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Biomedical subjects

C Coccia

Publications and source records attributed to C Coccia.

33 records · Page 2Linked to original sources
PubMed1996

Hemodynamic and metabolic effects of transjugular intrahepatic portosystemic shunt (TIPS) during anesthesia for orthotopic liver transplantation.

Recently, the transjugular intrahepatic portosystemic shunt (TIPS) has been advocated as a safe bridge to orthotopic liver transplantation (OLT). We retrospectively studied 53 consecutive cirrhotic patients who underwent OLT: 27 patients with TIPS were compared to 26 controls. Hemodynamic and oxyphoretic data (Fick method) were collected during six phases of OLT. There were no significant differences in demographic data and Child-Pugh class, nor in surgical time and blood product requirements before the anhepatic phase between TIPS patients and controls. In the TIPS group, we observed a marked hyperdynamic profile with a lower systemic vascular resistance index, higher cardiac index, and depressed oxygen consumption before native liver removal. During the same period, the TIPS group developed a greater acidosis and was treated with a larger amount of NaHCO3. Following the anhepatic phase, no differences between the two groups were detected. All transplantations were successful, and no complications related to TIPS were observed. These results seem to be the consequence of a reduced liver function reserve with a direct hemodynamic effect due to the TIPS.

Acidosis↗
PubMed1995

[Anesthesia in experimental single-lung transplantation: hemodynamic and respiratory changes during prostaglandin E1 and nitroglycerin infusion].

INTRODUCTION: The haemodynamic and oxyforetic modifications induced by continuous infusion (c.i.) of Prostaglandin E1 (PGE1) and Nitroglycerin (NG) during experimental lung transplantation have been studied. METHODS: Twenty lung transplants have been performed on pigs (Landrace). Haemodynamic monitoring consisted of ECG, femoral cannulation for arterial pressure and Swan Ganz catheter. Continuous infusion of drugs started during pneumonectomy. Data have been collected in phase 1: after the induction of anaesthesia; in phase 2: 30 min after the start of pulmonary vasodilation in one lung ventilation with left pulmonary artery clamped; in phase 3: 30 min after lung revascularization; in phase 4: at the end of the surgery. The animals have been divided in two groups. Group A consisted of 10 cases treated with 50 ng/kg/min in phase 2 and 25 ng/kg/min in phase 3 and 4 of PGE1; group B consisted of 10 cases treated with 1 ncg/kg/min in phase 2 and 0.5 ncg/kg/min in phase 3 and 4 of NG. RESULTS: In phase 2 and 4 PA, RVSWI, PRVI increased in group B more than in group A (p < 0.05); in phase 3 PA, PAWP increased in group B more than in group A (p < 0.05). DISCUSSION: In our experience PGE1 has shown to be a stronger pulmonary vasodilator than NG. PGE1 can be considered the drug of choice for pulmonary vasodilation in experimental single lung transplantation, even if more investigations are needed for reaching the real goal of this procedure.

Alprostadil↗
PubMed1992

Management of extremely low-birth-weight infants.

Better health care of women during pregnancy and delivery, improvement in neonatal intensive therapy and technology have led to a decrease in neonatal mortality and morbidity and to lower limits of birth weight and gestational age for survival. This paper refers to the management protocol used in the Department of Perinatal Pathology of the Provincial Maternity Hospital of Milan for extremely low-birth-weight (ELBW) infants (birth weight < 1000 g). In this hospital, all newborn infants presenting evidence of life, irrespective of birth weight and gestational age, are resuscitated and transferred to the Neonatal Intensive Care Unit (NICU) for clinical management. After the introduction of this protocol the mortality rate of ELBW infants dropped from 71.4% in 1977-78 to 48% in 1987-88. In a group of 72 ELBW infants with a mean birth weight of 850 g and a mean gestational age of 27 weeks, 80% presented a normal outcome, 12% presented a mild neurological impairment and 8% were affected by severe cerebral palsy at the age of two years. The intact survival of a newborn infant of 450 g at birth is also reported.

Clinical Protocols↗
PubMedDate not supplied

Atracurium, cisatracurium, vecuronium and rocuronium in patients with renal failure.

AIM: The cumulative index, the recovery, the onset and the duration of action, of atracurium, cisatracurium, vecuronium and rocuronium in uremic patients undergoing kidney transplantation compared to healthy patients undergoing general surgery were studied. METHODS: In all patients (64 uremic vs 62 "healthy" patients) after anesthesia induction, atracurium 0.5 mgxkg(-1) or cisatracurium 0.15 mgxkg(-1) or vecuronium 0.1 mgxkg(-1) or rocuronium 0.6 mgxkg(-1) were administered, and at the end of surgery when T1 reached 25% neostigmine 0.05 mgxkg(-1) was given. Neuro-muscu-lar transmission was monitored by accelerometry (TOF-GUARD, Organon). RESULTS: Cumulative index of vecuronium (1.3+/-0.1 vs 1.06+/-0.11, p<0.001) and rocuronium (1.45+/-0.18 vs 1.04+/-0.16, p<0.001), recovery index (time of T1 25-75) of atracurium (14.2+/-5 vs 9+/-4, p<0.005), cisatracurium (18.7+/-3 vs 9.1, p<0.001), vecuronium (18.5+/-3 vs 12.5+/-3, p<0.001) and rocuronium (18+/-6 vs 11+/-4, p<0.001) and interval T1 25% to TOF 0.8 of cisatracurium (20.5+/-1.2 vs 16+/-2.1, p<0.001) and vecuronium (27+/-6.3 vs 20+/-3.3, p<0.001) were longer in uremic patients. The onset time and the duration of action of atracurium, cisatracurium, vecuronium and rocuronium were similar in all groups compared to controls one. CONCLUSION: In patients with renal failure the use of atracurium, cisatracurium, vecuronium and rocuronium is suitable and predictable in terms of onset, and duration of action. Care has to be taken to vecuronium and rocuronium cumulative index. Neuromuscular trasmission has to be always monitored.

Adult↗
PubMedDate not supplied

[Substitutive therapy with surfactants in premature infants with respiratory distress syndrome].

The main pathogenetic moment of the respiratory distress syndrome (RDS) is recognized to be the lack of alveolar surfactant. Many attempts of substitutive therapy with several kinds of surfactants have been tried (artificial, synthetic, from amniotic fluid, exosurf). After the considerable results obtained in animals, the use of substitutive surfactant proved to be useful also in human newborns with RDS. The authors report the personal data relative to the TA-surfactant (artificial surfactant made of phospholipids + DPPC + protein substances extracted from bovine lung). They analyse first results and, on this ground, they put forward some assumptions in order to obtain a more rational and efficient use.

Administration, Oral↗