al servicio de urgencias. Métodos: Estudio prospectivo, observacional y comparativo que incluyó a pacientes ingresados en urgencias que presentaban dolor torácico como síntoma cardinal. Se calcularon cinco escalas de puntuación de dolor torácico. El desenlance principal fue el compuesto de muerte cardiovascular, infarto de miocardio, intervención coronaria, injerto de derivación de arteria coronaria o reingreso por causas cardiovasculares dentro de los 30 días. Resultados: Se estudió un total de 168 pacientes. La escala de puntuación que proporcionó el área bajo la curva más alta de 0.76 (IC de 95%: 0.70-0.85) fue la escala de historia clínica, ECG, edad, factores de riesgo y troponina (HEART, por sus siglas en inglés). Además, el indice de discriminación efectiva para la puntuación HEART fue un 6% más alto en comparación con las otras cuatro escalas de puntuación. Conclusiones: La escala de HEART proporcionó la mejor herramienta de clasificación para idenfiticar a los pacientes con mayor riesgo de ECVM, ya sea solo a agregando sus resultados a otros puntajes de clasificación, incluso en una población comórbida.

Attenuation of Extubation Response in Patients Undergoing Abdominal and Lower-Limb Surgeries under General Anesthesia – A Comparative Study between Dexmedetomidine and Esmolol

Introduction: Laryngoscopy and tracheal intubation cause significant changes in the hemodynamics of patients. Manypharmacological methods have been devised to reduce the extent of hemodynamic events. This study compares the efficacyof two such agents, dexmedetomidine and esmolol, for the attenuation of response to extubation.Materials and Methods: This study was carried out on 100 patients aged 18–60 years, belonging to the American Society ofAnesthesiologists Grades I and II, having no major systemic comorbidities, and undergoing abdominal or lower-limb surgeriesunder general anesthesia. They were randomly divided into two groups: Group D (dexmedetomidine) and Group E (esmolol).Pre-operative, intraoperative, and post-operative vitals and side effects were monitored.Results: Both the groups were comparable in terms of demographic variables, physical attributes, and baseline vitalparameters. It was observed that dexmedetomidine is better at controlling heart rate and systolic, diastolic, and mean bloodpressures during extubation than esmolol. There was no significant respiratory depression. No significant side effects wereobserved.Conclusion: Dexmedetomidine is an effective and safe drug to provide stable hemodynamics and protects against the stressresponse to extubation in patients undergoing abdominal and lower-limb surgeries under general anesthesia.

Efectos cardiovasculares debido al consumo de cannabinoides / Cardiovascular effects due to the use of cannabinoids

Resumen Objetivo dar a conocer los efectos cardiovasculares secundarios al consumo de marihuana según lo reportado en la literatura médica. Métodos se realizó una búsqueda con los términos MESH "Cannabis", "Marijuana smoking" y "adverse effects" en la base de datos PubMed hasta el año 2016. Se obtuvieron 265 referencias. Se excluyeron cartas de editores, protocolos de investigación en proceso, población pediátrica (menores de 18 años), embarazadas, referencias en idiomas diferentes a inglés y español y se escogieron solo referencias relacionadas con efectos cardiovasculares. Resultados se han establecido dos tipos de receptores de cannabinoides, los CB1 y los CB2, con localizaciones a nivel del sistema nervioso central, endotelial, renal y músculo liso. En la actualidad el consumo de marihuana ha venido en aumento y los médicos poco conocen de sus efectos y los diferentes nombres comerciales para esta sustancia. Existen efectos protectores a nivel vascular con detención de la progresión de la placa aterosclerótica y a la vez múltiples efectos no deseados como taquicardia, hipotensión y bradicardia. Múltiples reportes de caso documentan la relación de la marihuana con el infarto agudo de miocardio con o sin lesión de las arterias coronarias, así como con hemorragia subaracnoidea, pero no existen mecanismos claramente descritos que expliquen una relación directa con estos desenlaces. Conclusiones se conoce la fisiopatología y los receptores donde actúan los cannabinoides generando efectos tanto protectores como dañinos. Existe fuerte correlación con enfermedad cardiovascular, principalmente síndrome coronario agudo, pero el mecanismo fisiopatológico aún no es claro.

