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1.
Transplant Proc ; 48(9): 3203-3206, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27932181

ABSTRACT

Anesthesia for patients with moderate aortic stenosis accompanied by atrial fibrillation during high-risk surgery such as liver transplantation remains a challenge in maintaining control of heart rate and maintenance of cardiac output. The action of terlipressin on vasopressin receptors (mainly V1 receptors) leads to splanchnic vasoconstriction and is the key mechanism responsible for increasing systemic vascular resistance and reducing heart rate. We report successful anesthetic management using low-dose terlipressin infusion in an elderly patient who had moderate aortic stenosis with atrial fibrillation during urgent deceased-donor liver transplantation.


Subject(s)
Anesthetics/therapeutic use , Aortic Valve Stenosis/complications , Atrial Fibrillation/complications , Liver Transplantation/methods , Lypressin/analogs & derivatives , Aged , Female , Humans , Lypressin/therapeutic use , Male , Terlipressin
2.
Acta Anaesthesiol Scand ; 59(6): 788-95, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25736101

ABSTRACT

BACKGROUND: Intravenous or volatile agents reduce respiratory function, which can result in respiratory complications in geriatric patients. We hypothesised that there would be no differences in lung function between anaesthesia established using either drug. METHODS: Elderly patients were randomly assigned to receive either propofol with remifentanil (n = 48) or desflurane (DES) with remifentanil (n = 52) for knee surgery. Spirometry tests including forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), forced mid-expiratory flow (FEF25-75), and FEV1 /FVC ratio were performed preoperatively, and 30 min, 60 min, and 24 h after awakening. Emergence time and post-operative pain scores were also measured. RESULTS: Time to emergence was significantly longer in the propofol than in the DES group (17.0 vs. 12.5 min, P = 0.04). Post-operative FEV1 (1.6 or 1.4 l, P = 0.68 between groups) were significantly lower than preoperative values (2.1 or 2.0 l, P = 0.001 vs. post-operative values, respectively) in both groups. Reduced FEV1 lasted for 24 h after surgery (1.7 or 1.6 l, P = 0.001 vs. preoperative values, respectively). Post-operative FVC or FEF25-75 were lower than preoperative values. FEV1 /FVC ratio did not change during the study period in both groups. There was no difference in FEV1 , FVC, FEF25-75, FEV1 /FVC, and post-operative pain between the two anaesthetic techniques. CONCLUSIONS: Although there is a delay in awakening when using propofol, the effects of propofol on post-operative spirometry parameters are similar to those of DES when anaesthesia duration is approximately 3 h. Decreased respiratory parameters persisted up to 24 h after anaesthesia, irrespective of the choice of anaesthetic.


Subject(s)
Anesthetics, Inhalation/pharmacology , Anesthetics, Intravenous/pharmacology , Isoflurane/analogs & derivatives , Knee/surgery , Lung/drug effects , Propofol/pharmacology , Aged , Desflurane , Double-Blind Method , Female , Forced Expiratory Volume/drug effects , Humans , Isoflurane/pharmacology , Male , Postoperative Period , Spirometry , Vital Capacity/drug effects
3.
Med J Malaysia ; 69(1): 9-12, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24814621

ABSTRACT

OBJECTIVE: This study aimed to evaluate the prevalence of sensorineural hearing loss (SNHL) in ß-thalassaemia patients treated with Desferrioxamine (DFO) and determine the correlation of SNHL with average daily DFO dosage, serum ferritin level and Therapeutic index (T.I). METHODS: This is a cross sectional descriptive study carried out for a period of 14 months and 54 patients were recruited. The recruited patients are transfusion dependant ß- thalassaemia patient aged 3 years and above treated with DFO. An interview, clinical examination and hearing assessment, which included tympanogram, and Pure Tone Audiometry (PTA) or behaviour alaudiometry were performed. The data on age started on DFO, average daily DFO, duration of DFO intake, serum ferritin past 1 year and Therapeutic Index (T.I) were obtained from patients' case notes. RESULTS: The prevalence of SNHL was 57.4% and majority has mild hearing loss (93.6%). Fourteen patients (25.9%) have bilateral ear involvement and as many as 17 patients (31.5%) have SNHL in either ear. A total of 23 patients (42.6%) have normal hearing level. Although the prevalence of SNHL was 57.4%, only a small percentage of the patient noticed and complained of hearing loss (11.1%). There is no association between age started on DFO, average daily DFO and duration of DFO intake with normal hearing group and those patients with SNHL. Positive correlation was seen between average daily DFO with 2000 and 4000Hz on PTA in the left ear and between serum ferritin level past 1 year with 4000 and 8000Hz in the right ear and 8000Hz in the left ear. No significant correlation was seen between T.I on PTA. CONCLUSION: The prevalence of SNHL from hearing assessment is high in ß-thalassaemia patients in this study. However, it is manifested clinically in a smaller percentage. We suggest a baseline hearing assessment should be carried on all ß-thalassaemia patients prior to DFO chelation therapy.

