RESUMO
Atherosclerosis is one of the leading non-communicable diseases in Sri Lanka. Analysis of fatty acid composition in blood vessels is important in understanding the development of atherosclerosis. Here, analyses of fatty acid profiles in major arteries which are commonly used in Coronary Artery Bypass Graft surgery (CABG) were subjected to investigation. Patients (n = 27) undergoing elective CABG were enrolled in the study. A small biopsy segment of the saphenous vein (SV), radial artery (RA), and left internal mammary artery (LIMA) of patients was obtained during the surgery. The fatty acid (FA) profile of tissue samples was analyzed using Gas Chromatography-Mass Spectroscopy (GCMS). Among the different arteries tested, palmitic acid and stearic acid were the predominant fatty acids. As far as monounsaturated FA (MUFA) are concerned, oleic acid was found to be the most abundant MUFA in vessels. The FA profile of LIMA samples had a higher SFA percentage and lower unsaturated FA percentage compared to other vessels. Furthermore, the vessel samples of RA indicated the highest percentage of pro-inflammatory ω -6 polyunsaturated fatty acids (PUFA) as well as a higher percentage ratio between ω -6: ω -3 PUFA. The fatty acid composition and ω -6: ω -3 PUFA ratio suggests that LIMA graft is preferred for CABG over RA and SV.
Assuntos
Ponte de Artéria CoronáriaRESUMO
BACKGROUND: Severe cardiovascular responses are known to occur during trans-sphenoidal excision of the pituitary gland despite adequate depth of anaesthesia. This study was undertaken to evaluate the effects of bilateral maxillary nerve block with local anaesthetics on the cardiovascular responses to various stimuli during this procedure. METHODS: In a group of 32 patients, 5-10 ml of a mixture of bupivacaine 0.5% and lignocaine 2% (1:1) was injected in the pterygopalatine fossa after induction of general anaesthesia. Seven control group patients did not receive any nerve block. In all the patients, general anaesthesia was induced with thiopentone and maintained with nitrous oxide-oxygen, pentazocine, boluses of thiopentone and halothane. Pancuronium was used for neuromuscular blockade. RESULTS: In both the groups, maximum hypertension occurred on opening the blades of the bivalve nasal speculum. In the study group, hypertensive response was significantly less following nasal infiltration with adrenaline containing solution (10.26% increase vs. 23.08% in the control group, P < 0.05), nasal dissection (2.82% vs. 9.45%, P < 0.01) and on application of the nasal speculum (14.93% vs. 35.16%, P < 0.01). The effect on heart rate response was not significant. CONCLUSION: The described technique is a useful adjunct to general anaesthesia for suppressing the haemodynamic responses during trans-sphenoidal surgery.
Assuntos
Anestésicos Locais/administração & dosagem , Hipertensão/prevenção & controle , Hipofisectomia/métodos , Complicações Intraoperatórias/prevenção & controle , Nervo Maxilar , Bloqueio Nervoso , Adulto , Anestesia Geral , Anestésicos Combinados/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Bupivacaína/administração & dosagem , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Lidocaína/administração & dosagem , MasculinoAssuntos
Coartação Aórtica/cirurgia , Pressão Sanguínea , Permeabilidade do Canal Arterial/cirurgia , Aorta/fisiopatologia , Coartação Aórtica/fisiopatologia , Artéria Axilar/fisiopatologia , Permeabilidade do Canal Arterial/fisiopatologia , Artéria Femoral/fisiopatologia , Comunicação Interatrial/fisiopatologia , Comunicação Interatrial/cirurgia , Humanos , Hipertensão/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Recém-Nascido , MasculinoAssuntos
Comunicação Interventricular/cirurgia , Hipertensão Pulmonar/tratamento farmacológico , Nifedipino/uso terapêutico , Vasodilatadores/uso terapêutico , Pré-Escolar , Feminino , Comunicação Interventricular/complicações , Hemodinâmica , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologiaAssuntos
Função do Átrio Esquerdo , Pressão Sanguínea , Valva Mitral/cirurgia , Monitorização Intraoperatória , Adolescente , Adulto , Cateterismo/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Agulhas , Estudos Prospectivos , ToracotomiaAssuntos
Coartação Aórtica/diagnóstico , Doenças da Aorta/diagnóstico , Fístula Esofágica/diagnóstico , Fístula/diagnóstico , Adulto , Aneurisma da Aorta Torácica/diagnóstico , Ruptura Aórtica/diagnóstico , Calcinose/diagnóstico , Erros de Diagnóstico , Evolução Fatal , Humanos , Masculino , Arterite de Takayasu/diagnósticoRESUMO
Deep Hypothermia and Circulatory Arrest (DHCA) is widely used to repair complex congenital heart lesions in children. We report our experience of DHCA in seven patients of transverse aortic arch aneurysm repair. Anaesthesia consisted of Nitrous Oxide, Oxygen, morphine 1 to 1.5 mg kg-1, halothane and pancuronium. Core cooling on cardiopulmonary bypass was used. At 19 +/- 0.64 degrees C (rectal) temperature, Total Circulatory Arrest (TCA) was established. Thiopentone 30 mg.kg-1 and hydrocortisone hemisuccinate 400 mg was administered before arrest. Head was packed with ice during cooling and patients were placed in steep Trendelenberg's position before opening the aneurysm sac. Mean cardiopulmonary bypass time was 151.4 +/- 8.7 minutes. Mean duration of circulatory arrest was 38.6 +/- 6.9 minutes (range, 15 to 77 minutes). Permanent neurological deficit was found in two patients. Tracheostomy was performed in one of these patients for prolonged ventilation. Two patients died of persistent bleeding, low cardiac output and hypoxia due to right lung collapse.