Hemodynamics and cardiac autonomic modulation after an acute concurrent exercise circuit in older individuals with pre- to established hypertension

OBJECTIVES: Few studies have investigated whether post-exercise hypotension (PEH) after concurrent exercise (CEX) is related to changes in cardiac output (Q) and systemic vascular resistance (SVR) in older individuals. We tested whether PEH after a single bout of CEX circuits performed in open-access facilities at the Third Age Academies (TAA) in Rio de Janeiro City (Brazil) would be concomitant with decreased Q and SVR in individuals aged ≥60 years with prehypertension. Moreover, we assessed autonomic modulation as a potential mechanism underlying PEH. METHODS: Fourteen individuals (age, 65.8±0.9 y; systolic/diastolic blood pressure [SBP/DBP], 132.4±12.1/72.8±10.8 mmHg; with half of the patients taking antihypertensive medications) had their blood pressure (BP), heart rate (HR), Q, SVR, HR variability (HRV), and spontaneous baroreflex sensitivity (BRS) recorded before and 50 min after CEX (40-min circuit, including seven stations of alternate aerobic/resistance exercises at 60-70% HR reserve) and non-exercise control (CONT) sessions. The study protocol was registered in a World Health Organization-accredited office (Trial registration RBR-7BWVPJ). RESULTS: SBP (Δ=−14.2±13.1 mmHg, p=0.0001), DBP (Δ=−5.2±8.2 mmHg, p= 0.04), Q (Δ=−2.2±1.5 L/min, p=0.0001), and BRS (Δ=−3.5±2.6 ms/mmHg; p=0.05) decreased after CEX as compared with the CONT session. By contrast, the HR increased (Δ=9.4±7.2 bpm, p<0.0001), and SVR remained stable throughout the postexercise period as compared with the CONT session (Δ=0.10±0.22 AU, p=0.14). We found no significant difference between the CEX and CONT with respect to the HRV indexes reflecting autonomic modulation. CONCLUSION: CEX induced PEH in the older individuals with prehypertension status. At least in the first 50 min, PEH occurred parallel to the decreased Q and increased HR, while SVR was not different. The changes in autonomic outflow appeared to be unrelated to the acute cardiac and hemodynamic responses.

The application value of afterload-related cardiac performance in patients with sepsis-induced cardiomyopathy / 中华急诊医学杂志

Objective To investigate the application value of afterload-related cardiac performance(ACP) in patients with sepsis-induced cardiomyopathy.Methods A total of 148 patients with septic shock admitted by the department of critical care of Wuhan fourth hospital from April 2013 to March 2018 were retrospectively included,all included patients were divided into LVEF ＜ 50％ group and LVEF ≥ 50％ group according to left ventricular ejection fraction (LVEF),the mortality rate at 28 days and ACP value were compared in the 2 groups.All included patients were divided into normal group (ACP ＞ 80％),mild heart function impairment group (60％ ＜ ACP ≤ 80％),moderate heart function impairment group (40％ ＜ ACP ≤ 60％),and severe heart function impairment group (ACP ≤ 40％) according to ACP value,the mortality rate at 28 days was compared in the 4 groups.The measurement data were compared by grouped t test,the rates were compared by chi-square test.Results The mortality rate was 58.2％ in the LVEF ＜ 50％ group,and 30.9％ in the LVEF ≥ 50％ group,with statistically significant differences (x2=11.171,P＜0.01).The values of ACP in the LVEF ＜ 50％ group were (39.3±16.4) ％,and those in the LVEF ≥ 50％ group were (69.1±14.9) ％,with statistically significant differences (t=l 1.571,P＜0.01).The mortality rate was 14.81％ in the normal group,44.00％ in the mild,58.82％ in the moderate and 90.00％ in the severe group.The differences between the normal group and the mild and moderate groups were statistically significant,while those between the severe group and the mild and moderate groups were statistically significant.Conclusion Aflerload-related cardiac performance is of great value for the diagnosis and prognosis in patients with sepsis-induced cardiomyopathy.

The application value of afterload-related cardiac performance in patients with sepsis-induced cardiomyopathy / 中华急诊医学杂志

Objective@#To investigate the application value of afterload-related cardiac performance(ACP) in patients with sepsis-induced cardiomyopathy.@*Methods@#A total of 148 patients with septic shock admitted by the department of critical care of Wuhan fourth hospital from April 2013 to March 2018 were retrospectively included, all included patients were divided into LVEF < 50% group and LVEF≥50% group according to left ventricular ejection fraction (LVEF), the mortality rate at 28 days and ACP value were compared in the 2 groups. All included patients were divided into normal group (ACP > 80%), mild heart function impairment group (60% < ACP≤80%), moderate heart function impairment group (40% < ACP≤60%), and severe heart function impairment group (ACP≤40%) according to ACP value, the mortality rate at 28 days was compared in the 4 groups. The measurement data were compared by grouped t test, the rates were compared by chi-square test.@*Results@#The mortality rate was 58.2% in the LVEF < 50% group, and 30.9% in the LVEF≥50% group, with statistically significant differences (χ2=11.171, P<0.01). The values of ACP in the LVEF < 50% group were (39.3±16.4) %, and those in the LVEF≥50% group were (69.1±14.9) %, with statistically significant differences (t=11.571, P<0.01).The mortality rate was 14.81% in the normal group, 44.00% in the mild, 58.82% in the moderate and 90.00% in the severe group. The differences between the normal group and the mild and moderate groups were statistically significant, while those between the severe group and the mild and moderate groups were statistically significant.@*Conclusion@#Afterload-related cardiac performance is of great value for the diagnosis and prognosis in patients with sepsis-induced cardiomyopathy.

Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement

Context: Inhaled levosimendan may act as selective pulmonary vasodilator and avoid systemic side effects of intravenous levosimendan, which include decrease in systemic vascular resistance (SVR) and systemic hypotension, but with same beneficial effect on pulmonary artery pressure (PAP) and right ventricular (RV) function. Aim: The aim of this study was to compare the effect of inhaled levosimendan with intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement. Settings and Design: The present prospective randomized comparative study was conducted in a tertiary care hospital. Subjects and Methods: Fifty patients were randomized into two groups (n = 25). Group A: Levosimendan infusion was started immediately after coming-off of cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of levosimendan which would be given through intravenous route over 24 h was calculated and then divided into four equal parts and administered through inhalational route 6th hourly over 24 h. Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery systolic pressure [PASP], SVR) and RV function were assessed immediately after shifting, at 1, 8, 24, and 36 h after shifting to recovery. Statistical Analysis Used: Intragroup analysis was done using paired student t-test, and unpaired student t-test was used for analysis between two groups. Results: PASP and RV-fractional area change (RV-FAC) were comparable in the two groups at different time intervals. There was a significant reduction in PASP and significant improvement in RV-FAC with both intravenous and inhalational levosimendan. SVR was significantly decreased with intravenous levosimendan, but no significant decrease in SVR was observed with inhalational levosimendan. Conclusions: Inhaled levosimendan is a selective pulmonary vasodilator. It causes decrease in PAP and improvement in RV function, without having a significant effect on SVR.