4.
Horm Metab Res ; 43(9): 642-5, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21823060

ABSTRACT

Metabolic syndrome is a complex clinical disorder characterized by obesity, a disturbance of glucose metabolism, dyslipidemia, and hypertension, leading to increased cardiovascular risk. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine produced both by innate immune cells and by adipocytes, and it plays an important role in inflammatory and cardiovascular diseases. The goal of this study was to evaluate the expression of circulating MIF in patients with metabolic syndrome. A study was conducted involving 172 persons who attended the Jeju National University Hospital Health Promotion Center. Among the 172 subjects, 88 patients with metabolic syndrome and 84 healthy control subjects were included. Serum MIF levels were considerably higher in patients with metabolic syndrome than in healthy subjects (mean±SEM, 1413.0-pg/ml±102.6 vs. 1077.0-pg/ml±-91.3, p=0.016). Among the metabolic syndrome patients, MIF levels were significantly increased in women (1403.0-pg/ml±114.2 vs. 921.3 pg/ml±117.3, p=0.005), but not in men. Even after further linear regression adjustment for age and body mass index, the expression of MIF for women with metabolic syndrome was still clearly elevated when compared to healthy subjects (p=0.011). Circulating MIF concentrations showed a gender disparity between healthy and metabolic syndrome subjects. An elevation of systemic MIF in women with metabolic syndrome may contribute to pathogenesis of metabolic syndrome or to the development of metabolic syndrome-related diseases, such as atherosclerosis and type 2 diabetes mellitus.


Subject(s)
Macrophage Migration-Inhibitory Factors/blood , Metabolic Syndrome/blood , Adult , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Sex Factors
5.
J Orthop Surg (Hong Kong) ; 16(3): 348-50, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19126904

ABSTRACT

Kinetic magnetic resonance images (kMRIs) of 587 lumbar and 459 cervical spines of symptomatic patients in axially loaded, upright neutral (0 degrees), flexion (40 degrees), and extension (-20 degrees) positions were evaluated. Imaging took 10 to 12 minutes to complete in each position. Cervical kinematics were significantly affected by intervertebral disc degeneration, cervical cord compression, and sagittal alignment of the cervical spine. kMRI was effective in diagnosing lumbar disc herniations that are often missed using conventional MRI. kMRI is effective for diagnosing, evaluating, and managing degenerative disease or injury within the spine.


Subject(s)
Cervical Vertebrae , Lumbar Vertebrae , Spinal Diseases/pathology , Spinal Diseases/physiopathology , Biomechanical Phenomena/physiology , Cohort Studies , Humans , Magnetic Resonance Imaging , Posture/physiology , Retrospective Studies , Weight-Bearing/physiology
6.
Anaesthesia ; 57(3): 227-32, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11879211

ABSTRACT

We investigated whether human beta2 adrenoceptor (beta2AR) gene polymorphisms are associated with the pressor response to laryngoscopy and tracheal intubation. Ninety-two patients undergoing elective surgery under general anaesthesia were enrolled into this study. Arterial systolic pressure, heart rate and rate pressure product were measured before induction of anaesthesia and 1 min following laryngoscopy and tracheal intubation. Genomic DNA was then used to identify the beta2AR-16 and beta2AR-27 genes using an allele-specific polymerase chain reaction method. Using multiple linear regression models, controlling for age, sex, weight, baseline blood pressure, heart rate and rate pressure product, we found that patients who possessed the glutamic acid homozygote of beta2AR-27 produced significantly greater changes in mean arterial pressure and rate pressure products than patients with the glutamine homozygote of beta2AR-27 (beta coefficient for mean blood pressure = 11.81, beta coefficient for pulse-pressure product = 8.76, both p-values = 0.023). These findings suggest that genetic variability in the human beta2AR gene polymorphisms may be associated with the pressor response to laryngoscopy and tracheal intubation.


