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2.
A A Case Rep ; 8(4): 81-85, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28045723

RESUMO

A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed. Surgery was postponed, and both the LBBB and ectopy recurred frequently during the next 24 hours in the intensive care unit, particularly at heart rates >90 bpm. Troponins were normal, and the patient was diagnosed with a rate-dependent LBBB and cleared for surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/tendências , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Frequência Cardíaca , Bloqueio de Ramo/cirurgia , Eletrocardiografia/tendências , Feminino , Frequência Cardíaca/fisiologia , Humanos , Pessoa de Meia-Idade
3.
Mol Cell Biochem ; 395(1-2): 187-98, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24939362

RESUMO

Breathing high concentrations of oxygen (hyperoxia) causes lung injury and is associated with lung diseases such as bronchopulmonary dysplasia (BPD), respiratory distress syndrome and persistent pulmonary hypertension of the newborns. Hyperoxia (95-100 %O2) causes DNA damage and growth arrest of lung cells and consequently cells die by apoptosis or necrosis. Although supplemental oxygen therapy is clinically important, the level and duration of hyperoxic exposure that would allow lung cells to reenter the cell cycle remains unclear. We hypothesized that cells exposed to lower concentrations of hyperoxia will retain the capacity to enter cell cycle when recovered in room air. We employed varying concentrations of oxygen (21-95 %) to determine the response of lung cells to hyperoxia. Our results indicate that cells were growth arrested and failed to reenter the cell cycle when exposed to greater than 60 % oxygen. Cell cycle checkpoint proteins were increased in a biphasic manner, increasing until 70 % oxygen, but declined in greater than 90 % oxygen. Microarray analysis shows that there is significant decrease in the abundance of Cdks 6-8 and retinoblastoma protein (Rb), p107 and p130 in exposure to 90 % oxygen for 48 h. We further tested the effect of clinically relevant as needed oxygen [(pro-re-nata (prn)] in premature infant (125-days and 140-days) baboon model of BPD. The microarray results show that 6 or 14d PRN oxygen-exposed animals had induced expression of chromosomal maintenance genes (MCMs), genes related to anti-inflammation, proliferation, and differentiation.


Assuntos
Displasia Broncopulmonar/etiologia , Proteínas de Ciclo Celular/genética , Hiperóxia/genética , Pulmão/patologia , Animais , Displasia Broncopulmonar/genética , Displasia Broncopulmonar/patologia , Proteínas de Ciclo Celular/metabolismo , Cromossomos de Mamíferos/metabolismo , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Hiperóxia/metabolismo , Hiperóxia/patologia , Pulmão/metabolismo , Análise de Sequência com Séries de Oligonucleotídeos , Papio
5.
Acad Med ; 85(5): 791-3, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20520027

RESUMO

PURPOSE: To determine the degree of knowledge that medical students applying to the St. Luke's-Roosevelt Hospital Center anesthesiology residency program had regarding the core physician competencies mandated by the Accreditation Council for Graduate Medical Education. METHOD: As a part of the department's annual resident-selection process, in the fall of 2008, 193 interviewed fourth-year U.S. MD-degree medical students applying to the St. Luke's-Roosevelt Hospital Center anesthesiology program were given a brief, written questionnaire to determine their knowledge of the six core physician competencies. The instructions for completing the instrument were standardized and delivered to the applicants by one of the program directors. RESULTS: A total of 193 applicants completed the interview questionnaire. Seventy-six had no knowledge of any of the physician competencies, and only three were able to correctly identify all six. CONCLUSIONS: While this research is an observation of only one set of applicants to one residency program, if the findings are applicable to other programs and specialties, that suggests that medical schools and residency program directors should develop methods for increasing competency awareness among medical students.


Assuntos
Competência Clínica/normas , Estudantes de Medicina , Acreditação , Anestesiologia/educação , Educação de Pós-Graduação em Medicina/normas , Humanos , Internato e Residência , Inquéritos e Questionários , Estados Unidos
9.
J Cardiothorac Vasc Anesth ; 23(1): 54-61, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18834829