Effects of application of pulse contour cardiac output monitoring technology in early treatment of patients with large area burns / 中华烧伤杂志

Objective@#To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period.@*Methods@#Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample ttest and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis.@*Results@#(1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 (F=7.428, P<0.01). The PCCI values of patients at PIH 4, 8, 12, 16, 20, and 24 were (2.4±0.9), (2.6±1.2), (2.2±0.6), (2.6±0.7), (2.8±0.6), and (2.7±0.7) L·min-1·m-2, respectively, and they were significantly lower than the normal value 4 L·min-1·m-2(t=-3.143, -3.251, -11.511, -8.889, -6.735, -6.976, P<0.05 or P<0.01). At PIH 76, 80, 84, 88, 92, and 96, the PCCI values of patients were (4.9±1.5), (5.7±2.0), (5.9±1.7), (5.5±1.3), (5.3±1.1), and (4.9±1.4) L·min-1·m-2, respectively, and they were significantly higher than the normal value (t=2.277, 3.142, 4.050, 4.111, 4.128, 2.423, P<0.05 or P<0.01). The PCCI values of patients at other time points were close to normal value (P>0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 (F=7.863, P<0.01). The SVRI values of patients at PIH 12, 16, 20, 24, and 28 were (2 298±747), (2 581±498), (2 705±780), (2 773±669), and (3 109±1 215) dyn·s·cm-5·m2, respectively, and they were significantly higher than the normal value 2 050 dyn·s·cm-5·m2(t=0.878, 3.370, 2.519, 3.747, 3.144, P<0.05 or P<0.01). At PIH 4, 8, 72, 76, 80, 84, 88, 92, and 96, the SVRI values of patients were (1 632±129), (2 012±896), (1 381±503), (1 180±378), (1 259±400), (1 376±483), (1 329±385), (1 410±370), and (1 346±346) dyn·s·cm-5·m2, respectively, and they were significantly lower than the normal value (t=-4.593, -0.112, -5.157, -8.905, -7.914, -5.226, -6.756, -6.233, -7.038, P<0.01). The SVRI values of patients at other time points were close to normal value (P>0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 (F=0.704, P>0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value (t=-3.112, -3.554, -2.969, -2.450, -2.476, P<0.05). The GEDVI values of patients at other time points were close to normal value (P>0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 (F=1.859, P<0.01). The EVLWI values of patients at PIH 16, 20, 24, 28, 32, 36, and 40 were significantly higher than normal value (t=4.386, 3.335, 6.363, 4.391, 7.513, 5.392, 5.642, P<0.01). The EVLWI values of patients at other time points were close to normal value (P>0.05). (5) The fluid infusion coefficients of patients at the first and second 24 hours post injury were 1.90 and 1.39, respectively. The blood lactic acid values of patients from PID 1 to 7 were 7.99, 5.21, 4.57, 4.26, 2.54, 3.13, and 3.20 mmol/L, respectively, showing a declined tendency. (6) There was obvious negative correlation between PCCI and SVRI (r=-0.528, P<0.01). There was obvious positive correlation between GEDVI and PCCI (r=0.577, P<0.01). There was no obvious correlation between GEDVI and SVRI (r=0.081, P>0.05). There was obvious positive correlation between blood lactic acid and SVRI (r=0.878, P<0.01). (7) All patients were cured except the one who abandoned treatment.@*Conclusions@#PiCCO monitoring technology can monitor the changes of early hemodynamic indexes and volume of burn patients dynamically, continuously, and conveniently, and provide valuable reference for early-stage comprehensive treatment like anti-shock of patients with large area burns.

Effect of levosimendan on hemodynamic changes in patients undergoing off-pump coronary artery bypass grafting: A randomized controlled study.

Aims and Objective: We tested the hypothesis that use of levosimendan would be associated with better perioperative hemodynamics and cardiac function during off-pump coronary artery bypass grafting (OPCAB) in patients with good left ventricular function. Materials and Methods: Thirty patients scheduled for OPCAB were randomized in a double-blind manner to receive either levosimendan 0.1 μg/kg/min or placebo after induction of general anesthesia. The hemodynamic variables were measured after induction of anesthesia, at 6 minute after application of tissue stabilizer for the anastomoses of left anterior descending artery, diagonal artery, left circumflex artery, and right coronary artery and at 6, 12, 18, and 24 hours after completion of surgery. Results: Compared with placebo group, cardiac index (CI) was significantly higher and systemic vascular resistance index (SVRI) was significantly lower at 6, 12, 18, and 24 hour after surgery in levosimendan group. Norepinephrine was infused in 60% of the patients in the levosimendan group compared to 6.7% in the control group ( P < 0.05). Lactate and mixed venous oxygen saturation were not significantly different between groups. Conclusions: Levosimendan significantly increased CI and decreased SVRI after OPCAB but it did not show any outcome benefit in terms of duration of ventilation and intensive care unit stay.

A comparison of hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve repair / replacement for severe mitral stenosis.

Aims and Objectives: We aimed to compare the hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve surgery on cardiopulmonary bypass (CPB). Materials and Methods: Sixty patients were divided into 2 groups of 30 each. Group-L patients received levosimendan 0.1 μg/kg/min and Group-D patients received dobutamine 5 μg/kg/min while weaning off CPB. Additional inotrope and/or vasoconstrictor were started based on hemodynamic parameters. Hemodynamic data were collected at the end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours post-CPB. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), and lactate levels were measured. Results: Group-L showed increased requirement of inotropes and vasoconstrictors. The SVRI, CVP, and MAP were reduced more in Group-L. The CI was low in Group-L in the initial period when compared to Group-D. Later Group-L patients showed a statistically significant increase in CI even after 12 hrs of discontinuation of levosimendan infusion. The HR was increased more in Group-D. Lactate levels, intensive care unit stay, and duration of ventilation were similar in both groups. Conclusions: Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation and lesser inotropic activity in patients undergoing mitral valve surgery for mitral stenosis. Levosimendan compared to dobutamine showed a statistically significant increase in CI even after 12 hrs of discontinuation. The requirement of another inotrope or vasopressor was frequent in levosimendan group.