Subject(s)
Hypertension/genetics , Intubation, Intratracheal/adverse effects , Laryngoscopy/adverse effects , Polymorphism, Genetic , Receptors, Adrenergic, beta-2/genetics , Adult , Blood Pressure/genetics , Female , Genetic Predisposition to Disease , Genotype , Heart Rate/genetics , Humans , Hypertension/etiology , Hypertension/physiopathology , Linear Models , Male , Middle Aged , Pressoreceptors/physiopathology
7.
Can J Anaesth ; 48(6): 545-50, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11444448

ABSTRACT

PURPOSE: To examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC). METHODS: One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after the pneumoperitoneum. Group B received periportal and intraperitoneal bupivacaine at the end of the operation. Group C (preoperative) and Group D (postoperative) received only periportal bupivacaine and Group E (preoperative) and Group F (post-operative) received only intraperitoneal bupivacaine. The control group received no treatment. Pain and nausea were recorded at one, two, three, six, nine, 12, 24, 36, and 48 hr postoperatively. RESULTS: Throughout the postoperative 48 hr, incisional somatic pain dominated over other pain localizations in the control group (P <0.05). The incisional pain of groups A, B, C and D was significantly lower than that of the control group in the first and second hours. The incisional pain of groups A and C was significantly lower than that of the control group in the first three hours. CONCLUSION: Incisional pain dominated during the first two post-operative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three post-operative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.


Subject(s)
Anesthetics, Local/therapeutic use , Bupivacaine/therapeutic use , Cholecystectomy, Laparoscopic , Pain, Postoperative/prevention & control , Adult , Anesthesia, General , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Female , Humans , Injections, Intraperitoneal , Male , Middle Aged , Postoperative Nausea and Vomiting/epidemiology
8.
J Korean Med Sci ; 16(3): 375-7, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11410705

ABSTRACT

Permanent ischemic injury of the hand after radial artery cannulation is rare, but several cases of thromboembolism after the cannulation leading to amputation of affected limb or digits have been reported. A 48-yr-old man undergoing spine surgery showed normal modified Allen's test and had no preoperative vascular disease. We inserted 20-G radial artery catheter for the continuous monitoring of the blood flow and serial blood sampling. There was no specific event during the operation and the catheter was removed immediately after the operation. The signs and symptoms of the circulatory impairment of the radial artery developed four days after the operation and aggravated thereafter. Through the angiographic study, we found the total occlusion of the radial artery and some of its branches. After an emergent surgical exploration of the radial artery for removal of the thrombus and vein graft for the defect of the artery on the 8th postoperative day, the ischemic signs and symptoms disappeared and the radial pulse was restored.


Subject(s)
Catheterization, Peripheral/adverse effects , Fingers/blood supply , Hand/blood supply , Peripheral Vascular Diseases/surgery , Radial Artery/abnormalities , Thromboembolism/surgery , Embolectomy , Fingers/diagnostic imaging , Hand/diagnostic imaging , Humans , Male , Middle Aged , Peripheral Vascular Diseases/etiology , Radial Artery/surgery , Radiography , Thromboembolism/etiology , Treatment Outcome
9.
Acta Anaesthesiol Sin ; 38(2): 59-64, 2000 Jun.
Article in English | MEDLINE | ID: mdl-11000667

