Biomedical subjects

C Escudero

Publications and source records attributed to C Escudero.

10 recordsLinked to original sources

PubMed1992

Electrophysiological effects of atracurium and vecuronium on normal and denervated hearts.

Atracurium and vecuronium offer some advantages with respect to other nondepolarizing muscle relaxants. However, their administration has been associated with episodes of bradycardia and asystole, the mechanism of which has not yet been clarified. In an effort to analyze the effects of these drugs on automaticity, refractoriness, and conduction, 30 dogs underwent heterotopic heart transplantation to establish a model in which a normal heart (recipient) and a denervated heart (donor) could coexist. The electrophysiological studies included the determination of cycle length (CL), sinoatrial conduction time (SACT), antegrade and retrograde atrio-ventricular (A-V) node and ventricular block points (ABP and RBP), as well as effective antegrade and retrograde A-V node (ARPAVN and RRPAVN) and ventricular refractory periods (VRPs) in both hearts. These parameters were measured in a basal state and after injection of pancuronium (0.5 mg/kg) in 10 animals, atracurium (0.5 mg/kg) in another 10 dogs, and vecuronium (0.12 mg/kg) in the remaining animals. The results showed that pancuronium produced a tachycardia, significantly facilitated A-V conduction in the donor and the recipient hearts, and lowered the A-V node refractoriness in the donor organ, while atracurium and vecuronium induced no changes from the baseline values, either in normal or denervated hearts. Based on the results of this study, the episodes of sustained bradycardia reported in association with atracurium and vecuronium are attributed to the absence of antagonism of vagal stimuli provoked by pancuronium, and/or by surgical or anesthetic manipulations.

Animals↗

PubMed1992

Effect of fentanyl on cardiac automaticity and conduction: direct or mediated action?

The effects of fentanyl at a dose of 100 micrograms.kg-1 on cardiac automaticity, refractoriness and conduction have been studied in a model of heterotopic heart transplantation which combines a denervated heart (donor) and a non-denervated heart (recipient) in each of 20 dogs employed. Once the surgical procedure had been completed, cycle length, sinoatrial conduction time, antegrade and retrograde A-V node block points, cycle length at which 1:1 conduction ceases to exist and the antegrade effective refractory period of the A-V node and ventricles were measured. These parameters were determined in hearts both in the basal situation and 10 min after fentanyl injection. In the recipient organs, fentanyl produced statistically significant prolongation of cycle length, sinoatrial conduction time, antegrade block point and antegrade effective refractory periods of the A-V node and ventricles, with respect to the basal situation (P less than 0.01 for all these parameters); in 20% of cases, a complete A-V block was produced. In the donor hearts (denervated), prolongations of cycle length (P less than 0.01) and the antegrade block point (P less than 0.05), as compared with the basal situation, were recorded, but no other modifications were detected. To test whether these effects were due to the action of fentanyl, 10 animals were subsequently injected with naloxone, an agent which reverted the reported changes, although in the recipient organs, there persisted a slight prolongation of the cycle length with respect to basal measurements (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

Late sudden cardiac death in the follow-up of patients having a heart valve prosthesis.

Eight hundred thirty-one patients with Björk-Shiley prostheses (341 aortic, 345 mitral, and 145 double) had a mean follow-up time of 68.2 months per patient. Of these, 24 (16% of all deaths) died suddenly: six of 42 with aortic valve replacement (14.3%), 12 of 56 with mitral valve replacement (21.4%), and six of 36 with double valve replacement (16.6%). This correlated with evidence of premature ventricular complexes detected in multiple routine 12-lead follow-up electrocardiograms (p less than 0.001 for simple aortic or mitral valve replacements and p less than 0.01 for combined aortic and mitral valve replacements). Premature ventricular complexes were significantly more frequent among those who died suddenly than among survivors and those who died of other causes (p less than 0.001 in both cases); there were no significant differences between the latter two groups. The actuarial risk of sudden death was significantly greater among those patients who had premature ventricular complexes than among those who did not have this disorder (p = 0.0002). We conclude that the presence of premature ventricular complexes, as an independent variable, was correlated with the risk of sudden death.

Adult↗

PubMed1992

The Björk-Shiley valve prosthesis. Analysis of long-term evolution.

