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K Skarvan

Publications and source records attributed to K Skarvan.

At least 19 recordsLinked to original sources
PubMed1995

Exercise capacity as a predictor of postoperative complications in lung resection candidates.

Exercise testing with measurement of maximal oxygen uptake (VO2max) is increasingly used in the assessment of lung resection candidates, but its predictive value for postoperative complications remains controversial. We therefore sought to determine the prognostic value of VO2max compared with other pulmonary function tests. A consecutive group of 80 patients (mean age 61 yr; 57 males and 23 females) scheduled for lung resection (62 malignancies, 12 benign disorders, and 6 carcinoids) underwent pulmonary function tests and symptom-limited cycle ergometry. All patients underwent lung resections: 21 pneumonectomies, 45 lobectomies, and 14 segmental or wedge resections. Group A (64 patients, 80%) had an uneventful postoperative course, whereas Group B (16 patients, 20%) had complications; 3 of them died (4% overall mortality rate). In a stepwise logistic regression analysis used to determine independent risk factors for postoperative complications (within 30 d), VO2max expressed as a percentage of predicted (84 +/- 19 for Group A versus 61 +/- 11 for Group B) proved to be the best predictor (predictive value 85.5%). Although VO2max expressed in absolute values (ml/kg/min) was also highly predictive (79.5%), a ROC curve analysis proved the percentage predicted values to be significantly more sensitive. Of 9 patients with a VO2max < 60% of predicted, 8 had complications, including all 3 patients who died after resections of more than one lobe (sensitivity 50%, specificity 98%). The estimated probability (probit model SAS software package) of suffering no complication was 0.9 for VO2max > 75% of predicted and 0.1 for a VO2max < 43%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Massive intraoperative pulmonary embolism. Diagnosis and control following embolectomy with transesophageal echocardiography].

Massive intraoperative embolism is a life-threatening condition that may lead to immediate death. Important for the survival of the patient are rapid diagnosis and prompt surgical embolectomy. Case report. Nineteen days after a traffic accident, a 67-year-old patient who had complex ligamentous injuries was operated upon on both knees during general anaesthesia. The operation progressed uneventfully for the first 30 min when the patient's systolic blood pressure became slightly unstable and decreased to 85 mm Hg despite administration of ephedrine and infusion of hetastarch. This was followed 30 min later by an immediate drop to values that were undetectable on an oscilloscope. The pulse oximeter no longer detected a signal at the finger-tip and the end-tidal CO2 decreased to 1 kPa (7.5 mm Hg). To confirm the diagnosis of an acute pulmonary embolism, we performed transoesophageal echocardiography (TEE) and found a large amount of free-floating material in the right atrium, a dilated and hypokinetic right ventricle, and a collapsed left ventricle (Fig. 1 a). Embolectomy was immediately started using the inflow-occlusion technique supported by cardiopulmonary bypass (CPB). All emboli were removed from the right atrium and pulmonary artery (Fig. 1 b). During closure of the sternotomy, heart function was monitored by TEE and we again noted large emboli in the right atrium (Fig. 1 c). To remove these, we reinstated CPB and then placed an inferior vena cava filter. The final TEE control showed free heart chambers with good contractility (Fig. 1 d).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Spinal anaesthesia in a patient with Takayasu's disease.

We report the successful anaesthetic management of therapeutic abortion under spinal anaesthesia in a 32-yr-old woman with Takayasu's disease. The pathology and pathophysiology of this syndrome and their impact on anaesthesia are discussed.

Abortion, Therapeutic↗
PubMed1994

Prolonged decrease in heart rate variability after elective hip arthroplasty.

The pattern of postoperative heart rate variability may provide insight into the response of the autonomic nervous system to anaesthesia and surgery. We have obtained spectral (fast Fourier transform) and non-spectral indices of heart rate variability from electrocardiographic recordings, sampled during continuous perioperative Holter monitoring in 15 otherwise healthy patients with an uncomplicated postoperative course, undergoing elective hip arthroplasty with either spinal or general anaesthesia. In both groups, total spectral energy (0.01-1 Hz), low-frequency spectral energy (0.01-0.15 Hz) and high-frequency spectral energy (0.15-0.40 Hz) decreased after surgery to 32% (95% confidence interval (CI) 10.5; P < 0.01), 29% (95% CI 12.5; P < 0.01) and 33% (95% CI 12.5; P < 0.01) of their preoperative values, respectively, and these indices remained suppressed for up to 5 days. Non-spectral indices decreased to a similar extent. These findings indicate a substantial and prolonged postoperative decrease in both parasympathetic and sympathetic influence on the sinus node.

