Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Acta Anaesthesiol Scand ; 52(1): 73-80, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17976222

RESUMO

BACKGROUND: The angiotensin II receptor type 1 antagonist candesartan has been hypothesized to alter vasopressor requirements and brain-blood flow by changing cerebrovascular autoregulation. Therefore, we assessed the effects of a pre-anaesthetic treatment course with candesartan on cerebral arterial-jugular bulb oxygen content difference, middle cerebral artery blood velocity, and vasopressor requirements in hypertensive patients undergoing elective on-pump coronary artery bypass graft surgery. METHODS: In a randomized, double-blind, placebo-controlled study, we evaluated the effects of candesartan (8 mg po/d, given for 6-8 days before surgery) in 35 hypertensive patients. The mean arterial pressure was maintained above 60 mmHg by bolus administration of phenylephrine, if required, and dosages were recorded. RESULTS: Candesartan did not significantly alter oxygen content difference across the cerebral circulation, mean middle cerebral artery blood velocity during cardiopulmonary bypass, or phenylephrine requirements either before (0.0067 microg/kg/min+/-0.0042 vs. 0.0056 microg/kg/min+/-0.0049, P=0.48) or during cardiopulmonary bypass (0.0240 microg/kg/min+/-0.0240 vs. 0.0250 microg/kg/min+/-0.0190, P=0.97) compared with placebo. CONCLUSION: Thus, a 6-8-day treatment course with candesartan does not alter global cerebral perfusion and oxygen supply/demand ratio during cardiopulmonary bypass, or vasopressor requirements in hypertensive patients undergoing on-pump coronary artery bypass graft surgery, and no deleterious consequences of AT1-receptor blockade were detected.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Anti-Hipertensivos/farmacologia , Benzimidazóis/farmacologia , Encéfalo/metabolismo , Ponte Cardiopulmonar , Circulação Cerebrovascular/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Hipóxia Encefálica/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Oxigênio/metabolismo , Tetrazóis/farmacologia , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Benzimidazóis/uso terapêutico , Compostos de Bifenilo , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Ponte Cardiopulmonar/efeitos adversos , Artérias Cerebrais , Método Duplo-Cego , Feminino , Humanos , Hipertensão/complicações , Hipóxia Encefálica/etiologia , Complicações Intraoperatórias/etiologia , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média , Fenilefrina/administração & dosagem , Fenilefrina/uso terapêutico , Pré-Medicação , Tetrazóis/uso terapêutico , Falha de Tratamento
2.
Anaesthesia ; 62(3): 231-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17300299

RESUMO

Minimally invasive endoscopic intracardiac surgery including one lung ventilation has been proposed to decrease surgical trauma but its impact on oxygenation and resource consumption has not been reported. We compared effects on gas exchange, induction, total anaesthesia time, staffing costs, and complications in 42 consecutive patients to a matched group undergoing similar surgery conventionally. Use of endoscopic compared to conventional surgery evoked a decrease in the P(a)o(2)/F(I)o(2) ratio (mean (SD) 24.1 (14.9) vs 48.9 (14) kPa, p < 0.05) following termination of bypass with one lung ventilation (10 patients showed a P(a)o(2)/F(i)o(2) below 13.3 kPa (100 mmHg)). There was also an increase of anaesthesia induction time (47 (13) vs 31 (9) min, p < 0.05), and an increase by 156 min of total anaesthesia time (474 (89) vs 321 (69) min, p < 0.05). Anaesthetist staffing costs increased by 300%. Thus, minimally invasive endoscopic intracardiac surgery consumes many more anaesthesia resources than conventional surgery and can result in hypoxaemia, but overall can be considered feasible provided that extensive continuous monitoring is employed.


Assuntos
Anestesia Geral/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Troca Gasosa Pulmonar , Respiração Artificial/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/economia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/economia , Endoscopia/métodos , Feminino , Custos de Cuidados de Saúde , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Monitorização Intraoperatória/métodos , Oxigênio/sangue , Pressão Parcial
3.
Br J Anaesth ; 97(5): 630-3, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16914467

RESUMO

This report describes fatal disseminated cardiovascular thrombosis associated with Fc-receptor IIa-mediated platelet activation during surgery for aortic valve replacement in a patient with endocarditis. The patient's serum contained antibodies which strongly activated platelets via the Fc-receptor IIa. Antibodies did not bind to platelet factor 4 or aprotinin and binding was independent of heparin. The mechanisms and differential diagnosis for such a complication are discussed. Our data show for the first time in a patient with endocarditis that, beside HIT, other immune complexes can induce massive intravascular coagulation via platelet Fc-receptor IIa activation.