The long-term follow-up of 831 patients who underwent valve replacement with Björk-Shiley Delrin and standard Pyrolyte prostheses (341 aortic, 345 mitral, and 145 mitroaortic) between 1971 and 1980 is reviewed. The follow-up concluded in 1985. Cumulative follow-up amounted to 4724 years, with a mean of 5.68 years per patient. Data on survival were obtained in 754 patients (complete follow-up in 90.8% of cases). Perivalvular leak was the most frequent complication in aortic valve replacement, whether isolated or combined, with values significantly higher than those registered in isolated mitral replacement (p < 0.001 in both cases). No correlation was found between this complication and valve calcification, but it was statistically correlated with the size 19 model (p < 0.05). Prosthetic stenosis was more common in mitral than in aortic replacement (p < 0.001), and of the former, size 23 was that most often affected (p < 0.001). The earliest case of mitral pannus was diagnosed 20 months postsurgery, and from 45 months on this pathology was the cause of every case of stenosis. The risk of thromboembolism was similar in aortic, mitral, and double prostheses, while it was the single most frequent complication in isolated mitral replacement. Prosthetic thrombosis was triggered in all cases in which it occurred by discontinuance of anticoagulant therapy. Anticoagulant-induced hemorrhages were more frequent in double replacement than in mitral (p < 0.05) and aortic valve replacement. Endocarditis was the complication that produced the highest mortality rate in all groups; the frequency of this infection was higher among patients with double prostheses when compared with either aortic replacement (p < 0.05) or mitral replacement (p < 0.001). The risk of suffering endocarditis was correlated with the existence of active preoperative infection in patients with mitral prostheses and double prostheses (p < 0.001 in both cases). Overall morbidity was higher in the double replacement group with respect to the mitral group (p < 0.01). The rate of mortality was also higher among the double valve replacement patients when compared with both the aortic (p = 0.0002) and mitral (p = 0.006) groups.

Actuarial Analysis↗

PubMed1990

Electrophysiology of heterotopic heart transplant: experimental study in dogs.

Electrophysiological properties were studied in a heterotopic heart transplant model developed in 44 dogs (Group I). Cycle length was 359.5 +/- 55.2 ms in the recipient heart and 500.9 +/- 77.9 ms in the donor heart (P less than 0.001). Sinoatrial conduction time was 38.6 +/- 13.6 ms in the recipient heart and 38.6 +/- 10.4 ms in that of the donor (not significant). The Wenckebach point was 175.4 +/- 31.1 ms in the recipient organ and 214.3 +/- 42.6 ms in the donor heart (P less than 0.001). The retrograde block point was 271.6 +/- 48.0 ms in the recipient heart and 353.6 +/- 47.3 ms in that of the donor (P less than 0.01). The effective antegrade refractory period was 133.4 +/- 28.7 ms in the recipient heart and 167.3 +/- 46.3 ms in the donor organ (P less than 0.001). An epicardial atrial cartography was performed at 44 preset points in both hearts, revealing a normal activation sequence and delays of 36-98 ms (mean 58 ms) in the recipient heart and from 39 to 59 ms (mean 50 ms) in the donor heart (not significant). In another 11 dogs (Group II), the same electrophysiological study was carried out under basal conditions and after pharmacological blockade of the autonomic nervous system with atropine (0.04 mg (kg body weight)-1) and propranolol (0.2 mg (kg body weight)-1). No significant differences were found in any of the parameters studied upon comparison of Group II animals in basal conditions with Group I recipients, and Group II dogs after blockade with Group I donors. These results demonstrate that the differences in automatism, conduction and refractoriness between the donor and recipient hearts are not attributable to differences in the haemodynamic situation or in the anaesthetic technique, but to denervation.

Animals↗

PubMed1989

Sinus node function and protamine sulfate.

This report analyzes the effects of protamine sulfate (PS) on the heart rate and sinoatrial node function in dogs anesthetized with diazepam, fentanyl, and pancuronium bromide, and subjected to different modalities of extracorporeal circulation (ECC). All groups were given 3 mg/kg of heparin sodium and 5 mg/kg of PS. The sinus node function was evaluated by means of sinoatrial conduction time (SACT), absolute sinus node recovery time (SNRTa), and corrected sinus node recovery time (SNRTc). The spontaneous heart rate (HR) of the animals was also analyzed. Under the experimental conditions established in this study, the intravenous administration of a bolus of PS produced a decrease in the HR in all the groups, regardless of the type of ECC used. The modifications in the conduction and recovery times of the sinus node by PS did not correlate with those of the heart rate; the sinoatrial conduction time increased in groups subjected to ECC, while the absolute and corrected recovery times of the sinus node were prolonged only in the group that underwent rapid rewarming.

Animals↗

PubMed1988

Hemodynamic and morphologic alterations after experimental administration of protamine sulfate.

