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Biomedical subjects

G A Maccioli

Publications and source records attributed to G A Maccioli.

8 recordsLinked to original sources
PubMed2001

Dexmedetomidine.

Effective use of sedative-hypnotic and analgesic agents is an integral part of providing patient comfort and safety. Of the numerous drugs administered, benzodiazepines, propofol, and narcotics are the most popular. Even these proven, time-tested sedative-hypnotics and analgesics are not perfect, however, and modern intensive care demands a more ideal product. The development of dexmedetomidine, an alpha2-agonist, is an attempt to improve sedative/analgesic use and provide a drug that possesses the characteristics outlined in Table 1. It stimulates alpha2-adrenergic receptors in the locus ceruleus to provide sedation and in the spinal cord to enhance analgesia. It also causes sympatholysis via central and peripheral mechanisms. Dexmedetomidine binds alpha2-receptors eight times more avidly than clonidine and is shorter acting. It was initially evaluated as an anesthetic, but was associated with excessive bradycardia and hypertension, followed by hypotension. In late 1999, dexmedetomidine was approved for adult ICU use for less than 24 hours as a sedative infusion. It currently lacks approval in Europe. Most of the clinical experience with dexmedetomidine has been with surgical patients undergoing cardiac and vascular procedures. Careful patient selection and proper drug infusion are needed to avoid excessive deleterious hemodynamic results. Slower bolus loading over 20 minutes results in minimally decreased heart rate and blood pressure. Continuous infusion maintains unique sedation (patients appear to be asleep, but are readily roused), analgesic sparing effect, and minimal depression of respiratory drive. More experience with dexmedetomidine infusion in medical ICU patients and patients with complex end-organ dysfunction such as respiratory failure or systemic inflammatory response syndrome is needed before conclusions can be drawn about the drug's potential for wider application and its long-term (> 24 h) safety and effectiveness.

Dexmedetomidine↗
PubMed2000

Critical care and perioperative medicine. How goes the flow?

The specialty of anesthesiology is at a crossroad. Do anesthesiologists stay in the illusionary safe harbor of the operating room and allow critical care anesthesiologists to float alone? How can in-fighting with other medical and nonmedical providers be avoided, while maintaining or expanding the historic and hopefully future roles of anesthesiologists as hospital-based physicians? A different tact is required to redefine the scope of the practice with broadened training to provide increased expertise in the evolving medical marketplace. This approach would include solid training in business, informatics, data management, and critical thinking on outcomes. This paradigm shift may be challenging, and requires redirection, reallocation of assets, re-education, and a new mindset. If successfully applied, however, it presents a means to strengthen the respected position of the specialty and to promote the medical care and practice of perioperative specialists in the rapidly changing landscape of modern medicine. Regarding the question of turf and ownership of the ICU, the authors suggest pursuing the higher ground of an excellent scope of practice, which facilitates the care and activities of surgical and primary care colleagues. These colleagues, administrators, and governmental agencies will have to be re-educated to support training and provide equitable remuneration. Appropriately trained anesthesiologist-intensivists can complement many other care providers, while providing a wide range of services with an economy of care, whether in a semiclosed or closed ICU setting.

Anesthesia Department, Hospital↗
PubMed1990

Advances in oral anti-arrhythmic therapy: implications for the anaesthetist.

Surgical patients often are receiving antiarrhythmic therapy. Thus, because anaesthetic agents can affect cardiac function and may interact with concurrent antiarrhythmic medications, the anaesthetist should be aware of the electrophysiology associated with dysrhythmias and their management. Tocainide, flecainide, mexiletine, encainide and amiodarone have been introduced recently and each has an unique pattern of bioavailability, metabolism and toxicity. Patients treated with these drugs need special concern as they have abnormal cardiovascular systems and may be at increased risk for perioperative morbidity. In addition, unexpected untoward reactions and toxicity can result from interactions of anaesthetic agents and these drugs. This review discusses normal cardiac electrophysiology, common dysrhythmias and the electrophysiological effects of the newer oral antiarrhythmic drugs.

Administration, Oral↗
PubMed1988

Response of lower esophageal contractility to changing concentrations of halothane or isoflurane: a multicenter study.

A multiple-center study was performed to determine the relationship between lower esophageal contractility, clinical signs, and anesthetic concentration as expressed by minimum alveolar concentration (MAC). One hundred four American Society of Anesthesiologists Class I through III patients were exposed to isoflurane (with and without nitrous oxide) or halothane in concentrations of 0.5, 1.0, and 1.5 MAC. Heart rate and systolic blood pressure were continuously monitored. Both the amplitude and frequency of spontaneous and provoked lower esophageal contractions were measured in situ by using a 24-F probe equipped with provoking and measuring balloons. Combined results demonstrated statistically significant correlations (P less than 0.001) between lower esophageal contractility and MAC. Spontaneous lower esophageal contractions decreased from 1.10 +/- 0.12 (SEM) contractions per minute (0.5 MAC) to 0.42 +/- 0.05 (1 MAC) to 0.18 +/- 0.05 (1.5 MAC). Provoked lower esophageal contractility values decreased from 45 +/- 4 mm Hg (0.5 MAC) to 29 +/- 3 (1 MAC) to 19 +/- 2 (1.5 MAC). Heart rate changes did not correlate with MAC, and systolic blood pressure correlated in only one of three centers. Intracenter and intercenter analyses failed to demonstrate a significant relationship between lower esophageal contractility and heart rate or systolic blood pressure. No intracenter differences in either amplitude or frequency of lower esophageal contractions were observed, despite differences in volatile agents, induction techniques and agents, patient populations, and durations of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

The intra-aortic balloon pump: a review.

Intra-aortic balloon pump therapy is often life-saving in patients with refractory cardiac failure following cardiopulmonary bypass, in the peri-infarct period, or in treating complications of coronary artery angioplasty. Anesthesiologists are intimately involved in the care of the majority of IABP patients and require a thorough understanding of the equipment, its physiologic effects, and potential complications.

Animals↗