ABSTRACT

BACKGROUND: Formalin test is commonly used in animal model to assess injury-produced pain response. If the total amount of formaldehyde is fixed, its concentration and volume can be easily adjusted. We evaluated the effect of two sets of three solutions of formalin (one set of same dose of formaldehyde at different concentration and volume, i.e. 2.5%--100 microL, 5%--50 microL, 10%--25 microL, and another set of same volume but at different concentrations, i.e. 2.5%--100 microL, 5%--100 microL, and 10%--100 microL) on the injury-produced pain response in rat. METHODS: Male Sprague-Dawley rats weighing 250-300 g were used. Following injection of formalin (n = 8 in each group) or saline (n = 6, control), the flinching frequencies and time spent in licking or biting the injected hind-paw in the early phase 1 (0-5 min after injection) and the late phase 2 (20-60 min after injection) were recorded. Sham-injection rats (n = 5) underwent subcutaneous insertion of the needle, but no substance was injected. RESULTS: Flinching in phase 1 and 2 was more frequent in the 2.5%--100 microL and 5%--50 microL groups than in the control group (P < 0.05). Licking (or biting) time in phase 2 in all these three groups was longer than the control group (P < 0.05). In the groups of another set of three different solutions (2.5%--100 microL, 5%--100 microL, and 10%--100 microL), flinching in phase 1 and phase 2 was also more frequent than the control group (P < 0.05). Regarding lick behavior of another set, it occurred more frequently in 2.5%--100 microL group in phase 1 and in 2.5%--100 microL group as well as 5%--100 microL group in phase 2 than the control group (P < 0.05). CONCLUSIONS: The 10%--25 microL formalin produces fewer flinching responses than other concentrations. Flinching was a biphasic behavior which was more spontaneous and active than was licking. The volume of formalin was a more important factor than the concentration of formalin in the generation of the active biphasic flinching response in the rat model.


Subject(s)
Formaldehyde/pharmacology , Pain Measurement , Pain/chemically induced , Animals , Dose-Response Relationship, Drug , Male , Rats , Rats, Sprague-Dawley
10.
Acta Anaesthesiol Sin ; 38(4): 173-9, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11392064

ABSTRACT

BACKGROUND: The volatile anesthetics may reduce cardiac contractility by limiting both membrane Ca2+ entry and altering intracellular Ca2+ release. Additional pharmacological effects of calcium channel blockers could potentially enhance anesthetic-induced depression. The aim of this study was to compare the direct cardiac effects of enflurane and a new volatile anesthetic, desflurane, in combination with diltiazem on the isolated Sprague-Dawley rat heart. METHODS: After stabilization period isolated rat hearts (n = 40) were perfused with an oxygenated modified Krebs' solution at 55 mmHg equilibrated with 1, 2 and 3 MAC of enflurane (1.7, 3.4 and 5.1 vol% respectively) or desflurane (6, 12 and 18 vol% respectively) in combination with 100 ng/mL diltiazem at 36 degrees C. Isovolumetric left ventricular pressure (LVP), rate of change of ventricular pressure (dp/dt), spontaneous heart rate and coronary flow were measured. To examine the indirect metabolic effect due to autoregulation of coronary flow, O2 delivery (DO2), myocardial O2 consumption (MVO2) and percent O2 extraction (POE) were also monitored. RESULTS: Diltiazem plus enflurane or desflurane depressed LVP and dp/dt dose-dependently. Enflurane plus diltiazem significantly decreased heart rate more than desflurane plus diltiazem in a dose-dependent manner. Desflurane plus diltiazem significantly increased coronary flow more than enflurane plus diltiazem and oxygen delivery increased proportionally with coronary flow. But there were statistically insignificant dose-dependent increases in both groups. Myocardial oxygen consumption and percentage of oxygen extraction were also decreased dose-dependently in both groups. Bradydysrhythmia that accompanied atrioventricular dissociation occurred with diltiazem plus high enflurane or desflurane concentration at an incidence of 46% and 40% respectively. CONCLUSIONS: These in vitro results demonstrate that diltiazem plus enflurane or desflurane depresses left ventricular contractile function and diltiazem plus enflurane causes higher incidence of bradydysrhythmia more than equivalent levels of diltiazem plus desflurane.


Subject(s)
Anesthetics, Inhalation/pharmacology , Calcium Channel Blockers/pharmacology , Diltiazem/pharmacology , Enflurane/pharmacology , Heart Rate/drug effects , Isoflurane/analogs & derivatives , Isoflurane/pharmacology , Myocardial Contraction/drug effects , Animals , Desflurane , Diltiazem/administration & dosage , Enflurane/administration & dosage , In Vitro Techniques , Isoflurane/administration & dosage , Male , Oxygen Consumption/drug effects , Rats , Rats, Sprague-Dawley
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