Assuntos
Antígenos CD/fisiologia , Valva Aórtica/cirurgia , Coagulação Intravascular Disseminada/etiologia , Implante de Prótese de Valva Cardíaca , Ativação Plaquetária , Receptores de IgG/fisiologia , Endocardite Bacteriana/complicações , Evolução Fatal , Feminino , Humanos , Complicações Intraoperatórias , Pessoa de Meia-Idade
4.
Eur J Med Res ; 10(5): 218-26, 2005 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-15946923

RESUMO

BACKGROUND: Due to the surgical trauma a small amount of myocardial cellular damage is inherent during coronary artery bypass grafting (CABG). The purpose of the present study was to assess the degree of myocardial cellular damage after off-pump (OPCAB) and on-pump CABG (ONCAB) as measured by cardiac troponin I (cTnI), creatine kinase (CK), its MB isoenzyme (CK-MB) and myoglobin (Myo) and to examine its impact on early hemodynamics after surgery. METHODS: Ninety-nine consecutive OPCAB patients, operated between 01/1999 and 01/2004, were enrolled in the present study and compared to 99 ONCAB patients operated during the same period of time, who were matched for baseline data and mean number of grafts per patient. Early hemodynamics, cTnI, CK/CK-MB and Myo were measured preoperatively and at 1, 6, 12, 24 and 48 hours (h) postoperatively. Perioperative inotropic support, clinical data and potoperative outcome were recorded prospectively. RESULTS: The two groups were similar concerning preoperative characteristics. The mean number of distal grafts/patient was 2.1 +/- 1.0 in OPCAB and 2.1 +/- 0.8 in ONCAB patients (mean +/- SD). There was no significant difference among the groups regarding early hemodynamics in terms of cardiac index (CI), systemic vascular resistance index (SVRI), and left ventricular stroke work index (LVSWI), and inotropic support. However, cTnI, CK/CK-MB but not Myo levels were significantly lower in OPCAB compared to ONCAB patients at 1, 6, 12, 24, 36 and 48 h postoperatively (P<0.05). CONCLUSIONS: Off-pump surgery results in equal early hemodynamics despite a significantly lower release of cTnI and CK, suggesting a reduced myocardial cell damage as compared to ONCAB surgery.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Circulação Coronária , Circulação Extracorpórea/efeitos adversos , Miocárdio/patologia , Idoso , Biomarcadores , Creatina Quinase/sangue , Humanos , Complicações Intraoperatórias/patologia , Masculino , Pessoa de Meia-Idade , Mioglobina/sangue , Necrose , Complicações Pós-Operatórias/patologia , Resultado do Tratamento , Troponina I/sangue
5.
Artigo em Alemão | MEDLINE | ID: mdl-10665308

RESUMO

Tachyphylaxis to local anesthetics is defined as a decrease in duration, segmental spread or intensity of a regional block despite repeated constant dosages. However, there is disagreement about the incidence of tachyphylaxis. In contrast to tachyphylaxis, pseudotachyphylaxis denotes time dependent variations in pain or circadian changes in the duration of local anesthetic action. Tachyphylaxis appears neither to be linked to structural or pharmacological properties of the local anesthetics nor to the technique or mode of their administration. The mechanisms underlying tachyphylaxis are open to debate and include changes in pharmacokinetics or pharmacodynamics. Considering pharmacokinetics, local edema, an increased epidural protein concentration, changes in local anesthetic distribution in the epidural space or a decrease of perineural pH could result in decreased diffusion of the local anesthetics from the epidural space to their binding sites at the sodium channel. Increased clearance of local anesthetics from the epidural space may be caused both by increased epidural blood flow or increased local metabolism. Considering pharmacodynamics, antagonistic effects of nucleotides or increased sodium concentration, increased afferent input from nociceptors or receptor down regulation of the sodium channels have been implicated. However, none of these theoretical considerations is supported strongly enough by data to explain tachyphylaxis. A new possibility to maintain for a longer time neural blockade is the design of new ultralong-acting local anesthetics. Liposomal formulations of local anesthetics also appear suitable to provide longer lasting regional anesthesia. The recent observation that NMDA-antagonists as well as NO-synthase-inhibitors prevent the development of tachyphylaxis suggests involvement of the nitric oxide pathway in the development of tachyphylaxis. Accordingly, NMDA-antagonists or NO-synthase-inhibitors may prevent tachyphylaxis.


Assuntos
Anestesia por Condução , Anestésicos Locais/farmacocinética , Taquifilaxia , Humanos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...