To determine both the incidence of myocardial ischaemia and haemodynamic response to carotid cross-clamping in coronary artery disease, 30 patients undergoing carotid endarterectomy were studied with a clear history of effort related disabling angina pectoris. Myocardial ischaemia was detected by a recording of lead CM5 of the electrocardiogram. A radial arterial and a thermodilution pulmonary catheter were inserted to obtain haemodynamic measurements before and after carotid cross-clamping and unclamping. Anaesthesia was induced with increments of thiopental, fentanyl 6 micrograms X kg-1 and pancuronium. Additional fentanyl (2 micrograms X kg-1) was injected before skin incision and before carotid cross-clamping. Carotid cross-clamping results in a significant increase in both mean arterial blood pressure and capillary wedge pressure. Two patients experienced myocardial ischaemia with ST segment depression during carotid cross-clamping. Nitroglycerin infusion led to the improvement of ST segment depression. When halothane was additionally administered to patients who developed hypertension in response to carotid cross-clamping, arterial blood pressure returned to normal value. These results indicate that carotid cross-clamping increases determinants of myocardial oxygen demand and may cause myocardial ischaemia in patients suffering from angina pectoris.

Aged↗

PubMed1986

[Prevention of hypertensive attacks after carotid surgery. The value of nifedipine and diltiazem].

A randomized study was carried out to determine whether postoperative administration of either intranasal nifedipine or intravenous diltiazem was effective in preventing hypertensive episodes after carotid endarterectomy. Sixty-three consecutive patients undergoing this surgery were randomly assigned to three groups (n = 21): control (C), nifedipine (N) and diltiazem (D). Anaesthesia was induced with flunitrazepam (0.02 mg X kg-1), fentanyl 6 micrograms X kg-1 and pancuronium (0.1 mg X kg-1), and maintained by N2O/O2 (50%), additional fentanyl and halothane or enflurane when warranted. Postoperatively, patients were warned whilst under mechanical ventilation in a recovery room. Upon arrival in the recovery room, intranasal nifedipine (10 mg) was given to patients included in group N, while patients from group D received an intravenous dose of 0.3 mg X kg-1 of diltiazem, followed by a continuous infusion of 3 micrograms X kg-1 X min-1 until 15 min after extubation. No preventive treatment was given to patients in group C. If postoperative systolic blood pressure rose to more than 180 mmHg, 10 mg of nifedipine were administered intranasally. During the postoperative period, 13 patients from group C, 5 from group N and 4 from group D exhibited hypertensive episodes (systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 100 mmHg). Intranasal administration of 10 mg nifedipine led to the normalization of blood pressure in 20 out of these 22 patients. This study confirmed the high incidence of hypertensive attacks after carotid endarterectomy, and showed that prophylactic administration of nifedipine or intravenous diltiazem was highly effective in preventing such hypertensive episodes.

Aged↗

PubMed1986

Exclusion-bypass for aneurysms of the descending thoracic and thoracoabdominal aorta.

From October 1973 to April 1985, 81 patients with aneurysms of the descending thoracic or thoracoabdominal aorta underwent surgery. Eight (10%) of these patients were treated by exclusion-bypass. The aneurysm was located in the descending aorta alone in five cases, and in the descending thoracic and thoracoabdominal aorta in three cases. In all cases, the proximal anastomosis of the bypass was performed on the ascending aorta. The site of the distal anastomosis was the supraceliac aorta in two cases, the infrarenal aorta in three cases and the iliac arteries in three other cases. Exclusion was bipolar, at each end of the aneurysm, in six cases, and unipolar, ie. proximal interruption only, in two cases. Two patients died during the first postoperative month, one of rupture of the distal portion of the aortic arch, the second, after onset of secondary paraplegia. There were no other spinal, cardiac or cerebral complications. One patient died three months postoperatively of intercurrent pulmonary infection. The five other surviving patients whose mean follow-up period is 48.1 +/- 25 months, are alive and enjoying good health. Resection and grafting as advocated by Crawford, is the usual treatment proposed for aneurysms of the descending thoracic and thoracoabdominal aorta. Exclusion-bypass may however be preferred in the following cases: elderly patients with compromised respiratory status, aneurysms of the descending thoracic aorta, either voluminous, of infectious origin or associated with aneurysm of the infrarenal abdominal aorta.

Adult↗

PubMed1986

Hemodynamic effects of high-frequency jet ventilation in patients with and without circulatory shock.