The hemodynamic, hematologic, and morphologic effects induced by protamine sulfate have been studied in 28 dogs divided into 6 groups. All of the groups were given heparin (3 mg/kg body weight) and Groups I, II, III, and IV were given protamine (5 mg/kg body weight). Group I (control group) was not subjected to extracorporeal circulation. The other groups had the following interventions: Group II, cardiopulmonary bypass without aortic clamp, hypothermia, or cardioplegia; Groups III and V, hypothermia of 25 degrees C, aortic clamping for 25 minutes, administration of cardioplegic solution, and slow rewarming; and Groups IV and VI, the same as Groups III and V, but with rapid rewarming. After injection of protamine sulfate, there was a decrease in mean arterial pressure due to peripheral vasodilation and an increase in the mean pulmonary pressure due to increased pulmonary vascular resistance; marked diminution of the number of circulating platelets aside from the extracorporeal circulation; a decrease in the contractility of both ventricles with augmented right ventricular work and decreased cardiac output; and right ventricular edema in Groups I, II, III, and IV. These alterations were most evident in Groups III and IV.

Animals↗

PubMed1987

Coagulation defects during extracorporeal circulation in the dog.

This study was undertaken in an attempt to diminish the frequency and severity of postextracorporeal circulation hemorrhage in dogs. Its purpose is to ascertain the amount of 99mTc-labeled autologous fibrinogen deposited in the oxygenator, as well as the coagulation defect originated during the surgical procedure when heparin is not administered (group I) and when it is at doses of 1 mg/kg body weight (group II) and 3 mg/kg body weight (group III). The result demonstrate that the fibrinogen deposition in the oxygenator decreased as the dose of heparin administered was augmented. The coagulation disorders were produced by factor consumption, affecting all dogs in group I. The same type of alteration was produced with the use of heparin, but in some the platelet count, fibrinogen and fibrinogen degradation products and the prothrombin and thrombin times were maintained within normality or were only slightly altered. Significant differences were not detected between groups II and III. For this reason, we recommend the utilization of heparin in experimental extracorporeal circulation in a single dose of 1 mg/kg body weight, administered at the initiation of bypass, which provides a sufficient level of anticoagulation for at least 60 min and makes its neutralization with protamine unnecessary, the effects of which are especially adverse in the dog.

Animals↗

PubMedDate not supplied

Effects of different doses of acetylsalicylic acid on platelet aggregation: an experimental study of prosthetic materials in dogs.

Laminar flow is the condition best suited to the study of platelet thrombi. This type of thrombus is predominant in arteries, in the tubes of cannulas used in artificial circulatory systems, in cardiac valve prostheses and in prosthetic arterial implants. Antiplatelet drugs could, in these cases, reduce the extent of thrombus formation. At present the optimal dose of acetylsalicylic acid (ASA) to achieve the best antithrombotic effect is unknown; some papers show that high doses augment experimental thrombosis. By means of autologous platelets labelled with 111In-oxine, we have quantified the accumulation on different materials used in cardiovascular surgery (woven, knitted and double velour Dacron, Avcothane 51 elastomere and smooth surface and rough surface pericardium). Samples of these fabrics were placed in a laminar flow chamber connected between the right atrium and femoral artery of the experimental animals (dogs). The animals were divided into four groups of eight dogs: Group I: no treatment Group II: animals treated one week earlier with ASA (1 mg/kg/day) Group III: as in Group II, but at a dose of 5 mg/kg/day Group IV: as in Group II, but at a dose of 20 mg/kg/day. The materials upon which the least amount of platelets were accumulated were the smooth, epicardial surface of pericardium (SP) and Avcothane (AV). The least deposition was produced in Group III, with the exception of SP. In the case of this material, there was no difference between Groups I and III. In Group IV, the deposit was greater with respect to the untreated group (Group I), except in the case of AV, in which there was no difference between Groups I and IV.

Animals↗

PubMedDate not supplied

Design of a laminar flow chamber to study platelet aggregation.

The growing importance of the utilization of artificial materials in cardiovascular surgery makes it necessary to know their thrombogenic capacity. Our flow chamber, which is constructed of methacrylate, is capable of providing a laminar flow. The chamber itself consists of the trunks of two cones, one for the inflow and the other for the outflow, which are joined at their widest point to the ends of a cylinder of the same diameter. In the interior of the cylinder, which constitutes the central part of the system, are placed three rectangular fragments of the material to be studied. The vertices of the trunks of the cones allow the coupling of two flexible siliconized tubes in such a way that the system can be utilized in an "ex vivo' experimental model, constituting a bridge between the femoral artery and the right atrium of a large experimental animal, as well as in vitro, coupled to a continuous perfusion pump. The advantages provided by this system are that: (a) three materials can be studied simultaneously in an identical situation, (b) it is possible to submit these materials to conditions similar to those that give rise to platelet thrombi, and (c) it is possible to quantify the aggregation on each material by labelling the platelets with 111In-oxine.

Biocompatible Materials↗