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Biomedical subjects

L Tritapepe

Publications and source records attributed to L Tritapepe.

34 records · Page 2Linked to original sources
PubMed1996

Anaesthesia for caesarean section in a Marfan patient with recurrent aortic dissection.

PURPOSE: We report the anaesthetic management of a 34-yr-old pregnant woman with recurrent aortic dissection and Marfan syndrome for Caesarean section. CLINICAL FEATURES: She presented at 28 wk gestation with recurrent aortic dissection and had undergone aortic valve replacement and coronary ostia reimplantation (Bentall procedure) in the first trimester of pregnancy. She was treated in hospital with labetalol, anticoagulants and steroids and daily echocardiographic examination until 34 wk when caesarean section was planned. After positioning radial artery and CVP catheters and a transoesophageal echocardiographic probe, general anaesthesia was induced with thiopentone and maintained with isoflurane, and endotracheal intubation was facilitated with vecuronium. The site of incision was infiltrated with lidocaine before surgery which was uneventful. The patient was discharged at 10 days. CONCLUSIONS: With appropriate preoperative care and monitoring, uneventful general anaesthesia for caesarean section was achieved in a patient with Marfan syndrome in the presence of recurrent aortic dissection.

Adult↗
PubMed1996

Changes in coagulation patterns, blood loss and blood use after cardiopulmonary bypass: aprotinin vs tranexamic acid vs epsilon aminocaproic acid.

Cardiopulmonary bypass (CPB) increases risk of postoperative bleeding and need for transfusion. The aim of this study was to evaluate the effects of aprotinin, epsilon aminocaproic acid and tranexamic acid on coagulation patterns and need for banked blood transfusion. Ninety-six consecutive patients who underwent coronary artery bypass surgery were randomly assigned to 4 groups (24 patients each). The following parameters were monitored before, during and after CPB: activated lotting time, hemoglobin, prothrombin time, activated prothromboplastin time, fibrinogen, antithrombin III, xDP, Factor VIII, Thrombin-Antithrombin Complex and plasminogen. Analysis of postoperative bleeding and need for transfusion showed that the aprotinin group had significantly lower mediastinal bleeding. Transfused patients were 2, 4, 12 and 18 respectively in the aprotinin, epsilon aminocaproic acid, tranexamic acid and placebo treated group. In conclusion the use of protease inhibitors significantly reduces postoperative bleeding and transfusion. The aprotinin-treated group had the lower need for transfusion.

Aminocaproic Acid↗
PubMed1996

Effects of three techniques of lung management on pulmonary function during cardiopulmonary bypass.

In this study, 30 patients undergoing elective myocardial revascularization were divided randomly in three groups (10 patients each) with different management of the lungs during CPB: Group 1, lungs deflated; Group 2, static inflation with PEEP = 5 cmH2O and FIO2 = 1.0; Group 3, static inflation with PEEP = 5 cmH2O and FIO2 = 0.21. Measurements (Qs/Qt, P(A-a)O2, PaO2, Cstat, Cdyn, PIP, AUTO-PEEP, Rrs,max, Rrs,min and DRrs) were performed after the induction of anesthesia (T0), 20 minutes (T1) and 2 hours (T2) after the end of CPB. Respiratory mechanics data were obtained only at T0 and T2 because the sternal retraction. The Group 1 presented a statistically significant increase in Qs/Qt, P(A-a)O2 and Peak Inspiratory Pressure (PIP); in this group we noticed also a decrease in PaO2 values, static compliance (Cstat) and dynamic compliance (Cdyn) values comparing basal versus T1 and T2 values. The Group 2 showed a statistically significant increase in Qs/Qt and P(A-a)O2 values; also in this group we observed a statistically significant decrease in PaO2 and Cdyn values comparing basal versus T1 and T2 values. The Group 3 presented a statistically significant decrease in PaO2 values (basal versus T1 and T2); this group also presented an increase in Qs/Qt values, in the immediate postbypass period (T1), and P(A-a)O2 values significantly increase comparing basal versus T1 and T2 values. In all the three groups the respiratory system resistance and AUTO-PEEP values were unchanged after the end of CPB. The comparison between the groups showed a significant minor impairment of gas exchange (PaO2 and P(A-a)O2), Qs/Qt and Cstat in the third group of patients. These results show that lungs inflation with air during CPB, effectively preserve respiratory system mechanics: this might be due to a preservation of bronchial perfusion simply due to the mechanic expansion of the lung otherwise compromized when the lungs are completely collapsed. However it is necessary to emphasize that CPB has negative effects on gas-exchange whatever technique of lung management is used.

Anesthesia, Inhalation↗
PubMed1995

Nitric oxide release during hypothermic versus normothermic cardiopulmonary bypass.