Nineteen critically ill patients with acute respiratory failure were studied to compare the hemodynamic effects of continuous positive-pressure ventilation (CPPV) and high-frequency jet ventilation (HFJV) at comparable levels of alveolar ventilation. Patients were divided into three groups: Group 1 included seven patients without circulatory shock in whom mean airway pressure (Paw) was slightly higher during CPPV than during HFJV (17.3 +/- 3.0 vs. 13.0 +/- 2.9 mmHg); Group 2 included six patients without circulatory shock in whom HFJV and CPPV were compared at the same level of Paw (19.2 +/- 5.0 mmHg); Group 3 included seven patients with circulatory shock in whom HFJV and CPPV were compared at the same level of Paw (16.0 +/- 3.9 mmHg). The following respiratory frequencies were used in HFJV: Group 1, 200 +/- 76 beats/min; Group 2, 238 +/- 103 beats/min; Group 3, 286 +/- 149 beats/min. In all patients comparable levels of PaCO2 were obtained with CPPV and HFJV. In Group 1 patients, mean arterial pressure, cardiac index, and stroke index were significantly higher during HFJV. In Group 2 patients, no significant difference was found between HFJV and CPPV. In Group 3 patients, the following hemodynamic variables were significantly higher during HFJV: mean arterial pressure (71 +/- 24 vs. 84 +/- 23 mmHg), cardiac index (3.6 +/- 1 vs. 4.1 +/- 1.41 X min-1 X m-2), and oxygen delivery (403 +/- 93 vs. 471 +/- 124 ml X min-1 X m-2).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1986

Roles of fentanyl and nitroglycerin in prevention of myocardial ischemia associated with laryngoscopy and tracheal intubation in patients undergoing operations of short duration.

The purpose of this study was to evaluate intravenous nitroglycerin given during induction of anesthesia as a means for prevention of myocardial ischemia and hemodynamic changes associated with induction, laryngoscopy, and intubation, in patients with stable angina scheduled for vascular operations of moderate duration. Forty-six patients were randomly assigned to receive either fentanyl, 3 micrograms/kg (group 1, n = 6), fentanyl, 8 micrograms/kg (group 2, n = 20), or fentanyl 3 micrograms/kg plus a continuous intravenous nitroglycerin infusion, 0.9 microgram X kg-1 X min-1 (group 3, n = 20), in addition to thiopental-pancuronium anesthetic induction, prior to laryngoscopy and intubation. The criteria for recognizing myocardial ischemia were the following: horizontal or downsloping ST segment depression equal to or greater than 1 mV, and/or ventricular arrhythmia, on CM5 recording. In group 1, myocardial ischemia occurred during laryngoscopy and intubation in four patients, and mean blood pressure (MBP), heart rate, and mean pulmonary wedge pressure (PCWP) increased significantly (P less than 0.05). Despite greater stability in MBP and heart rate in group 2, myocardial ischemia still occurred in four patients (not significantly different from group 1). Nitroglycerin added to low-dose fentanyl (group 3) produced significant reduction in myocardial ischemia (1/20) when compared with group 1 (P less than 0.01), and significantly greater stability in PCWP during laryngoscopy and intubation in comparison to groups 1 and 2. In patients with stable angina undergoing operations of short duration, the use of nitroglycerin infusion and low-dose fentanyl significantly decreases the incidence of myocardial ischemia associated with induction of anesthesia and tracheal intubation.

Aged↗

PubMed1986

[Post-stress nonlithiasic acute cholecystitis. Contribution of ultrasonics to the diagnosis and treatment in 50 cases].

Fifty cases of post-stress acute acalculous cholecystitis were observed during the past 9 years, mainly after major surgery or trauma. The apparently increasing incidence over the last 4 years (42 cases) could probably be explained by a better diagnostic approach of this condition by routine use of ultrasonography. No specific etiological factor could be found; however total parenteral nutrition and/or sepsis and/or use of narcotics could possibly play a role in the appearance of this complication. Although diagnosis can occasionally be suspected in the basis of abdominal and infectious signs, diagnosis was made primarily on the following ultrasonographic signs: enlarged gallbladder with thickened wall, sludge, and occasionally a double-wall aspect and a pericholecystic collection. In this series, most of the patients were treated by cholecystectomy, but a new therapeutic approach was used in 10 cases: percutaneous transhepatic drainage under sonographic control. Outcome is still poor, with a 50 p. 100 mortality rate.

Acute Disease↗

PubMed1981

[Milking and milk production in sedentary village herds in the north of the Ivory Coast].

Explore the source record for details and available documents.

Animals↗

PubMed1980

[Milking and milk production in sedentary village herds in the north Ivory Coast].

Explore the source record for details and available documents.

Animal Husbandry↗