Cálculo de resistencia vascular sistémica por ecocardiografía en la insuficiencia cardíaca crónica: una herramienta para optimizar la dosis de IECA y ARA II / Systemic vascular resistance by echocardiography in chronic heart failure: a tool to optimize the dose of ACE inhibitors and ARBs: uma ferramenta para otimizar a dose de inibidores da IECA e BRA II / Cálculo da resistência vascular sistêmica por ecocardiografia na insuficiência cardíaca crônica

Introducción. Los inhibidores de enzima de conversión y bloqueadores de receptores de angiotensina mejoran el pronóstico en la insuficiencia cardíaca (IC), aunque muchos pacientes no reciben dosis recomendadas. Objetivo. Determinar si el conocimiento de la resistencia vascular sistémica (RVS) por ecocardiografía permite aumentar el porcentaje de pacientes tratados con la dosis objetivo. Material y métodos. Se incluyeron pacientes con IC por disfunción sistólica sin contraindicación para enalapril/ losartán. La dosis objetivo considerada fue enalapril/losartán ≥20/25 mg/día. Se randomizaron a ajustar el tratamiento con enalapril/losartán según criterios clínicos y resistencia vascular sistémica versus criterio clínico exclusivo (Grupos A y B). En el grupo A una RVS ≥1200 dinas.seg.cm-5 fue indicación de aumentar dosis de enalapril/losartán un mínimo del 25%; al llegar a 40 mg de enalapril se adicionaba losartán 25 mg hasta 50 mg o hasta contraindicación. Se evaluó el cambio porcentual de pacientes recibiendo dosis objetivo entre ingreso y último control. Resultados. Se incluyeron 70 pacientes, 50 de ellos fueron hombres, edad 60±12 años, 30 en clase funcional I, con una RVS de 2033 ± 802 dinas.seg.cm-5. El tiempo de seguimiento fue de 12,3 meses. No se observaron diferencias significativas basales entre ambos grupos. Al final del seguimiento, el grupo A mostró un aumento significativo del porcentaje de pacientes con dosis objetivo de enalapril/losartán (50% versus 64%; p < 0,01); el grupo B mostró una disminución del mismo porcentaje (59% versus 47%; p < 0,05). Conclusión. El cálculo ecocardiográfico de la RVS aumenta el porcentaje de pacientes con IC que reciben dosis objetivo de enalapril/losartán.

Background. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers improve heart failure prognosis, but many patients are not treated with target doses. Objective. Our aim was to determine if the echocardiographic measurement of systemic vascular resistance could increase the number of patients treated with optimal doses. Material and methods. Patients with heart failure due to systolic dysfunction and no contraindications to enalapril/ losartán were included. The target doses considered were enalapril/losartán ≥ 20/25mg/day. Patients were randomized to adjusted dose using clinical approach and systemic vascular resistance vs clinical parameters only (Groups A and B). In group A if systemic vascular resistance was ≥ 1200 dynes.sec/cm-5, enalapril dose was increased 25% up to 40mg and then losartán was added (unless contraindication). The main outcome measures in follow-up were changes in proportion of patients receiving enalapril/losartán target doses, comparing recruit vs last control in both groups. Results. Seventy patients (50 males, age 60±12 years old, 30 in functional class I, systemic vascular resistance 2033±802 dines.seg.cm-5), were included and followed-up for 12.3±months. There were no significant basal differences between groups. In group A significant increase was observed in the proportion of patients receiving target dose of enalapril/losartán (50% recruit vs 64% last control, p < 0.01). In group B a significant decrease was observed in the same proportion (59% vs 47%, p <0.05). Conclusion. More patients with heart failure received target doses of enalapril/losartán, when echocardiographic measurement of systemic vascular resistance was used.

Introdução. Os inibidores da enzima conversora da angiotensina e bloqueadores dos receptores da angiotensina melhoram o prognóstico na insuficiência cardíaca (IC), embora muitos pacientes não recebem doses recomendadas. Objetivo. Determinar-se o conhecimento da resistência vascular sistêmica (RVS) por ecocardiografia aumenta a percentagem de pacientes tratados com dose ótima. Material e métodos. Foram incluídos pacientes com IC por disfunção sistólica sem contra-indicação para enalapril/losartán. A dose ótima foi considerado enalapril/losartán ≥20/25 mg/dia. Foram randomizados para ajustar o tratamento com enalapril/losartán de acordo com a clínica e resistência vascular sistêmica contra apreciação clínica exclusiva (Grupos A e B). No grupo A uma RVS ≥1200 dinas.seg.cm-5 foi indicativo de doses crescentes de enalapril/losartán pelo menos 25%, até atingir os 40 mg de enalapril foi além de losartán 25 mg a 50 mg ou contra-indicações. Foi avaliada a variação percentual em pacientes que receberam doses-alvo entre entrada no hospital e controle final. Resultados. Foram incluídos 70 pacientes, 50 eram do sexo masculino, idade 60 ± 12 anos, 30 em classe funcional I, com uma RVS de 2033 ± 802 dinas.seg.cm-5. O tempo de seguimento foi de 12,3 meses. Não houve diferenças significativas basais entre os dois grupos. No final do seguimento, o grupo A mostrou uma porcentagem significativamente maior de pacientes com dose ótima de enalapril/losartán (50% versus 64%, P <0,01), o grupo B mostrou uma diminuição na mesma percentagem (59% versus 47%, P <0,05). Conclusão. O cálculo ecocardiográfico de RVS aumenta a porcentagem de pacientes com insuficiência cardíaca receberam a dose ótima de enalapril/losartán.