RESUMO

OBJECTIVE: Pulmonary artery (PA) flow reversal has been associated with poor outcome in patients with atriopulmonary (APC) and total cavopulmonary connection (TCPC) lateral tunnel (LT) Fontan modification. The authors studied PA flow after TCPC in relation to the incidence of early Fontan outcome and complications. DESIGN: A prospective observational study. SETTING: A university hospital. PARTICIPANTS: Pediatric patients undergoing a Fontan procedure. INTERVENTION: Nineteen patients were studied. PA flow was measured by pulse-wave Doppler during the surgery after chest closure. Patients were divided into 2 groups according to patterns of PA flow: group 1, positive (biphasic or continuous flow), and group 2, negative (with flow reversal component). The postoperative complications were recorded. MEASUREMENTS AND MAIN RESULTS: There were no deaths or reoperations for Fontan takedown. Ten patients had positive and 9 had negative flow. There were no differences between groups regarding age, weight, length of procedure, and cardiopulmonary bypass. The chest tube drainage in patients with negative flow was significantly longer than those in the positive-flow group (8.3 +/- 7.0 days in the negative-flow group v 2.8 +/- 1.7 days in the positive-flow group, p = 0.03). The total number of complications was higher in the negative-flow group compared with the positive-flow group (3.0 +/- 1.3 v 1.2 +/- 0.6, p = 0.003). The differences between groups in terms of pediatric intensive care unit and/or hospital length of stay did not reach statistical significance, possibly because of the low number of patients. CONCLUSION: PA flow pattern appears to be predictive of the length of postoperative chest tube drainage and the number of postoperative complications.


Assuntos
Técnica de Fontan/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Artéria Pulmonar/fisiologia , Circulação Pulmonar/fisiologia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos
10.
J Clin Anesth ; 20(5): 379-382, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18761249

RESUMO

Implantable cardioverter defibrillators (ICDs) are routinely placed in the cardiac electrophysiology laboratory. Previously, these procedures were performed in the operating room during general anesthesia. In recent years, electrophysiologists have been performing these procedures using local anesthetics in conjunction with intravenous sedation. We report a case in which thoracic paravertebral blocks with mild sedation were successful for infected ICD and laser lead extraction. Randomized, controlled trials are required to determine whether thoracic paravertebral block with sedation is more effective than local anesthesia with sedation in providing adequate anesthesia for ICD placement and extraction.


Assuntos
Remoção de Dispositivo/métodos , Bloqueio Nervoso/métodos , Infecções Relacionadas à Prótese/cirurgia , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/microbiologia , Eletrodos Implantados/efeitos adversos , Eletrodos Implantados/microbiologia , Humanos , Lasers , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas
11.
J Cardiothorac Vasc Anesth ; 20(6): 826-33, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17138088

RESUMO

OBJECTIVE: The purpose of this study was to compare jugular venous bulb saturation (SjvO(2)) and regional cerebral oximetry (rSO(2)) by near-infrared spectroscopy (NIRS) during procedures with deep hypothermic circulatory arrest (DHCA). DESIGN: Prospective observational study. SETTING: Academic hospital. PARTICIPANTS: Patients undergoing aortic reconstructive surgery with DHCA from July 2001 to January 2005. INTERVENTION: The authors examined cerebral oxygenation by continuous NIRS monitoring and by blood gas analysis of intermittently sampled jugular bulb blood (SjvO(2)). Data were obtained during various stages of the procedure in 29 patients. NIRS measurements were compared with SjvO(2). MEASUREMENTS AND MAIN RESULTS: NIRS and SjvO(2) trends were similar. Overall, cerebral venous oxygen saturation obtained from NIRS was lower compared with SjvO(2) (p < 0.05), especially during periods of low temperature. The mean correlation between NIRS and SjvO(2) was 0.363, and the individual correlations varied from -0.11 to 0.91. The low mean correlation was because of a high degree of variability in the NIRS data between patients. CONCLUSION: It was concluded that NIRS does not closely correlate with SjvO(2) in this patient population. Cerebral oximetry measured by NIRS could not replace jugular bulb saturation as an intraoperative marker of adequate metabolic suppression.


Assuntos
Circulação Cerebrovascular/fisiologia , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Veias Jugulares/fisiologia , Monitorização Intraoperatória/métodos , Oxigênio/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Idoso , Anticoagulantes/administração & dosagem , Gasometria/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Heparina/administração & dosagem , Humanos , Masculino , Monitorização Intraoperatória/instrumentação , Oximetria/métodos , Oxigênio/sangue , Estudos Prospectivos , Fatores de Tempo
13.
J Cardiothorac Vasc Anesth ; 19(6): 734-8, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16326297

RESUMO

OBJECTIVE: The purpose of this study was to examine the influence of caudal anesthesia on outcomes (pediatric intensive care unit [PICU] length of stay, hospital length of stay, ventilatory time, early extubation rate) in pediatric patients undergoing congenital heart disease repair requiring cardiopulmonary bypass (CPB). DESIGN: Retrospective. SETTING: University teaching hospital. PARTICIPANTS: Pediatric patients undergoing surgery to treat congenital heart disease between 1999 and 2002. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Thirty-four patients with atrial septal defect (ASD), 37 with ventricular septal defect, and 46 with tetralogy of Fallot (TOF) were included in the analysis. No differences were found in preoperative and intraoperative data between caudal and noncaudal group for each disorder. There was no difference between caudal and noncaudal groups in PICU and hospital stay. A statistically significant difference was found in the postoperative ventilatory time in patients with ASD and TOF between caudal and noncaudal groups. The early extubation rate was higher in the TOF caudal group compared with the noncaudal group. CONCLUSIONS: This retrospective study demonstrated that postinduction placement of caudal anesthesia does not affect PICU or hospital length of stay. A well-controlled prospective study is needed to confirm these findings.