Aged↗
PubMed1993

[Perioperative transesophageal echocardiography in heart surgery].

Transesophageal echocardiography (TEE) has proven to be a safe and useful method in open heart surgery. TEE allows the anesthesiologist to monitor global and regional ventricular function continuously and to optimize hemodynamic management. It offers the cardiac surgeon additional information and more safety with regard to planning and conduct of surgery as well as the possibility of immediate assessment of the surgical result. Correctly applied, TEE improves the overall quality of perioperative patient care.

Anesthesia↗
PubMed1993

[Transesophageal echocardiography for evaluating left ventricular function].

By means of transesophageal echocardiography it is now possible to assess and to monitor left ventricular function during anesthesia and surgery. Furthermore, the determinants of the left ventricular function (preload, afterload and contractility) can also be evaluated in real time. Based on this information, a specific therapy can be started immediately should ventricular function become inadequate. In addition to global function, regional ventricular function can be analyzed at the same time. The detection of regional wall motion abnormalities can be most helpful for anesthetic management of patients with coronary heart disease and for the diagnosis of intraoperative myocardial ischemia.

Anesthesia Recovery Period↗
PubMed1992

Perioperative myocardial ischemia in patients undergoing elective hip arthroplasty during lumbar regional anesthesia.

Perioperative myocardial ischemia predicts unfavorable outcomes and occurs in as many as 41% of patients with coronary artery disease or cardiac risk factors undergoing noncardiac surgery. To determine the prevalence of myocardial ischemia, we studied 52 consecutive unselected patients undergoing elective hip arthroplasty during lumbar regional anesthesia. Patients were continuously monitored for 6 days using a three-channel Holter monitor. Ninety-nine episodes of myocardial ischemia occurred in 16 patients (31%), six of whom were considered preoperatively to be at low risk for coronary artery disease. Forty-four percent of the ischemic episodes were preceded or accompanied by a heart rate greater than or equal to 100/min and 56% by a heart rate greater than or equal to 90 beats/min. Ninety-six percent of the ischemic episodes were clinically silent, and 82% were not related to patient care events. Thirteen episodes of myocardial ischemia occurred preoperatively, 1 intraoperatively, and 85 postoperatively. The incidence of postoperative ischemic episodes showed a circadian variation: 44% occurred between 6 AM and noon, 33% between noon and 6 PM, 17% between 6 PM and midnight, and 6% between midnight and 6 AM. Six adverse cardiac events occurred during hospitalization (three of the six among patients with perioperative ischemia) and an additional four events during a follow-up period of 12 months (all four events occurred among patients with perioperative ischemia). Patients with perioperative myocardial ischemia had a relative risk of 2.6 (95% confidence interval 1.3-5.2) to develop an adverse cardiac event postoperatively.

Aged↗
PubMed1992

Failure of continuous three-channel Holter monitoring to detect acute peri-operative myocardial infarction.

Continuous peri-operative three-channel Holter monitoring in a 70-year-old patient undergoing elective hip arthroplasty failed to show onset and progression of a lethal postoperative myocardial infarction, which was clearly visible in a 12-lead electrocardiogram. The modified bipolar leads used for Holter monitoring differed from the corresponding leads of the 12-lead electrocardiogram. The limitations of Holter monitoring applied to clinical management and research are highlighted.

Aged↗
PubMed1990

[Transesophageal echocardiography].

Transesophageal echocardiography is a new, semi-invasive technique for the examination of the heart and the aorta. Within 10-15 minutes it is possible to obtain good pictures of the anatomy and function of the heart. Diagnostic indications are native and prosthetic valvular heart disease; the method is particularly suitable for visualization of endocarditic vegetations, evaluation of embolic events or congenital heart disease and assessment of aortic dissection. In the intensive care unit transesophageal echocardiography is a new window to the heart, yielding instantaneous information on cardiac status. For the anesthetist it is the first method to provide perioperative beat to beat analysis of ventricular function.

Aortic Dissection↗
PubMed1990

Prevention of aortocoronary vein bypass graft occlusion: which antithrombotic treatment and for how long?

The effects of 50 mg aspirin combined with 400 mg dipyridamole were compared with those of standard anticoagulant therapy, in the prevention of aortocoronary vein bypass graft occlusion. Early graft occlusion in 249 patients, with 749 distal vein graft anastomoses, were angiographically assessed 11.5 +/- 2 days after surgery and were almost equal in both treatment groups. In half of the patients in each group, active treatment was replaced by placebo after 3 months. Repeat angiography after 1 year (360 +/- 24 days) showed that more new late graft occlusions occurred in patients with only 3 months active medication (either regimen). The incidence of major complications was significantly higher in patients treated with anticoagulants, with minor side-effects more common in the antiplatelet group. Thus, this antiplatelet drug regimen was as effective as standard anticoagulant therapy in the prevention of early and late bypass graft occlusion, but carried a significantly lower risk of severe complications. In addition, as replacement of active treatment by placebo after 3 months resulted in significantly more graft occlusions, antithrombotic treatment should be continued for at least one year after coronary artery bypass graft surgery.