The perioperative application of vasoconstrictor in patients of congenital heart disease with sever pulmonary arteries hypertension / 中华胸心血管外科杂志

Objective To compare the curative effects of different ideas for application of vasoactive drugs in patients of congenital heart disease with SPAH during perioperative period and to choose a method to improve the survival rate of patients with high-risk SPAH.Methods Thirty two patients were separated into two groups randomly,one group was treated by vasodilator to dilate the pulmonary artery and decrease the pulmonary pressure as conventional therapeutic strategy,the other was treated by vasoactive drugs to decrease the right cardiac output,which maintain the normal vessel resistance and cardiac output and reduce right heart failure.Indexes were recorded respectively,including hemodynamic,right cardiac working index(RCWI),the time of using respirator and postoperative complications to compare the differences.Results Indexes were recorded in two groups as following:Aortic/pulmonary artery pressure inversion(6.25％ vs.56.25％),RCWI (1626.87 ±411.23 vs.3808.99 ± 275.52),incidence of right heart failure (6.25％ vs.93.75％),respirator applying time[(68.00 ± 7.17) h vs.(115.00 ± 13.68) h],ICU time[(5.0 ± 0.8) d vs.(8.0 ± 1.5) d],incidence of postoperative pulmonary complications (6.25％ vs.81.25％),mortality(0 vs.12.5％).Conclusion The new therapeutic idea that using vasoactive drugs to reduce RCW1 and to maintain peripheral vessel resistance and appropriate cardiac output is superior for postoperative complications and mortality reduction.

Reproducibilidad de la estimación de índice cardíaco y resistencias vasculares sistémicas por eco-Doppler en pacientes con insuficiencia cardíaca crónica / Reproducibility of the estimation of the cardiac index and systemic vascular resistances by Doppler echocardiography in patients with chronic heart failure

Antecedentes: la estimación del índice cardíaco (Ic) y de la resistencia vascular sistémica (RVS) por eco-Doppler cardíaco ha sido validada por varios autores en su correlación con datos obtenidos en forma invasiva, con buena reproducibilidad intra e interobservador. En pacientes con insuficiencia cardíaca crónica (ICC), los reportes son escasos. Objetivo: determinar la variabilidad intra e interobservador de la estimación del Ic y de la RVS para el equipo de ecocardiografía de una unidad de tratamiento de pacientes ambulatorios con ICC. Método: las variables ecocardiográficas directas (VED) registradas fueron: diámetro del tracto de salida del ventrículo izquierdo (TSVI), integral velocidad-tiempo del TSVI(IVTTSVI), estimación de presión de aurícula derecha (PAD) según diámetro de vena cava inferior y su variación con la respiración. Se registró además frecuencia cardíaca (FC) y presión arterial (PA), calculando la PA media con la fórmula PA media=PA diastólica + 1/3 PA diferencial. Para el cálculo de Ic, gasto cardíaco (GC) y RVS se aplicaron las siguientes fórmulas: Ic = GC/superficie corporal, GC = (IVTTSVI x área TSVI) x FC, RVS = (PA media – PAD)/GC. Para la variabilidad intraobservador se compararon VED y cálculos realizados por un mismo observador en cinco pacientes, cinco veces consecutivas en cada uno, separadas por 15 minutos. Para la reproducibilidad interobservador se obtuvieron medidas y cálculos en 12 pacientes consecutivos por dos operadores a nivel 3 independientes, valorando la concordancia a través del índice kappa. Todos los pacientes se encontraban en ritmo sinusal. Resultado: la variabilidad intraobservador fue de 5,7% (aceptable) para VED y 13,6% (aceptable) para las medidas de cálculo. La reproducibilidad interobservador mostró un índice ...

Background: systemic vascular resistance (SVR) and cardiac index (CI) estimation by Doppler echcocardiography have a good correlation with invasive estimations and a good reproducibility. There are few reports about these echocardiographic estimations in chronic heart failure. Aim: to determine intra and interobserver variability of systemic vascular resistance and cardiac index estimation for the echocardiographic team of an ambulatory heart failure care unit.Method: direct echocardiographic variables were: outflow tract (OFT) diameter, OFT velocity-time integral (VTI) , right atrial pressure (RAP) estimated through inferior cave vein diameter and respiration variation. Cardiac frequency, arterial presssure and middle arterial pressure (MAP) were registered. To calculate CI, cardiac output (CO) and SVR next formulas were applied: CI: CO/ body surface area, CO: (OFT-VTI . OFT area). cardiac frequency, SVR: (MAP-RAP) /CO. Intraobserver variability (direct and calculated variables) was determine through a unique observer who made 5 consecutive observation (15 minutes separated each one) in 5 different patients. Kappa index was calculated for inter observer reproducibility by 2 observers level 3 who took direct and calculated variables in 12 consecutive patients. All observations were done in sinus rythm.Results: intraobserver variability was 5,7% for direct echocardiographic variables and 13,6% for calculated ones (acceptable). Ponderated kappa index for interobserver reproducibility was 0,87 (very good). Conclusion: our echocardiographic team show acceptable intra and inter observer reproducibility for CI and SVR estimation by Doppler echocardiography in chronic heart failure patients.

Utilidad de la estimación del índice cardíaco y de la resistencia vascular sistémica por eco-Doppler para el diagnóstico de insuficiencia cardíaca / The utility of estimating cardiac index and systemic vascular resistance by Doppler echocardiography for the diagnosis of heart failure