Abstract Objective To determine the cardiovascular side-effects of smoking marihuana according to that reported in the medical literature. Methods A search was performed using the MeSH terms, "Cannabis", "Marijuana smoking" and "adverse effects", in the PubMed database up to the year 2016. A total of 265 references were obtained. The exclusion criteria were; Letters to the editor, protocols of research in process, paediatrics (less than 18 years), pregnancy, articles in languages other than English or Spanish. Only references associated with cardiovascular effects were collected. Results Two types of cannabinoid receptors, CB1 and CB2, have been defined and are located in the central nervous system, as well as in endothelial, renal and smooth muscle. The consumption of marijuana is increasing, and doctors know little about its effects, as well as the different marketing names used for this substance. There are protective effects at vascular level, with the slowing down of atherosclerotic plaques, as well as the many undesired effects such as, tachycardia, hypotension, and bradycardia. Many case reports document the association of marijuana with acute myocardial infarction with or without coronary artery lesions, as well as with subarachnoid haemorrhage, but there are no clearly described mechanisms that could explain a direct relationship with these events. Conclusions The pathophysiology is known, as well as where the cannabinoid receptors act to generate their protective and harmful effects. There is a strong association with cardiovascular disease, mainly acute coronary syndrome, but the pathophysiological is still not clear.

Effects of Aqueous Quassia Amara l. (Korales) leaf extract on the cardiovascular and respiratory functions of male Sprague-Dawley rats

@#<p><strong>OBJECTIVE:</strong> To evaluate potential effects of the aqueous extract of Quassia amara L. leaves on the cardiovascular and respiratory systems of adult male Sprague- Dawley rats.</p><p><strong>METHODS:</strong> The cardiovascular and respiratory effects of the Quassia amara L. leaf extract on adult male Sprague-Dawley rats were assessed using non-invasive blood pressure (NIBP) determination and head-out plethysmography, respectively, in a randomized, parallel group study. Mean observations of blood pressure and heart rate were recorded at different time periods after dosing. Respiratory flow and irritation effects were evaluated using mean observations of respiratory rate (RR), tidal volume (TV), mid-expiratory flow rate (EF50), time of inspiration (TI) and expiration (TE), and time of break (TB) and pause (TP).</p><p><strong>RESULTS:</strong> There were no significant differences among the control and the treatment groups in SBP, DBP and HR parameters. The extract showed statistically significant effect on mean RR by time period (F=2.45, p=0.0234), trends over time of TV among the dose groups (F=2.00, p=0.0202), and EF50 among dose groups ((F=3.11, p=0.0422). However, these did not correlate with the changes in the time of break (TB) and time of pause (TP) which are more sensitive and specific tests for respiratory irritation.</p><p><strong>CONCLUSION:</strong> Aqueous leaf extract of Quassia appeared to have no significant effects on SBP, DPB, Pulse pressure, and HR. There are no conclusive dose-related respiratory flow or pulmonary irritation effects.</p>

Combination Therapy for the Cardiovascular Effects of Perinatal Lead Exposure in Young and Adult Rats / Alterações cardiovasculares da exposição perinatal ao chumbo em ratos jovens e adultos: papel da terapia combinada

Background: Combination therapy can play a significant role in the amelioration of several toxic effects of lead (Pb) and recovery from associated cardiovascular changes. Objective: To investigate the effects of combination therapy on the cardiovascular effects of perinatal lead exposure in young and adult rats Methods: Female Wistar rats received drinking water with or without 500 ppm of Pb during pregnancy and lactation. Twenty-two- and 70-day-old rat offspring who were or were not exposed to Pb in the perinatal period received meso-dimercaptosuccinic acid (DMSA), L-arginine, or enalapril and a combination of these compounds for 30 additional days. Noradrenaline response curves were plotted for intact and denuded aortas from 23-, 52-, 70-, and 100-day-old rats stratified by perinatal Pb exposure (exposed/unexposed) and treatment received (treated/untreated). Results: Systolic blood pressure was evaluated and shown to be higher in the 23-, 52-, 70-, and 100-day age groups with Pb exposure than in the corresponding control age groups: 117.8 ± 3.9*, 135.2 ± 1.3*, 139.6 ± 1.6*, and 131.7 ± 2.8*, respectively and 107.1 ± 1.8, 118.8 ± 2.1, 126.1 ± 1.1, and 120.5 ± 2.2, respectively (p < 0.05). Increased reactivity to noradrenaline was observed in intact, but not denuded, aortas from 52-, 70-, and 100-day-old exposed rats, and the maximum responses (g of tension) in the respective Pb-exposed and control age groups were as follows: 3.43 ± 0.16*, 4.32 ± 0.18*, and 4.21 ± 0.23*, respectively and 2.38 ± 0.33, 3.37 ± 0.13, and 3.22 ± 0.21, respectively (p < 0.05). Conclusions: All treatments reversed the changes in vascular reactivity to noradrenaline in rats perinatally exposed to Pb. The combination therapy resulted in an earlier restoration of blood pressure in Pb-exposed rats compared with the monotherapies, except for enalapril therapy in young rats. These ...

