Patients undergoing extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis are anesthetized and immersed in water in a semisitting position. Hypertension and tachycardia have been reported to accompany ESWL, and it was hypothesized that those problems were a result of adrenal medullary release of epinephrine or norepinephrine. Therefore, the effects of ESWL on cardiovascular variables and circulating epinephrine and norepinephrine levels in nine patients anesthetized with 1.1% isoflurane in 50% nitrous oxide and oxygen were studied. End-tidal carbon dioxide (CO2) was maintained at 34 +/- 2 mmHg. Cardiac output (CO) and mean arterial pressure (MAP) were measured, and total peripheral resistance (TPR) was calculated at the following time points: (1) after immersion prior to shock wave therapy (control); (2) after 300 shocks; (3) after 800 shocks; and (4) 5 minutes after the completion of ESWL with the patient still immersed. Circulating epinephrine and norepinephrine concentrations were determined at the above times as well as before and after induction of anesthesia but prior to immersion. There was a statistically significant (p less than 0.05) decrease in CO and an increase (p less than 0.05) in MAP and TPR with ESWL treatment. These values returned to baseline levels when treatment was stopped. Plasma epinephrine and norepinephrine values did not change significantly throughout the study period. It was concluded that these ESWL-associated hemodynamic changes were probably not mediated via epinephrine or norepinephrine.

Adult↗

PubMedDate not supplied

Echocardiographic and hemodynamic determinations of the ventricular filling pattern in some teleost fishes.

The current concept of ventricular filling in elasmobranch and teleost fishes is that atrial contraction is the primary, if not the exclusive, determinant of ventricular filling. Recent echocardiographic and on-line hemodynamic data for elasmobranchs, however, have demonstrated a biphasic ventricular filling pattern, characterized by an early phase that occurs during ventricular relaxation and a late phase that follows atrial systole. This study reports echocardiographic and hemodynamic analyses of ventricular filling in three teleost genera (Paralabrax, Channa, Monopterus) having markedly different heart morphologies. Both the profiles of the atrioventricular pressure gradient in Paralabrax and the ventricular inflow velocity in all three genera indicate a biphasic ventricular filling pattern. Although the relative contribution of the early and late filling phases differed among the species studied, interspecific differences in heart structure did not obscure the biphasic pattern. Also, pericardiectomy did not affect the biphasic ventricular filling pattern in Paralabrax. The presence of biphasic filling in teleosts establishes a functional similarity with the elasmobranchs and, because the biphasic ventricular filling pattern predominates in higher vertebrates, suggests that this ventricular filling mechanism may be present in the entire subphylum Vertebrata.

Animals↗

PubMedDate not supplied

Ethical and social issues posed by genetic studies of cardiovascular disease.

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Biomedical Research↗