Resumen Antecedentes. La estimación del índice cardíaco (Ic) y de la resistencia vascular sistémica (RVS) por eco-Doppler cardíaco (ED) es factible y reproducible, según resultados de nuestro equipo y de otros. Objetivo. Determinar el valor del patrón hemodinámico estimado por ED en la evaluación diagnóstica de pacientes con posible insuficiencia cardíaca congestiva (ICC). Método. Se reclutaron 111 pacientes en ritmo sinusal, entre el 1/10/04 y el 30/9/06 que concurrieron a evaluación por ED para valorar su ingreso a una unidad de tratamiento avanzado de ICC. Fue condición de ingreso a la unidad la presencia de criterios de Boston definitivos para ICC y/o fracción de eyección del ventrículo izquierdo (FEVI) ≤ 40%. Se definieron 3 grupos: "disfunción sistólica" (DS) 74 pacientes con FEVI ≤ 40%, "ICC sin DS significativa" 26 pacientes con FEVI > 40% y "rechazados de la unidad" (R) 11 pacientes sin DS ni ICC. Se determinó el porcentaje (%) de pacientes con Ic bajo y RVS altas en cada grupo. Se estimó el valor predictivo positivo y negativo (VPP y VPN) así como la sensibilidad (S) y especificidad (E) del Ic bajo y las RVS altas para ICC o DS analizados en conjunto, como criterios de ingreso a la unidad. Se compararon los grupos según edad, Ic y RVS. La normalidad de las variables se determinó por test de Shapiro-Wilk; las variables normales se compararon por análisis de varianza y las no normales por Kruskal-Wallis. Nivel α aceptado 0,01. Resultados. Los 3 grupos eran comparables en edad. Grupo "DS": 78,4% con Ic bajo y 85,1% con RVS altas. Grupo "ICC sin DS significativa": 57,7% con Ic bajo y 88,5% con RVS altas. Grupo "R": 0,0% Ic bajo y 45,5% RVS altas. El grupo "DS" presentó Ic menor y RVS mayor que el grupo "R" (p=0,003 y 0,01) y no se diferenció del grupo "ICC sin DS significativa". Este último no se diferenció del grupo "R" para RVS (p=0,15), exhibiendo una tendencia a un menor Ic (p=0,02). El VPP y VPN del Ic bajo para ICC o DS fueron 100,0% y 28,9% con un intervalo de confianza 95% (IC 95%) (14,5-43,4) y los de RVS alta fueron 94,5% (89,8-99,2) y 30,0% IC95%(9,9-50,1), respectivamente. La E del Ic bajo para ICC o DS fue de 100,0% y la de la RVS alta fue de 54,5% IC95% (25,1-84,0); la S fue del 73,0% (IC95%[64,3-81,7]) y 86,0% (IC95%[79,2-92,8]), respectivamente. Conclusión. En pacientes con sospecha de ICC, el hallazgo de Ic bajo confirma el diagnóstico de ICC o el alto riesgo de padecerla (DS asintomática), con alto VPP y especificidad. La RVS alta si bien se asocia a ICC, es poco específica para su diagnóstico en este grupo etario.

Background. According to the results obtained by our team and others, the estimation of cardiac index (Ci) and systemic vascular resistance (SVR) by Doppler echocardiography (DE) is feasible and reproducible. Objective. To determine the value of hemodynamic pattern estimated by DE in the diagnostic evaluation of patients with possible congestive heart failure (CHF). Method. We recruited 111 patients in sinusal rhythm, who underwent DE evaluation to assess their entry into a unit for advanced treatment of CHF between 01/10/04 and 30/09/06. We considered as inclusion criteria the Boston definitive criteria for CHF and / or ejection fraction of left ventricle (LVEF) ≤ 40%. Three groups were defined: "Systolic Dysfunction (SD)" 74 patients with LVEF ≤ 40%; "CHF without significant SD" 26 patients with LVEF> 40%, and "Rejected from the unit" (R) 11 patients without SD or CHF. We determined the percentage (%) of patients with low Ci and high SVR in each group. As criteria for admission to the unit we estimated the positive and negative predictive value (PPV and NPV) and sensitivity (S) and specificity (E) of the low Ci and high SVR, for CHF or SD analyzed together. We compared groups according to age, Ci and SVR. The normality of variables was determined by Shapiro-Wilk test, normal variables were compared by analysis of variance and non-normal by Kruskal-Wallis. Accepted α level: 0.01. Results. The 3 groups were comparable in age. "SD" group: 78.4% with low Ci and 85.1% with high SVR. "CHF without significant SD" group: 57.7% with low Ci and 88.5% with high SVR. "R" group: 0.0% with low Ci and 45.5% with high SVR. The "SD" group presented lower Ci and higher SVR than the "R" group (p=0.003 and 0.01) and did not differ from "CHF group without significant SD". The latter did not differ from "R" group for SVR (p=0.15), showing a trend towards lower Ci (p=0.02). The PPV and NPV of low Ci for CHF or SD were 100.0% and 28.9% with a 95% confidence interval (CI 95%) (14,5-43,4), and high SVR were 94, 5% (89,8-99,2) and 30,0% (CI 95% [9,9-50,1]) respectively. The E from low Ci for CHF or SD was of 100.0%, and from the high SVR was 54.5% (CI95% [25,1-84,0]); the S was 73,0% (CI95% [64,3-81,7]) and 86,0% (95% [79,2-92,8]) respectively. Conclusion. In patients with suspected CHF, low Ci finding confirms the diagnosis of CHF or a high risk to suffer it (asymptomatic SD), with high PPV and specificity. Although high SVR is associated with CHF, it is not specific for diagnosis in this age group.

Antecedentes. A estimativa do índice cardíaco (Ic) e da resistência vascular sistêmica (RVS) por eco-Doppler cardíaco (ED) é factível e reproduzível, segundo resultados da nossa equipe e de outros. Objetivo. Determinar o valor do padrão hemodinâmico estimado por ED na avaliação diagnóstica de pacientes com possível insuficiência cardíaca congestiva (ICC). Método. Recrutaram-se111 pacientes em ritmo sinusal, entre el 1/10/04 e 30/9/06 que compareceram à avaliação por ED para avaliar o ingresso a uma unidade de tratamento avançado de ICC. Foi condição de ingresso à unidade a presença de critérios de Boston definitivos para ICC e/ou fração de ejeção do ventrículo esquerdo (FEVE) ≤ 40%. Definiram-se 3 grupos: "disfunção sistólica" (DS) 74 pacientes com FEVE ≤ 40%, "ICC sem DS significativa" 26 pacientes com FEVE > 40% e "rechaçados da unidade" (R) 11 pacientes sem DS nem ICC. Determinou-se a porcentagem (%) de pacientes com Ic baixo e RVS altas em cada grupo. Estimou-se o valor preditivo positivo e negativo (VPP e VPN) assim como a sensibilidade (S) e especificidade (E) do Ic baixo e as RVS altas para ICC ou DS analisados em conjunto, com critérios de ingresso à unidade. Compararam-se os grupos segundo idade, Ic e RVS. A normalidade das variáveis determinou-se por test de Shapiro-Wilk; as variáveis normais compararam-se por análise de variância e as não normais por Kruskal-Wallis. Nível α aceitado 0,01. Resultados. Os 3 grupos eram comparáveis em idade. Grupo "DS": 78,4% com Ic Baixo e 85,1% com RVS altas. Grupo "ICC sem DS significativa": 57,7% com Ic baixo e 88,5% com RVS altas. Grupo "R": 0,0% Ic baixo e 45,5% RVS altas. O grupo "DS" apresentou Ic menor e RVS maior que o grupo "R" (p=0,003 e 0,01) e não se diferenciou do grupo "ICC sem DS significativa". Este último não se diferenciou do grupo "R" para RVS (p=0,15), mostrando uma tendência a um menor Ic (p=0,02). O VPP e VPN do Ic baixo para ICC ou DS foram 100,0% e 28,9% com um intervalo de confiança de 95% (IC 95%) (14,5-43,4) e os de RVS alta foram 94,5% (89,8-99,2) e 30,0% IC95%(9,9-50,1), respectivamente. A E do Ic baixo para ICC ou DS foi de 100,0% e a da RVS alta foi de 54,5% IC95% (25,1-84,0). O S foi de 73,0% (IC95% [64,3-81,7]) e 86,0% (IC95% [79,2-92,8]), respectivamente. Conclusão. Em pacientes com suspeita de ICC, o Ic baixo encontrado confirma o diagnóstico de ICC ou o alto risco de padecê-la. (DS assintomática), com alto VPP e especificidade. A RVS alta se bem que se associa à ICC, é pouco específica para seu diagnóstico neste grupo etário.