Introdução: A terapia combinada parece desempenhar papel significativo em reduzir os efeitos cardiovasculares deletérios da exposição ao chumbo (Pb). Objetivo: Para investigar esta possibilidade, ratas Wistar receberam Pb (500 ppm na água de beber) ou água durante a prenhez e a lactação. Ratos com 22 e 70 dias, expostos perinatalmente ao Pb ou não, receberam DMSA, L- arginina, enalapril e a combinação destes por 30 dias adicionais. Métodos: Curvas concentração-efeito à noradrenalina foram obtidas em aortas intactas e desnudas, de ratos com 23, 52, 70 e 100 dias expostos ou não ao Pb, tratados ou não. Resultados: A pressão arterial sistólica caudal (mmHg) foi avaliada e mostrou-se aumentada em ratos expostos ao Pb [23, 52, 70 e 100 dias, respectivamente: controle 107,1±1,8, 118,8±2,1, 126,1±1,1, 120,5±2,2; Pb 117,8±3,9*, 135,2±1,3*, 139,6±1,6* e 131,7± 2,8*]. Observou-se aumento de reatividade à noradrenalina em aorta intacta, mas não desnudada, de ratos com 52, 70 e 100 dias expostos ao Pb [resposta máxima (g de tensão) 52 dias: Pb 3,43±0,16*, controle 2,38±0,33; 70 dias: Pb 4,32±0,18*, controle 3,37±0,13; 100 dias: Pb 4,21±0,23*, controle 3,22±0,21]. (*) p < 0,05 em relação ao respectivo controle. Conclusões: Todos os tratamentos restauraram as alterações de reatividade à noradrenalina em aortas de ratos expostos perinatalmente ao Pb. Exceto pelo enalapril em ratos jovens, a terapia combinada restaurou mais precocemente a pressão arterial de ratos expostos ao Pb em relação aos tratamentos isolados. Estes resultados representam uma nova abordagem no desenvolvimento de protocolos terapêuticos no tratamento da hipertensão induzida pela exposição ao Pb. .

Effects of carbetocin infusion on hemodynamics during cesarean delivery under spinal anesthesia

BACKGROUND: Carbetocin is a long-acting synthetic analogue of oxytocin that is used to prevent postpartum hemorrhage. Cardiovascular effects of oxytocin include tachycardia and hypotension. We investigated hemodynamic changes induced by carbetocin during spinal anesthesia. METHODS: Carbetocin 100 microg was infused over 5 min in 40 women undergoing cesarean delivery. Hemodynamic parameters were measured noninvasively using the Finometer(R) device. The hemodynamic values were analyzed using multivariate analysis of variance followed by Bonferroni test for multiple comparisons. RESULTS: Statistically significant hemodynamic effects were seen with a maximal effect at about 75 seconds after infusion start compared with those of baseline: Mean arterial pressure (MAP) decreased 21.6 +/- 8.8 mmHg, systemic vascular resistance (SVR) decreased 28.6 +/- 11.1% and heart rate (HR) increased 15.3 +/- 7.9 beats/min. Following the maximal effect, MAP and SVR remained almost constant at this decreased level until the end of study period. However, HR was slowly recovered after the peak, approaching the baseline value. CONCLUSIONS: We observed that the maximal hemodynamic changes were occurred at about 75 seconds after administration of carbetocin. Therefore, careful observation is required during this early period.