Cardiopulmonary bypass (CPB) produces hemodynamic and inflammatory disorders involving changes in vascular permeability and regional blood flow and alterations of coagulation and complement systems. It has been reported that an abnormal release of vasoactive substances during CPB, like bradykinin or nitric oxide, could play a role. The aim of this study was to investigate the changes in nitric oxide (NO) release occurring in patients undergoing CPB, under both hypothermic and normothermic conditions. Forty patients (mean age 61.4 +/- 8.4 years) undergoing coronary bypass surgery were studied. In 20 patients (group A) systemic hypothermic CPB and antegrade cold intermittent crystalloid cardioplegia were used. The remaining 20 cases (group B) underwent surgery under systemic normothermic CPB and with antegrade warm blood intermittent cardioplegia. Nitric oxide was measured as the nitrite plasma level (NPL) by the Gries reaction. The time course of changes in NPL were obtained by collecting five whole blood samples: before CPB, 10 and 30 min after the start of CPB, and 10 and 60 min after the end of CPB. Although there were no significant variations of NPL shortly after the start of CPB (10 min after), values measured 30 min after CPB commencement and 10 min after the end of CPB showed a significant increase (P < 0.0001) in both groups. Considering the two groups separately, NPL changes seemed to be similar, so independent of temperature; however, in group B higher values of NPL were measured during (30 min) and after (60 min) CPB (P < 0.0001). In conclusion, during CPB there is a progressive increase, independent of temperature in NO release.

Blood Pressure↗
PubMed1991

[THe surgical treatment of aneurysmatic lesions of the ascending aorta: the immediate and long-term results in 40 patients].

From January 1981 to January 1991, 40 patients underwent operation for acute ascending aorta dissection (AAD, 14 patients), chronic ascending aorta dissection (CAD, 9 patients) or aortic ectasia (AE, 17 patients), with simultaneous aortic valve replacement in 30 cases (75%). Average age was 54 years with a 3:1 M/F ratio. In 20 cases (50%) a composite graft bearing a mechanical bileaflet valve was inserted with coronary artery reattachment (Bentall operation). In 16 cases (40%) the ascending aorta was replaced by a woven dacron graft alone (7 cases) or associated with aortic valve substitution (7 cases) or resuspension (2 cases). In 1 case (2.5%) a sutureless ring graft replacement of ascending aorta was carried out and 3 patients (7.5%) underwent aortoplasty with aortic valve substitution. Postoperative mortality rate was 21% for AAD group, 11% for CAD group and 6% for AE group. Non-fatal postoperative complications developed in 36% of AAD patients and in 78% and 29% of CAD and AE patients respectively. These complications occurred in 45% of patients who underwent Bentall operation, in 44% of those who underwent ascending aorta replacement associated with aortic substitution or resuspension, and in 14% of those operated of simple ascending aorta replacement. Average follow-up was 41.6 months (range 1.7-107.4 months). During this period 5 deaths occurred for a long-term mortality rate of 14.2%. Out of 30 survivors 21 (70%) underwent CT-study to evaluate the natural course of the false channel and the risk of redissection or late aneurysm formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Anesthesia using high doses of fentanyl in coronary patients subjected to myocardial revascularization. Comparison of 2 administration methods].

Eighteen patients to be submitted to heart surgery for myocardial revascularization have been considered. The patients were subdivided into two groups, A and B, and a high dose morphinic was administered for the induction and maintenance of the anaesthetic without further analgesic and/or narcotic supplement. The haemodynamic data obtained pointed to excellent stability in patient cardiocirculatory condition: preservation of IC within acceptable values was very interesting, owing to the fact that the high dose morphinic employed triggers very limited myocardiodepression. To conclude, the anaesthesiological techniques adopted seemed reliable and sufficiently protective with regard to exaggerated hyperdynamic responses to algogenic stimuli that trigger harmful haemodynamic conditions in coronary patients.

Aged↗
PubMedDate not supplied

[Anesthesia with high dosage fentanyl in coronary patients: effects of pretreatment with droperidol and diazepam].

The Authors have considered the effects of droperidol or diazepam treatments in patients undergoing high-dose fentanyl anesthesia in cardiac surgery. Twenty patients have been examined and divided in two groups: group A received droperidol (0.2 mg.kg-1) and group B diazepam (0.1 mg.kg-1) five minutes after fentanyl anesthesia induction (500 micrograms.min-1) to reach the "sleep dose". The diazepam pretreatment, as regards droperidol, reduces a dose of fentanyl necessary to obtain the conscience loss (21.5 +/- 2.5 micrograms.kg-1 vs 28 +/- 2.9 micrograms.kg-1). Hemodynamically the droperidol group is very stable, whereas the diazepam group shows certain myocardial depression and less protection at the OTI time.