Hemodinamia de la insuficiencia cardíaca crónica estimada por eco-Doppler cardíaco y su evolución a un año / Hemodinâmica da insuficiência cardíaca crônica estimada por eco Doppler cardíaco e sua evolução após um ano / Hemodynamic of chronic heart failure estimated by cardiac eco-Doppler and its evolution to one year

Antecedentes. La característica fisiopatológica principal de la insuficiencia cardíaca es el índice cardíaco (Ic) disminuido. Existen pocas referencias bibliográficas sobre el patrón hemodinámico de la insuficiencia cardíaca crónica (ICC) valorado por ecocardiografía Doppler (ED) y su evolución. Objetivo. Identificar el patrón hemodinámico en pacientes ambulatorios con ICC con disfunción sistólica (DS) y comparar el mismo al ingreso a un programa avanzado de tratamiento de la ICC con el obtenido a los 6 meses y al año. Método. Se reclutaron 74 pacientes con ICC en ritmo sinusal, entre el 01/10/2004 y el 30/9/2006 que concurrieron al laboratorio de ED para ingresar a un programa de tratamiento avanzado de ICC. Se estimaron la fracción de eyección del ventrículo izquierdo (FEVI), el Ic y la resistencia vascular sistémica (RVS). Se incluyeron aquellos pacientes con al menos un control por ED a los 6 meses del ingreso. Se compararon los valores hallados de Ic (L/min/m-2), RVS (dinas/seg/cm-5) y FEVI (%), media y rango, obtenidos en la evolución (6 meses y 1 año), con los datos del ingreso, a través del test de t para muestras apareadas (α=0,05). Resultado. Se consideraron 36 pacientes con al menos un control con ED (media: 5,7 meses, luego del ingreso) con una edad media de 60±9 años, 25 (69%) eran hombres. La FEVI al ingreso fue del 30±7% [15-40], disminuida en el 100% de los casos, el Ic de 1,95±0,79 [1,05-4,98] L/min/m-2, disminuido en el 78% de los casos y la RVS de 2098±711 [569-3523] d/seg/cm-5, aumentada en el 86% de los casos. En el primer control, la FEVI fue del 35±11% [20-58], el Ic de 1,99±0,69 [0,66-4,26] L/min/m-2 y la RVS de 2106±763 [885-3770] d/seg/cm-5. La FEVI mostró, respecto al ingreso, un aumento significativo (p=0,01). El Ic y la RVS mostraron diferencias no significativas, con p=0,85 y p=0,96, respectivamente. Trece pacientes tuvieron un segundo control con ED a los 12 meses del ingreso con una edad media de 60±9 años, 8 (62%) eran hombres. Valores al ingreso: FEVI 33±7% [33-40], Ic 2,06±0,98 [1,30-4,98] L/min/m-2, y RVS 1975±755 [569-3107] d/seg/cm-5. Valores en el segundo control: FEVI 40±9% [30-65], Ic 1,99±0,55 [1,25-3,02] L/min/m-2, RVS 2134±929 [1382-4526] d/seg/cm-5. La FEVI mostró un aumento significativo (p=0,03). El Ic y la RVS mostraron diferencias no significativas (p=0,71 y p=0,51). Conclusión. La FEVI y el Ic disminuidos y la RVS elevada son el patrón hemodinámico esperable en pacientes con ICC por DS. Se verificó una mejoría de la FEVI a los 6 meses y al año del ingreso a un programa avanzado de tratamiento sin cambios significativos en el Ic ni en la RVS.

Background. The main physiopathological characteristic of heart failure is the diminished cardiac index (CI). There are few references on hemodynamic pattern of chronic heart failure (CHF) assessed by Doppler echocardiography (DE) and its evolution. Objective. To identify the hemodynamic pattern in outpatients with CHF due to systolic dysfunction (SD) and compare it to the basal, through an advanced treatment for CHF program, with those obtained at 6 months and a year. Method. Between 1/10/04 and 30/9/06 seventy-four patients with CHF in sinusal rhythm who attended to DE for admission to an advanced treatment program for CHF were recruited. Left ventricular ejection fraction (LVEF), CI and systemic vascular resistance (SVR) were estimated. Those patients with at least one control with DE at 6 months of income were considered. Values found in CI (L.min.m-2), SVR (dinas.seg.cm-5) and LVEF (%), mean and range, earned in the evolution (6 months and 1 year), were compared to the income data through the sample paired t test (α=0.05). Result. Thirty six patients with at least one control (average: 5.7 months after the entry), mean age 60±9 years, 25 (69%) men, were considered. Basal LVEF was 30±7% [15-40], diminished in 100% of the cases; CI 1.95±0.79 [1.05-4.98] L.min.m-2, diminished in 78% of the cases; and SVR 2098±711 [569-3523] d.seg.cm-5, increased in 86% of the cases. During the first control, LVEF was 35±11% [20-58], CI 1.99±0.69 [0.66-4.26] L.min.m-2 and SVR 2106±763 [885-3770] d.seg.cm-5. LVEF showed, regarding the income, a significant increase (p=0.01). CI and SVR indicated non significant differences, with p=0.85 and p=0.96, respectively. Thirteen patients underwent a second control 12 months after the income with average age 60±9 years, 8 (62%) men. Income values: LVEF 33±7% [33-40], CI 2.06±0.98 [1.30-4.98] (L.min.m-2), and SVR 1975±755 [569-3107] d.seg.cm-5. Second control values: LVEF 40±9% [30-65], CI 1.99±0.55 [1.25-3.02] L.min.m-2, SVR 2134±929 [1382-4526] d.seg.cm-5. LVEF presented a significant increase (p=0.03). CI and SVR indicated non significant differences (p=0.71 and p=0.51). Conclusion. Diminished LVEF and CI, and increased SVR are the expected hemodynamic pattern in patients with CHF due to SD. There was an improvement in LVEF at 6 months and one year after admission to an advanced treatment program without significant changes in either CI or SVR.