Cardiovascular and arousal responses to single-lumen endotracheal and double-lumen endobronchial intubation in the normotensive and hypertensive elderly / 대한마취과학회지

BACKGROUND: Endotracheal intubation usually causes transient hypertension and tachycardia. The cardiovascular and arousal responses to endotracheal and endobronchial intubation were determined during rapid-sequence induction of anesthesia in normotensive and hypertensive elderly patients. METHODS: Patients requiring endotracheal intubation with (HT, n = 30) or without hypertension (NT, n = 30) and those requiring endobronchial intubation with (HB, n = 30) or without hypertension (NB, n = 30) were included in the study. Anesthesia was induced with intravenous thiopental 5 mg/kg followed by succinylcholine 1.5 mg/kg. After intubation, all subjects received 2% sevoflurane in 50% nitrous oxide and oxygen. Mean arterial pressure (MAP), heart rate (HR), plasma catecholamine concentration, and Bispectral Index (BIS) values, were measured before and after intubation. RESULTS: The intubation significantly increased MAP, HR, BIS values and plasma catecholamine concentrations in all groups, the peak value of increases was comparable between endotracheal and endobronchial intubation. However, pressor response persisted longer in the HB group than in the HT group (5.1 +/- 1.6 vs. 3.2 +/- 0.9 min, P < 0.05). The magnitude of increases in MAP and norepinephrine from pre-intubation values was greater in the hypertensive than in the normotensive group (P < 0.05), while there were no differences in those of HR and BIS between the hypertensive and normotensive groups. CONCLUSIONS: Cardiovascular response and arousal response, as measured by BIS, were similar in endobronchial and endotracheal intubation groups regardless of the presence or absence of hypertension except for prolonged pressor response in the HB group. However, the hypertensive patients showed enhanced cardiovascular responses than the normotensive patients.

Chemical composition and cardiovascular effects induced by the essential oil of Cymbopogon citratus DC. Stapf, Poaceae, in rats / Composição química e efeitos cardiovasculares do óleo essencial de Cymbopogon citratus DC. Stapf, Poaceae, em ratos

Cymbopogon citratus DC. Stapf, Poaceae, is used in the folk medicine for hypertension treatment. This work investigated the chemical composition and cardiovascular effects in rats of C. citratus essential oil (EOCC). A phytochemical screening demonstrated the presence of eight constituents, being geranial the major compound (43.08 percent). In rats, EOCC (1, 5, 10, and 20 mg/kg, i.v.) induced transient hypotension and bradycardia that were attenuated by atropine and sodium thiopental, but not by L-NAME or indomethacin. In rings of rat superior mesenteric artery pre-contracted with phenylephrine, EOCC (1 to 3000 µg/mL) induced relaxation that was not affected after removal of the endothelium, after TEA or in rings pre-contracted with KCl (80 mM). Furthermore, EOCC (1000 µg/mL) was not able to induce additional effect on maximal relaxation of nifedipine (10 µM). In conclusions, EOCC induces hypotension, possibly by reduction in vascular resistance caused by inhibition of the Ca2+ influx, and bradycardia probably due to an activation of cardiac muscarinic receptors.

C. citratus é utilizada na medicina popular para tratar hipertensão. Este trabalho investigou a composição química e os efeitos cardiovasculares do óleo essencial do C. citratus (OECC). Foram identificados oito constituintes no OECC, sendo geranial o majoritário (43,08 por cento). Em ratos, o OECC (1, 5, 10 e 20 mg/kg, i.v.) induziu hipotensão e bradicardia que foram atenuadas pela atropina e tiopental sódico, mas não por L-NAME ou indometacina. Em anéis de artéria mesentérica de ratos pré-contraídos com fenilefrina, o OECC (1 a 3000 µg/mL) induziu relaxamento que não foi afetado após remoção do endotélio, após TEA ou em anéis pré-contraídos com KCl (80 mM). Além disso, o OECC (1000 µg/mL) não induziu efeito adicional sobre o relaxamento máximo da nifedipina (10 µM). Em conclusão, o OECC induz hipotensão possivelmente devido à redução da resistência vascular que pode ser causada por inibição do influxo de Ca2+, e bradicardia provavelmente devido à ativação de receptores muscarínicos cardíacos.