Anesthesia↗
PubMedDate not supplied

[Intramuscular and oral clonidine in premedication of the heart surgery patient: hemodynamic effects and interaction with high-dose fentanyl induction].

OBJECTIVE: The aim of the study was to evaluate the efficacy of oral and i.m. clonidine as premedication in reducing the requirements of fentanyl for induction and to analyze its effects on the hemodynamics of patients with ischemic heart disease. SETTING: University Hospital. MATERIALS AND METHODS: The authors considered 30 patients (27 male and 3 female) undergoing CABG. Patients were premedicated 60-90 min before induction of anesthesia and were randomly distributed in three groups: Group A: oral diazepam 0.1 mg x kg -1; Group B: oral diazepam 0.1 mg x k-1 + oral clonidine 5 micrograms x kg-1; Group C: oral oral diazepam 0.1 mg kg-1 + i.m. clonidine 4 micrograms x kg-1. Induction of anesthesia was realized with fentanyl at speed of 500 mcg x min-1 until loss of consciousness was reached (no answer to three consecutive questions). MEASUREMENT: Hemodynamic data were recorded at TO(baseline), T1(induction of anesthesia), T2(3 min after intubation), T3(3 min. after skin incision). Results were analyzed by utilizing the average comparison Student "t" test and paired "t" test. A value of p < 0.05 was regarded as statistically significant. MAIN RESULTS: In groups B and C the inductive dose of fentanyl was much lower (p < 0.001) compared to control group (B = 19.23 +/- 3.57 micrograms x kg-1; C = 19.92 +/- 4.15 micrograms x kg-1; A = 28.39 +/- 6.4 micrograms x kg-1). This difference remained statistically significant (p < 0.001) also at T2 and T3 (T1: A = 42.79 +/- 3.21 mcg x kg-1; B = 29.07 +/- 6.18 micrograms x kg-1; C = 29.84 +/- 5.46 micrograms x kg-1; T2: A = 57.28 +/- 5.32 micrograms x kg-1; B = 43.22 +/- 3.87 micrograms x kg-1; C = 43.48 +/- 4.25 micrograms x kg-1). Considering the hemodynamic data, we report the heart rate in group B increased at T2 (p < 0.01), and systolic artery pressure raised in groups A (p < 0.05) and C (p < 0.01) at T2. Compared to baseline cardiac index showed a decrement at T3 in all groups of patients (p < 0.05). Systemic vascular resistance increased in all groups at T3 compared to baseline (p < 0.05). CONCLUSIONS: Clonidine proved to be useful to reduce narcotic requirements and to provide hemodynamic stability.

Administration, Oral↗
PubMedDate not supplied

[Prolonged neuromuscular block caused by succinylcholine in a patient with normal cholinesterase activity].

The authors describe a case of prolonged neuromuscular blockade following suxamethonlum in a patient with a normal cholinesterase activity and dibucaine number > or = 75%. In this case a peripheral nerve stimulator and capnography allowed neuromuscular blockade evaluation and fresh frozen plasma infusion led to a normal recovery from suxamethonium neuromuscular blockade. This report suggests a case of abnormal cholinesterase activity described as "silent variant".

Adult↗
PubMedDate not supplied

[Weaning in cardiopulmonary bypass patients with compromised cardiac function. Comparison of enoximone and dopamine].

OBJECTIVE: Evaluate the effects of enoximone and dopamine in patients with impaired left ventricular function after cardiopulmonary bypass (CPB). DESIGN: Prospective study on a consecutive series of patients subdivided into two groups: enoximone (Group E) and dopamine (Group D). SETTING: Policlinico Umberto I, University La Sapienza of Rome. PATIENTS AND METHODS: Thirty patients undergoing elective myocardial revascularization. Before weaning from CPB the patients received inotropic drugs as follows: Group E: enoximone: bolus: 1 mg/kg in 10 min, and continuous infusion of 5 mcg/kg/min; Gruppo D: dopamine: continuous infusion of 5 mcg/kg/min. Hemodynamic measurements were made using a Swan-Ganz catheter inserted before the induction of anaesthesia. RESULTS: Enoximone has proved to be effective in decreasing pre-load and after-load of both right and left ventricle by a positive lusitropic effect and a reduction of systolic stress, thereby increasing the cardiac index. In group D patients maintenance of cardiac output has been demonstrated to be dependent on a chronotropic effect. As a consequence in group D the increase in rate-pressure product has reached potentially dangerous values, reflecting a marked increase in myocardial oxygen consumption. On the contrary in Group E the increase in rate-pressure product has been much more limited. Finally both drugs have proven effective, since all patients have been easily weaned from CPB. CONCLUSIONS: Enoximone is a useful and easily-handled drug to facilitate weaning from CPB of patients with preoperative impaired ventricular function.

Assisted Circulation↗