Antecedente. A principal característica fisiopatológica da insuficiência cardíaca é o índice cardíaco (Ic) diminuído. Existem poucas referências bibliográficas sobre o padrão hemodinâmico da insuficiência cardíaca crônica (ICC) avaliado por eco cardiografia Doppler (ED) e sua evolução. Objetivo. Identificar o padrão hemodinâmico em pacientes ambulatórios com ICC por disfunção sistólica (DS) e comparar o mesmo ao ingresso a um programa avançado de tratamento de ICC com o obtido aos 6 meses e ao ano. Método. Recrutaram-se 74 pacientes com ICC em ritmo sinusal, entre o 01/10/2004 e o 30/9/2006 que compareceram ao laboratório de ED para ingressar a um programa de tratamento avançado de ICC. Estimaramse a fração de ejeção do ventrículo esquerdo (FEVE), o Ic e a resistência vascular sistêmica (RVS). Incluíramse aqueles pacientes com pelo menos um controle por ED após 6 meses do ingresso. Compararamse os valores encontrados de Ic (L.min.m-2), RVS (dinas.seg.cm-5) e FEVE (%), média e categoria, obtidos na evolução (6 meses e 1 ano), com os dados do ingresso, através do test de t para amostras emparelhadas (α=0,05). Resultado. Consideraram-se 36 pacientes com pelo menos um controle (média: 5,7 meses, após o ingresso) com uma idade média de 60±9 anos, 25 (69%) eram homens. A FEVE ao ingresso foi de 30±7% [15-40], diminuída em 100% dos casos, o Ic de 1,95±0,79 [1,05-4,98] L.min.m-2, diminuído em 78% dos casos e a RVS de 2098±711 [569-3523] d.seg.cm-5, aumentadas em 86% dos casos. No primeiro controle, a FEVE foi de 35±11% [20-58], o Ic de 1,99±0,69 [0,66-4,26] L.min.m-2 e a RVS de 2106±763 [885-3770] d.seg.cm-5. A FEVE mostrou, com respeito ao ingresso, um aumento significativo (p=0,01). O Ic e a RVS mostraram diferenças não significativas, com p=0,85 y p=0,96, respectivamente. Treze pacientes tiveram um segundo controle aos 12 meses do ingresso com idade média de 60±9 anos, 8 (62%) eram homens. Valores ao ingresso: FEVE 33±7% [33-40], Ic 2,06±0,98 [1,30-4,98] L.min.m-2, e RVS 1975±755 [569-3107] d.seg.cm-5. Valores no segundo controle: FEVE 40±9% [30-65], Ic 1,99±0,55 [1,25-3,02] L.min.m-2, RVS 2134±929 [1382-4526] d.seg.cm-5. A FEVE mostrou um aumento significativo (p=0,03). O Ic e a RVS mostraram diferenças não significativas (p=0,71 y p=0,51). Conclusão. A FEVE e o Ic diminuído e a RVS elevada são os padrões hemodinâmicos esperáveis em pacientes com ICC por DS. Verificou-se uma melhora da FEVE após 6 meses e a um ano do ingresso a um programa avançado de tratamento sem mudanças significativas no Ic nem na RVS.

Distribution of abnormal circulation vascular resistance and cardiac function in population at Guangxi / 基础医学与临床

Objective To analyze the distribution features of systemic vascular resistance(SVR)disorder in healthy subjects at Guangxi province.Methods SVR and systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),pulse pressure(PP),cardiac output(CO),cardiac index(CI),stroke volume(SV),stroke index(SI),left ventricular ejection time(LVET),left cardiac work(LCW) and cardiovascular function were measured with Bioz.com Cardio Dynamics.Results The incidence of SVR disorder in youngster and elder was higher than other subjects.The prevalence of SVR disorders was more among females than among males(P

Hemodynamic Effect of Propofol and Esmolol under Isoflurane Anesthesia in Dogs / 대한마취과학회지

BACKGROUND: Propofol has gained widespread popularity but it should at least be questioned in the presence of heart rate lowering medications such as beta-blockers. Esmolol, due to its ultrashort action and cardioselective properties, has been shown to be safe and effective for use in intraoprative tachycardia and hypertension. The purpose of this study is to evaluate the hemodynamic effects of esmolol and propofol under isoflurane anesthesia in dogs. METHODS: Six-mongrel dogs were induced with thiopental, intubated and ventilated with a mixture of isoflurane (1-1.5 vol%) and oxygen. A pulmonary artery catheter was placed via femoral vein and the femoral artery was cannulated. After stabilization, baseline hemodynamic measurements (HR, MAP, CO, SVR) were obtained. Measurements were repeated 5 and 15 minutes after injection of propofol (2 mg/kg), esmolol (1 mg/kg), and additional esmolol (1 mg/kg) for 30 seconds. Data was analyzed by repeated measurement of ANOVA. P < 0.05 was considered significant. RESULTS: Propofol produced no change in heart rate, MAP, CO and SVR. Heart rate decreased significantly during esmolol administration and remained decreased up to 15 minutes after the injection whereas the MAP, CO and SVR showed no significant changes. CONCLUSIONS: We have demonstrated that the decrease in heart rate continued up to 15 minutes after esmolol administration. These findings suggest that concomittent administration of propofol and esmolol requires monitoring of the heart rate after a bolus intravenous injection of esmolol.