Cardiovascular effects induced by the hydroalcoholic extract of the stem of Xylopia cayennensis in rats / Efeitos cardiovasculares induzidos pelo extrato hidroalcoólico das cascas de Xylopia cayennensis em ratos

The cardiovascular effects induced by the hydroalcoholic extract of the stem of Xylopia cayennensis (HEXC) were studied in rats using a combined in vivo and in vitro approach. In non-anesthetized rats, HEXC injections produced a significant and dose-dependent hypotension associated with an increase in heart rate. The hypotensive response was not attenuated after nitric oxide (NO) synthase blockade, L-NAME (20 mg/Kg, i.v.). In isolated rat superior aortic rings, HEXC was able to relax the tonus induced by phenylephrine (1 µM) and KCl (80 mM), (EC50 = 85±13 and 62±5 µg/mL, respectively). The smooth muscle-relaxant activity of HEXC was not inhibited by removal of vascular endothelium (EC50 = 58±6 µg/mL). HEXC antagonized CaCl2-induced contractions in depolarizing medium nominally without Ca2+. HEXC inhibited the intracellular calcium-dependent transient contractions induced by caffeine (20 mM) in Ca2+-free solution, but not those induced by norepinephrine (1 µM). In isolated rat atrial preparations, HEXC produced negative inotropic and chronotropic responses (IC50= 534±42 and 259±22 µg/mL, respectively). The results obtained suggest that the hypotensive effect of HEXC is probably due to a peripheral vasodilatation, at least, secondary to an interference with the Ca2+ mobilization as a consequence of voltage-dependent Ca2+ channel blockade and the inhibition of Ca2+ release from caffeine-sensitive intracellular stores. Finally, HEXC acts directly on the heart decreasing contractility and heart rate, these effects are of little importance to the expression of the hypotensive response induced by HEXC.

Os efeitos cardiovasculares induzidos pelo extrato hidroalcoólico do caule de Xylopia cayennensis (EHXC) foram estudados em ratos, utilizando uma abordagem combinada in vivo e in vitro. Em ratos não anestesiados, EHXC induziu uma hipotensão não dependente de dose associada com um aumento da freqüência cardíaca. Esta resposta hipontesora não foi atenuada depois do bloqueio com L-NAME (20 mg/Kg, i.v.). Em anéis de aorta isolados de rato, EHXC foi capaz de relaxar o tônus induzido por fenilefrina (1 µM) e KCl (80 mM), (CE50 = 85±13 e 62±5 µg/mL, respectivamente). A atividade vasorelaxante do HEXC não foi inibida pela remoção do endotélio vascular (CE50 = 58±6 µg/mL). HEXC antagonizou as contrações induzidas por CaCl2 em meio despolarizante nominalmente sem Ca+2. EHXC antagonizou de maneira dependente de concentração as contrações transientes induzidas por cafeína (20 mM), em meio livre de Ca2+, contudo não alterou aquelas induzidas por noradrenalina (1 µM). Em átrio isolado de rato, EHXC induziu um efeito inotrópico e cronotrópico negativo (CI50= 534±42 µg/mL e 259±22 µg/mL; respectivamente). Os resultados obtidos demonstram que EHXC apresenta um potente efeito hipotensor, provavelmente conseqüência da diminuição da resistência periférica total que parece ser, em parte, devido a uma ação inibitória sobre o influxo de Ca+2 através de canais de cálcio dependentes de voltagem e também através da inibição da liberação de Ca+2 dos estoques intracelulares sensíveis à cafeína. HEXC atua diretamente no coração diminuindo a contratilidade e a freqüência cardíaca, estes efeitos têm importância pequena na expressão da resposta hipotensiva induzida por HEXC.

Estudio comparativo entre bupivacaina + fentanyl vs. Bupivacaina sola por vía peridural para el control del dolor obstétrico / A comparative study between bupivacaine + fentanyl vs. Bupivacine alone for a peridural to control obstetric pain