Assuntos
Anestesia Caudal , Procedimentos Cirúrgicos Cardíacos , Analgésicos Opioides/uso terapêutico , Ponte Cardiopulmonar , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Tempo de Internação , Masculino , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Estudos Retrospectivos , Tetralogia de Fallot/cirurgia , Resultado do Tratamento
14.
Paediatr Anaesth ; 15(11): 953-8, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16238556

RESUMO

BACKGROUND: Central venous cannulation can be particularly difficult in pediatric patients. Central line placement is associated with many well-known complications. While ultrasound-guided techniques are well established, the majority of central venous catheters are placed using landmark guidance. This retrospective study compares the safety and efficacy of ultrasound guidance vs landmark guidance in central venous cannulation of pediatric cardiac surgery patients. METHODS: The medical records of 149 pediatric patients undergoing cardiac surgery over 3-year period were reviewed. Patients were classified into two cohorts based on whether central venous cannulation of the internal jugular vein was performed by ultrasound or landmark guidance. Overall success and traumatic complication rates were compared between the two groups. Additionally, comparisons between the groups were made to determine if patient size or age affected the success rate of either approach in different manner. RESULTS: Patients in the ultrasound-guided (n = 47) and the landmark-guided (n = 102) groups were similar with respect to age, weight, and surgical procedure for which central venous access was indicated. The overall success rate for cannulation of the internal jugular vein was 91.5% in the ultrasound-guided group and 72.5% in the landmark-guided group (P = 0.010). But in the subgroup of children under 1 year of age, success rate was 77.8% in ultrasound group and 60.9% in landmark group (P = 0.44); in children under 10 kg in weight, success rate was 80% in ultrasound group and 56.7% in landmark group (P = 0.19). There were no significant differences in the rate of traumatic complications between the two methods. CONCLUSIONS: The overall success of internal jugular vein cannulation for pediatric cardiac surgery is significantly improved with the use of ultrasound guidance, without a significant difference in traumatic complications. However, mostly children above 1 year of age or 10 kg of weight experience advantages of ultrasound technique.


Assuntos
Cateterismo Venoso Central/métodos , Cardiopatias Congênitas/cirurgia , Procedimentos Cirúrgicos Operatórios , Cateterismo Venoso Central/efeitos adversos , Criança , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Prontuários Médicos , Estudos Retrospectivos , Tetralogia de Fallot/cirurgia , Ultrassonografia
19.
J Cardiothorac Vasc Anesth ; 18(5): 573-80, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15578467

RESUMO

OBJECTIVE: Activated coagulation times (ACTs) are widely used for monitoring anticoagulation during cardiac surgery. Significant variability of this test is well known. Variability in test results was studied, which may arise from the sample drawing site. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Sixty-five patients scheduled for surgery requiring cardiopulmonary bypass were enrolled in the study. INTERVENTION: ACTs were assessed using the Hemochron 801 ACT machine. Samples were collected (1) baseline I from the arterial catheter before anesthetic induction, (2) baseline II from the arterial and venous collection sites after pulmonary artery catheterization, (3) after heparin administration, (4) 10 minutes after blood collection number 3, and (5) after protamine administration. MEASUREMENTS AND MAIN RESULTS: At the baseline II, the ACT measures using venous blood were significantly higher than that obtained using an arterial sample (p = 0.001). There was no significant difference in ACT measures obtained using either arterial or venous blood samples at the other time points. After heparin administration, the ACT variability in individual patients was quite striking, with ranges of up to 600 seconds in repeated measures. CONCLUSION: During the period of systemic anticoagulation, there is great individual variability between ACT measures obtained from venous and arterial samples. Further studies are required to analyze the cause of differences at the baseline and the source of variable coagulation times after heparin.


Assuntos
Artérias/fisiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Veias/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Artérias/efeitos dos fármacos , Ponte Cardiopulmonar/métodos , Cateterismo de Swan-Ganz/métodos , Feminino , Heparina/administração & dosagem , Antagonistas de Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Protaminas/administração & dosagem , Fatores de Tempo , Veias/efeitos dos fármacos , Tempo de Coagulação do Sangue Total/métodos
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