Changes of Whole Body Oxygen Consumption According to Changes of Systemic Vascular Resistance During Hypothermic Extracorporeal Circulation / 대한마취과학회지

Changes in whole body oxygen consumption associated with decreasea in systemic vascular resistance produced by Nipride (ssodium nitroprusside) infusion were measured in 15 patients during hypothermic extracorporeal circulation. When the body temperature was 29.3+/-2.16degrees C, mixed venous and arterial blood were sample simultaneously for the calculation of whole body oxygen consumption. Blood sample were withdrawn simultaneouely from the arterial outlet line and venous inlet line of the oxygenator for blood gas analysis. In each patient, whole body oxygen consumption at 29.3+/-2.16degrees C was determined as control. After then Nipride was infused until 10% decreasing of systemic vascular resistance was achieved and whole body oxygen consumption waa calculated. Body temperature, pump flow and hematocrit were maintained within a narrow range in each patients during studies. Arterial and mixed venous blood gases were analyzed at 37degrees C, uncorrected for body temperature(alpha-stat acid-base management). The result was that the whole body oxygen consumption changed from 43.3+/-12.12mL/min/m to 68.9+/-19. 16mL/min/m by Nipride infusion during hypothermic extracorporeal circulation. The 10% de- creasing of systemic vascular resistance by Nipride during hypothermic extracorporeal circulation lead to the 58+/-6.2% increasing of whole body oxygen consumption. We found that significant increase in whole body oxygen consumption hsd occured following Nipride infusion.

The Influence of isoflurane on systemic vascualr resistance during cardiopulmonary bypass / 대한마취과학회지

The influence of isoflurane on systemic vascular resistances was studied during total cardiopulmonary bypass with membrane oxygenator, low rate of 2.4 L/min/m(2) and moderate hypothermia Data were obtained from 40 adult patients undergoing corrective surgery for congenital or aquired heart disease. The materials were randomly divided in two groups with 20 and 20 patients, respectively, Before cadiopulmonary bypass, the same anesthetic technique was applied to 2 groups. During cardiapuhnonary bypass, isoflurane was given into oxygenator at 0.5-1.5% concentration in group I. In group II, no isoflurane was given but 0.2 mg/kg midazolam was supplied into the oxygenator at the beginning of bypass. To both groups small amounts of fentanyl were given during bypass. There were no significant differences in mean cardiopulmonary bypass time and pump flow between the groups.In group I, systemic vascular resistance did not increase until 60 minutes, whereas in group II systemic vascular resistance increased significantly after 30 minutes and maximal increase was noticed at 60 minutes. Data for base excess demonstrated that significant fall after 40 minutes of perfusion in group II, but not changes in group I. It is concluded that isoflurane exerts a beneficial vasodilatory action during caardiopulmonary bypass and hypothermia. And the harzards of local reduction in organic blood flow are ehminated, because an adequate perfusion pressure and flow are maintained by the heart lung machine.

Measurement of Right Ventricular Ejection Fraction(RVEF) in Patients Undergoing Cardiac Surgery / 대한마취과학회지

The left ventricle is realized as the cardiac structure of greatest importance for cardiac pump function, and the role of the right ventricle has been overlooked. However, the right ventricle and the left ventricle are in series and physiologically coupled so that a disturbance in the one ventricular function will influence the behavior of the other. Thus, there ia growing interest in the importance of the right side of the heart, particularly in patients undergoing cardiac surgery. Moreover recently, right ventricular failure has been identified as a cause of progressive deterioration in patients undergoing cardiac operations, and it may limit the overall success of the procedure. This study was performed to investigate right ventricular ejection fraction of the cardiac patients at pre and post-perfusion period. 10 cases were measured and analyzed. The results were as follows: I) There were no singificant differences statistically in demographic data of the patients. 2) Pulmonary capillary wedge pressure(PCWP) of postperfusion 10 min. was significantly increased compared to preperfusion period(p<0.01). 3) Systemic vascular resistance(SVR) of immediate postperfusion period was significantly decreased compared to preperfusion period. 4) Heart rate and central venous pressure(CVP) of postperfusion period were statistically significantly increased, but clinically no significant change compared to preperfusion period. 5) Cardiac output(CO) and right ventricular ejection fraction(RVEF) of postperfusion period were no significant change compared to preperfusion period.

Effect of Intravenous Anesthetics on Systemic Vascular Resistance during Cardiopulmanary Bypass / 대한마취과학회지

We have studied the effect of thiopental sodium, propofol, midazolam and ketamine on systemic vascular resistance(SVR) during cardiopulmonary bypass with constant pump flow in 20 patients undergoing elective open heart surgery. SVR decreased about 13(+/-3.42)% of control values after thiopental sodium 4 mg/kg, about 10 (+/-5.30)% of control after propofol 2 mg/kg and about 8(+/-3.72)% of control after midazolam 0.2 mg/kg; it returned to control values about 2 min 30 sec(+/-1 min 20 sec) after administration of thiopental sodium and about 4 min 30 sec(+/-2 min 15 sec) after administration of propofol. It remained under control values after 10 min after administration of midazolam. Ketamine showed no significant changes on SVR. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups. Change of SVR after administration of thiopental sodium did not have statistical significance(P< 0.05).

Hemodynamic Effects of Relative Doses of Calcium Gluconate Injection Following Cardiopulmonary Bypass / 대한마취과학회지

Calcium gluconate is frequently administered after the end of cardiopulmonary bypass in order to produce moderate improvement in myoeardial contractility and performance. Numerous investigators found good correlation between the cardiac output measured by combined transesophageal Doppler cardiac output and thermodilution or Fick cardiac output. Transesophageal Doppler cardiac output monitoring was more reproducible, showing less short- term variability than thermodilution cardiac output. We researched the hemodynamic effects of l0, 20, and 30 mg/kg of calcium gluconate with transesophageal Doppler cardiac output in 30 valve replacement patients following cardiopulmo- nary bypass. The results were as follows; l) The mean arterial pressure was statistically increased for 5 minutes after 30 mg/kg injection of calcium gluconate, but there was no special changes after l0 and 20 mg/kg injection of calcium gluconate. We could not find profound bradycardia after calcium gluconate injection. 2) The cardiac index was statistically increased for 5 minutes after 30 mg/kg injection of calcium gluconate, but there were no changes in less doses. The systemic vascular resistance was decreased after calcium gluconate injection and more pronounced in 30 mg/kg injection of calcium gluconate. 3) Ionized calcium was most increased at 1 minute after calcium gluconate injection and specially about 50% rise at 1 minute after 30 mg/kg injection of calcium gluconate. After 1 minute, there was sharply decreased, not sustained. In conclusions it was available to administer 30 mg/kg of calcium gluconate for hemodynamic assistance following cardiopulmonary bypass. Calcium gluconate should probably not be routinely administered upon discontinuing cardiopulmonary bypass, but should be selectively used when needed to transiently augment myocardial contractility.

Acute hemodynamic effects of increasing hemoglobin concentration in children with congenital heart disease and relative anemia

No abstract available.