Objetivo: Evaluar la calidad y duración de la analgesia obstétrica que se obtiene al utilizar bupivacaína + fentanyl, en comparación a cuando solo se utiliza bupivacaína.Método: Se realizó un estudio comparativo, prospectivo, longitudinal, evaluándose 120 pacientes, las cuales fueron divididas en 2 grupos: Grupo A: Bupivacaína 20mg + Fentanyl 50ucg y Grupo B: Bupivacaína sola 20mg, vía peridural administrados en embarazadas de 38 a 40 semanas de gestación. Los datos fueron recolectados mediante un formato, en el cual se incluyó valoración del dolor (EVA), Frecuencia cardiaca (FC),Tensión Arterial Sistólica (TAS), Tensión Arterial Diastólica (TAD), Presión Arterial Media (PAM), Frecuencia Cardiaca Fetal (FCF).Resultados: En el presente estudio la edad promedio fue de 25años (28%), la mayoría primigestas (54.5%), con una dilatación promedio de 6 cm. (37.5%), valoradas preanestésicamente con ASA 1 (95%), y ASA 2 (5%), para ambos grupos; se valoró la EVA (escala visual análoga de dolor) siendo de 10 (valor máximo) al inicio del estudio y a los 45 minutos 0 para el grupo A y 2 para el grupo B.Conclusiones: La administración de narcóticos por vía peridural, con fines de analgesia, es una técnica que ha dado excelentes resultados, especialmente en el ámbito médico, en el campo de la obstetricia, ya que ha demostrado ser una técnica muy efectiva para el control del dolor en el trabajo de parto.

Objectives: To evaluate the quality and duration of the obstetric analgesic that is obtained by using bupivacaine + fetanyl in comparison to just using bupivacaine.Method: A comparative, prospective, longitudinal study was done in with 120 patients were divided in two groups:1.Group A: Bupivacaine 20 mg + Fentanyl 50ucg2.Group B: Bupivacaine 20 mg aloneIn which it was administered by peridural in expecting women in there 38 – 40 week.The data was collected using a format with include evaluating the visual analog pain scale, heart rate, Systolic pressure, Diastolic Pressure, mean arterial blood pressure and fetal heart rate.Results: In this study the average age is 25 years old (28%), the majority were primipara 54.5% with a dilatation of 6 cm (37.5%). When analyzed pre- anesthesia with an ASA 1 (95%) and ASA 2 (5%). For both groups we evaluated the visual analog pain scale being 10 the maximum score at the beginning and after 45 minutes 0 for group A and 2 for group B.

Neuromuscular and Cardiovascular Effects of Rocuronium during Propofol, Fentanyl, N2O/O2, Isoflurane Anesthesia / 대한마취과학회지

The neuromuscular blocking and cardiovascular effects of rocuronium (Roc) have been compared with succinylcholine (Scc), mivacurium (Miv) and vecuronium (Vec). Thirty six healthy adult patients were randomly assigned to receive Roc (0.6 mg/kg), Scc (1.0 mg/kg), Miv (0.16 mg/kg) and Vec (0.08 mg/kg) during induction with propofol and fentanyl. The 3M surface electtodes (Red Dot, Ag/AgC1) were applied over the ulnar nerve at the wrist and supramaximal transcutaneous stimulation from a peripheral nerve stimulator (Innervator, Fisher & Paykel, New Zealand) using a 0.2 ms square wave pulses in duration at 0.1 Hz were applied. The twitch response of the thumb adductor was measured mechanomyographically using 2 kg load cell strain gauge (Model No. 505H, RS Component, Ltd, U.K.) with a thumb piece modification. Recordings were made on a Gould TA 240 Easy Graf Thermal Array Recorder with a 6600 series transducer signal. The time from injection of muscle relaxant to complete depression of control twitch height (onset), the time from injection to 25% recovery of control twitch height (clinical duration, CD) and recovery indices (RI, time from 25% to 75% recovery of control twitch height) were measured, and the cardiovascular effects; heart rate (HR) and mean arterial pressure (MAP), were determined before and after injection of muscle relaxants. Onset times for patients, receiving Roc, Scc, Vec and Miv were 65.0+/-13.5 s, 54.0+/-5.2 s, 191.+/-58.0 s and 201.3+/-37.6 s. CDs were 33.6+/-6.6 min, 8.4+/-2.1 min, 21.6+/-4.8 min and 13.0+/-2.2 min. RIs were 12.9+/-4.3 min, 5.5+/-1.2 min, 10.9+/-3.8 min and 6.9+/-1.3 min. There were no significant changes of HR, however MAP were decreased significantly from 2 min after injection of Roc. Consequently, onset time of Roc were faster than that of Miv or Vec and slower than that of Scc but not significant. However, CD and RI of Roc were significantly longer than those of the others, with minimum cardiovascular effects.

