Isobolographic analysis was used to assess quantitatively the combined direct negative inotropic effect of halothane and nifedipine as well as to define the type of interaction between these two agents. Experiments were performed on an isolated rat heart preparation. Developed left ventricular pressure and dP/dtmax were used as indices of inotropic action. It was found that the combination of halothane and nifedipine gives mostly additive direct negative inotropic effect. However, with a small level of myocardial depression (ED25), there was some deviation from the additive interaction toward an infra-additive effect (p less than 0.01), and with a high level of depression (ED75), some deviation toward a supra-additive effect (p less than 0.05).

Animals↗

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Database Conference January 27-30, 2000, Washington D.C.--Do existing databases answer clinical questions about geriatric cardiovascular disease and stroke?

EXECUTIVE SUMMARY: Most randomized, controlled trials evaluating the effectiveness of pharmaceutical, surgical, and device interventions for the prevention and treatment of cardiovascular disease have excluded patients over 75 years of age. Consequently, the use of these therapies in the older population is based on extrapolation of safety and effectiveness data obtained from younger patients. However, there are many registries and observational databases that contain large amounts of data on patients 75 years of age and older, as well as on younger patients. Although conclusions from such data are limited, it is possible to define the characteristics of patients who did well and those who did poorly. The goal of this conference was to convene the principal investigators of these databases, and others in the field of geriatric cardiology, to address questions relating to the safety and effectiveness of treatment interventions for several cardiovascular conditions in the elderly. Seven committees discussed the following topics: (I) Risk Factor Modification in the Elderly; (II) Chronic Heart Failure; (III) Chronic Coronary Artery Disease: Role of Revascularization; (IV) Acute Myocardial Infarction; (V) Valve Surgery in the Elderly; (VI) Electrophysiology, Pacemaker, and Automatic Internal Cardioverter Defibrillators Databases; (VII) Carotid Endarterectomy in the Elderly. The chairs of these committees were asked to invite principal investigators of key databases in each of these areas to discuss and prepare a written statement concerning the available safety and efficacy data regarding interventions for these conditions and to identify and prioritize areas for future study. The ultimate goal is to stimulate further collaborative outcomes research in the elderly so as to place the treatment of cardiovascular disease on a more scientific basis.

Aged↗

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Aortic valve replacement in a hemodialysis-dependent patient: anesthetic considerations--a case report.

In the anesthetic management of a hemodialysis-dependent patient undergoing aorticvalve replacement, technical and pathophysiologic problems considered included: 1. The presence of an arteriovenous hemodialysis fistula. 2. Hemodynamic alterations associated with aortic insufficiency. 3. Choice of anesthetic agents, fluid, and electrolyte balance in the presence of renal failure. 4. Postoperative management of hypertension and hyperkalemia. While there are many possible approaches, the authors present one successful technic for consideration.

Adult↗

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Failure to induce hepatic pathology in animals sensitized to a halothane metabolite and subsequently challenged with halothane.

The results of this animal study confirm the induction of delayed hypersensitivity to a halothane metabolite, but the sensitization does not cause hepatic damage on subsequent halothane exposures. Before the hypothesis that hepatic necrosis following halothane has an immunologic basis can be accepted or rejected, more critical studies with different approaches must be made.

Animals↗

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Anesthetic considerations in patients with gas gangrene.

Anesthesia for a patient with gas gangrene presents a challenge for the anesthesiologist, since it is an uncommon disease requiring emergency treatment. The authors, faced with such a challenge and finding little guidance in the literature, have proposed modalities of anesthetic management based on pathophysiology, symptomatology, and the reported experience of others. In addition to choice of anesthetic agents, problems reviewed include shock, hypovolemia, tachycardia, fever, anemia, renal dysfunction, pulmonary insufficiency, and contamination. Factors relating to anesthesia during hyperbaric-O2 therapy are also reviewed.

Adjuvants, Anesthesia↗

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Hepatitis and operating-room personnel: an approach to diagnosis and management.

Hepatitis represents a common problem in operating room (OR) personnel. The differential diagnosis is usually narrowed to viral hepatitis versus halothane-associated hepatitis. While specific immunologic technics are available to diagnose viral hepatitis, halothane hepatitis cannot presently be unequivocally diagnosed with available clinical, biochemical, immunologic, or pathologic technics. Suggestions for management of OR personnel with hepatitis can only be based on insufficient evidence at present. The authors have initiated a prospective study to help clarify this situation.

Acute Disease↗

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Steroids and anesthesia.

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Anesthesia↗

PubMedDate not supplied

Ketamine in the anesthetic management of asthmatic patients.

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Adolescent↗