Adult↗
PubMed1990

[Diagnostic value of CK-MB for the determination of perioperative infarct in coronary artery bypass operation].

To assess the diagnostic value of CK-MB determinations after CABG surgery to detect or exclude perioperative myocardial infarction, 228 consecutive patients were studied with serial ECGs, as well as pre- and postoperative left heart catheterization and thallium-201-scintigraphy. CK-MB values above or below 100 U/l had a sensitivity and specificity of 73% each. There was a linear correlation between CK-MB values and total ischemic time. Thus, an increasing amount of myocardium is lost with each additional minute of ischemia despite today's methods of myocardial protection. Due to its low diagnostic accuracy CK-MB seems not to be very helpful for the diagnosis of perioperative myocardial infarction.

Adult↗
PubMed1989

[The heart as the field of conflict between surgery and anesthesia].

Both surgical trauma and anesthesia have an important impact on the heart and its function. The operation affects the heart by sympathoadrenergic stress reaction, blood loss, and various surgical manipulations all of which challenge its functional reserve. Although anesthesia should protect the heart against the untoward effects of the operation, it may itself compromise cardiovascular function. The understanding of the complex interactions between surgery and anesthesia is essential for the perioperative management of the cardiovascular system. Taking these interactions into account ensures a safe, complication-free anesthesia even in patients with heart disease.

Anesthesia↗
PubMed1989

Trial of low-dose aspirin plus dipyridamole versus anticoagulants for prevention of aortocoronary vein graft occlusion.

In a prospective randomised trial, 249 patients who had aortocoronary vein bypass surgery were assigned either to a platelet inhibitory drug regimen or to standard anticoagulant therapy. Treatment was replaced by placebo in half of the patients in each group after 3 months. The platelet inhibitory drug regimen--very low-dose aspirin combined with dipyridamole--was as effective as standard anticoagulant therapy to prevent early and late graft occlusion. Death, myocardial infarction, and severe bleeding occurred significantly more often in patients receiving anticoagulants, whereas mild drug-related gastrointestinal and cerebral side-effects were more common in patients taking platelet inhibitory drugs. Antithrombotic treatment should be continued for at least 1 year after coronary artery bypass graft surgery.

4-Hydroxycoumarins↗
PubMed1989

[Right ventricular function during and after aortocoronary bypass].

A transient depression of right ventricule (RV) function following aortocoronary bypass operation is a common event. Occasionally, RV failure may be responsible for postoperative low cardiac output syndrome, cardiogenic shock or intracardiac right-left shunt. Understanding and monitoring of RV function is essential for proper management of patients during and after aortocoronary bypass operation.

Coronary Artery Bypass↗
PubMed1988

Cardiovascular effects of diltiazem in the dog.

The effects of two bolus injections (0.2 mg kg-1) and two infusion rates (0.2 mg min-1 and 0.4 mg min-1) of diltiazem on global and regional left (LV) and right ventricular (RV) performance (ultrasonic dimension technique), on coronary (electromagnetic flow meters) and systemic haemodynamics, and on electrophysiology (PR, QRS, QTc intervals) were studied in eight open-chest dogs anaesthetized with droperidol and fentanyl. The two bolus injections of diltiazem resulted in plasma concentrations of 688 +/- 115 and 650 +/- 85 ng ml-1 (means +/- SE), respectively, and caused substantial decreases in systemic and coronary vascular resistances, and in aortic pressure, and increases in LV segment shortening, stroke volume and aortic flow. Electrophysiological variables were little affected. At the low infusion rate (plasma concentration 140 +/- 23 ng ml-1) coronary and systemic vasodilatation occurred, but global and regional RV and LV performance were little affected. PR interval increased by 15%. At the higher infusion rate (plasma concentration 282 +/- 33 ng ml-1) coronary and systemic vasodilatation were maintained. Aortic pressure decreased slightly. Whereas LV end-diastolic and end-systolic dimensions remained unchanged, they increased in the RV. In addition, the PR interval increased by 35%, and three animals developed atrioventricular block type I. The data indicate that diltiazem is a potent coronary and systemic vasodilator with little effect on global RV and LV performance. However, at a higher infusion rate RV dimensions clearly tend to increase, and conduction abnormalities develop.

Animals↗