What Plasma Ionized Calcium Concentration Increased by Intravenous Injection with 3% Calcium Chloride and 10 % Calcium Gluconate Is Affected on Cardiovascular System? / 대한마취과학회지

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows;, 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p<0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p<0.05).

What Plasma Ionized Calcium Concentration Increased by Intravenous Injection with 3% Calcium Chloride and 10 % Calcium Gluconate Is Affected on Cardiovascular System? / 대한마취과학회지

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows;, 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p<0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p<0.05).

Hemodynamic Effects of Naloxone and Nalbuphine Following High-dose Fentanyl Anesthesia in Dogs / 대한마취과학회지

The hemodynamic changes of naloxone and nalbuphine following intravenous administra tion of high-dose fentanyl were studied using dogs anesthetized with halothane and ventilated artificially. After 50ug/kg of fentanyl was given to all experimental animals, they were randomly divided into two groups, such as group 1 and group 2. Group 1 and 2 were given 20ug/kg of naloxone and 0.3mg/kg of nalbuphine known as antagonists of fentanyl-induced respiratory depression respectively. Hemodynamic parameters were recorded before, 5 and 30 minutes after fentanyl and 1,10 and 20 minutes after naloxone or nalbuphine. During halothane anesthesia, fentanyl significantly decreased mean arterial pressure, heart rate, cardiac index, rate pressure product, left ventricular stroke work index and right ventricular stroke work index in all dogs(p<0.05). After fentanyl reversal by antagonists, dogs in group 1 promptly developed significant increases above baseline values in mean arterial pressure, heart rate, mean pulmonary arterial pressure, central venous pressure, pulmonary capillary wedge pressure, rate pressure product and left ventricular stroke work index(p<0.05), whereas dogs in group 2 did not show significant hemodynamic changes. These results suggest that the abrupt, untoward and significant hyperdynamic events which accompany narcotic reversal with naloxone can be avoided if nalbuphine instead of naloxone is administered.

Cardiovascular Effects of Epinephrine Administration for Hemostasis to Pediatric Patients for Tonsillectomy during Halothane Anesthesia / 대한마취과학회지

Epinephrine induced cardiac dysrhythmias and cardiovascular responses during halothane anesthesia for 70 pediatric tonsillectomy cases were observed at Taegu Catholic Medical College from January to July, 1991 We have evaluated the frequencies of cardiac arrhythmia, and the changes of heart rate and blood pressure according to the administration of epinephrine for the purpase of hemostasis on the operating fields. All patients were divided into 3 groups as follows: Group I; Epinephrine used under halothane anesthesia(n=30). Group II; Epinephrine used under halothane anesthesia with fentanyl(n=20). Group III; Epinephrine used under halothane anesthesia with fentanyl, but shut-off the halothane inhalation briefly(n=20). The results were as follows: l) Systolic blood pressure, Increases of systolic blood pressure were observed in all groups compared with pre-injection state and there were statistical significances in group L 2) Heart rate; Decreases of heart rate were observed in group III compared with pre-injection state and there were statistical significances in group III compared with group I. 3) Dysrhythmias; Most childrens electrocardiograms revealed the sinus rhythms except only 4 cases of premature ventricular contraction and 2 cases of nodal rhythm. These benign dysrhythmias were restored to normal sinus rhythms immediately after administration of small doses of lidocaine & 100% oxygen and simultaneously shut-off the inhalation of halothane.

Cardiovascular Effects of Anesthetic induction with Midazolam for Open Heart Surgery / 대한마취과학회지

Midazolam, an imidazobenzodiazepine derivative, is utilized as a premedicant, sedative and anesthetic induction agent. Cnmpared to diazepam, midazolam is characterized by better solubility in water, better venous tolerance and a more rapid onset of action. Though the onset of pharmacological action of midazolam takes longer than thiopental, midazolam exerts more gradual effects on circula- tion than thiopental. Because it maintains hemodynamic stability and induces amesthesia smoothly, madazolam is a potential alternative as an induction agent in high-risk patients. To evaluate the safe margin of i. v. midazolam and to investigate the effect of carbon dioxide retention by midazolam, 32 cardiac patients were divided into 4 groups: Group I, midazolam 0.2 mg/ kg with spontaneous respiration: Group II, midazolam 0.2 mg/kg with assist respiration: Group III, midazolam 0.4 mg/kg with assist respiration: Group IV, midazolam 0.4 mg/kg with spontaneons respiration. In each group, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, cardiac output and arterial blood gas analysis were checked before and 2,4 and 6 minutes after i. v. injection of midazolam. Systolic blood pressure decreased significantly after injection of midazolam in all four groups. Diastolic blood pressure decreased significantly in group II and IlI. Systolic blood pressure was lower in group III than II 4 and 6 minutes following midazolam administration. The elevation of arterial carbon dioxide tension in group I and IV did not cause any changes in cardiovascular variables. The time from the end of injection of midazolam to spontanous closing of eyes and the time from the end of injection to disappearance of eyelash reflex were measured. But there were no significant differen-ces between all four groups. .On the basis of these data, we could conclude that in unpremedicated patients for open heart surgery midazolam alone allows rapid and smooth induction. In case of using the dose of 0.4 mg/kg, care must be taken in the decrease of systolic blood pressure.

Cardiovascular Effects of Verapamil during Isoflurane Anesthesia / 대한마취과학회지

12 mongrel dogs were divided into two groups and anesthetized with 100% O and isoflurane in different concentrations (1MAC and 2MAC). Blood pressures and heart rates were monitored and cardiac outputs were measured during all experiments. Cardiovascular effects of isoflurane in different concentrations were investigated. And then, intra-venous verapamil was injected slowly in bolus (0.2mg/kg) in each group and its cardiovascular effects were also investigated. The results were as follows: 1) Heart rate was decreased when the concentration of isoflurane was increased (p<0.05) but there was no significant change after administration of verapamil. 2) Mean arterial pressure was decreased when the concentration of isoflurane was increased (p<0. 01), and after verapamil was injected intravenously in each group (p<0.01). 3) Cardiac index and stroke volume were decreased when the concentration of isoflurane was increased (p<0.05). 4) Left ventricular stroke work index was decreased when the concentration of isofiurane was increased (p<0.01) and it was also decreased significantly after administration of verapamil in high concentration of isoflurane (2 MAC) (p< 0.01), and the degree which was decreased by the administra- tion of verapamil was much more in high concentration of isoflurane than that of low concentration (p< 0.05). 5) There were no statistically significant changes in central venous pressure, pulmonary arterial pressure, pulmonary capillary pressure, vascular resistances, and right ventricular stroke work index.

The Cardiovascular Effects of Vecuronium during Anesthesia with Isoflurane / 대한마취과학회지

To investigate the cardiovascular effects of vecuronium during isoflurane anesthesia, I compared with effects of pancuronium. Eight mongrel dogs were anesthetized with intravenous thiopental sodium and maintained with oxygen (41/min)-isoflurane (1 MAC). Cardiovascular parameters were determined and recorded 1 minute before and 5, 10, 20, 30 minutes after administration of 3 times the ED, dose of pancuronium and vecuronium respectively. Only one neuromuscular relaxant was studied with each anesthetic administration. The results are as follows; 1) Pancuronium increased heart rate, mean arterial blood pressure, cardiac output. 2) Vecuronium caused no significant cardiovascular chanaes.

Anesthetic Induction with Fentanyl / 대한마취과학회지

We evaluated the efficacy as an anesthetic induction agent and cardiovascular effects of fentanyl in sixty patients with myocardial ischemia on electrocardiogram, who were scheduled for elective operations of more than two-hour duration. In addition, the effects of pretreatment with pancuronium and/or lorazepam prior to anesthetic induction were evaluated on the induction speed, the incidence and severity of skeletal muscle rigity, heart rate, and systolic blood pressure. All the patients were given 30ug/kg of fentanyl and divided into four equal groups of fifteen patients according to pretreatment drugs administered before fentanyl. The results were as follows: 1) Eighty-seven percent of the patients in control group (pretreated with saline)were rendered unconscious during or one minute after infusion of 30ug/kg of fentanyl. 2) Pretreatment with lorazepam before fentanyl significant#ly increased the induction speed (p 0.05). From the above results, it is concluded that anesthetic induction with 30 ug/kg of fentanyl produces profound analgesia and amnesia, stable cardiovascular dynamics, and a minimum of problems, and pretreatment with small doses of lorazepam and pancuronium before fentanyl facilitates not only a rapid loss of consciousness but also a reduction in the incidence and severity of fentanyl-induced rigidity.