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Biomedical subjects

N D Kon

Publications and source records attributed to N D Kon.

At least 37 records · Page 2Linked to original sources
PubMed1995

Acquired cor triatriatum after orthotopic cardiac transplantation.

Orthotopic cardiac transplantation was performed in a 42-year-old woman with idiopathic cardiomyopathy. Postoperative right ventricular failure developed and a transesophageal echocardiogram demonstrated acquired cor triatriatum with marked obstruction to mitral valve inflow and severe right ventricular dilatation. At reexploration, redundant donor atrial tissue was excised correcting the cor triatriatum. She was alive and well with normal hemodynamic parameters 12 months after transplantation.

Adult↗
PubMed1995

Comparison of implantation techniques using freestyle stentless porcine aortic valve.

Stentless porcine aortic valves demonstrate superior hemodynamic performance when compared with their stented counterparts. The technical considerations for implanting these valves can be demanding. The Medtronic Freestyle aortic root bioprosthesis resembles an allograft, has zero-pressure-fixed leaflets treated with an antimineralization agent, and can be implanted using a variety of techniques. In this study of that valve, total root replacement (TRR) was compared with a partial scallop aortic inclusion technique (PSI). Implications were performed in 75 patients (49 PSI and 26 TRR). There were no significant differences with respect to age, sex, or incidence of concomitant procedures. Mean aortic cross-clamp times were significantly less in the PSI group than in the TRR group (51.8 +/- 11.7 minutes versus 125.5 +/- 19.7 minutes; p = 0.0001). At discharge, mean systolic gradients seen on color-flow Doppler echocardiography were less in the TRR group than in the PSI group (6.17 +/- 3.66 versus 10.01 +/- 4.83 mm Hg; p = 0.014). Discharge echocardiography revealed trivial valve regurgitation in 8.3% of the TRR group and in 41.7% of the PSI group (p = 0.004). No patient experienced any significant valvular regurgitation on discharge echocardiography. We conclude that early experience with the Medtronic Freestyle aortic root bioprosthesis shows excellent short-term function regardless of implantation technique. Shorter cross-clamp times, comparable with those of stented valve procedures, occurred with PSI implantation. We anticipate that effects on long-term durability will be beneficial.

Adult↗
PubMed1995

Effect of cardiopulmonary bypass on hand and forearm blood flow.

We have assessed the relationship between the aorto-radial pressure difference at the conclusion of cardiopulmonary bypass and blood flow to the hand. Hand blood flow was estimated from the difference between forearm blood flow measured without and with exclusion of the hand circulation. On the same hand, the skin temperature on the palm and on the middle finger was recorded, with the amplitude of the finger pulse oximeter trace. The aorto-radial pressure difference, after cardiopulmonary bypass, correlated with hand blood flow (r = 0.59, P = 0.002). There was a significant (P < 0.0001) palm-finger temperature gradient before and after cardiopulmonary bypass. In conclusion, while the mean aorto-radial pressure difference after bypass results from increased hand blood flow, the finger is not a reliable site to assess the state of the systemic circulation, before or after cardiopulmonary bypass.

Aged↗
PubMed1994

Reliability of the radial arterial pressure during anesthesia. Is wrist compression a possible diagnostic test?

STUDY OBJECTIVE: To evaluate wrist compression as a test to identify low radial from low systemic pressure and to see if the gradient found after cardiopulmonary bypass is also present whenever hand vascular resistance may decrease. DESIGN: This was a prospective study. SETTING: Operating room area of a university medical center. PARTICIPANTS: (1) Forty patients undergoing coronary bypass grafting studied at discontinuation of cardiopulmonary bypass. (2) Twenty-six patients received isoflurane anesthesia before major noncardiac operations. (3) Hydraulic model: a fluid container with a tube 66-cm long, 6- to 1.8-mm internal diameter, connected at its base. INTERVENTIONS: Before induction of anesthesia, the radial artery was cannulated and, in the first group, the aorta or femoral arteries as well. The radial pressure was compared consecutively with and without wrist compression. In the model, the pressure was recorded simultaneously at three sites along the tube while different flows ran through its distal end. MEASUREMENTS AND RESULTS: Overall, wrist compression increased radial (p < 0.001) systolic, diastolic, and mean arterial pressures. In the first group, compression reduced the femoral/aortic-radial mean pressure difference by 50 percent and never produced higher radial than central mean pressure. Plot of the pressure difference produced by wrist compression against the average of the (compared) radial pressures and considering increases > or = 4 mm Hg as real, showed that, in the first group, systolic arterial pressure (SAP) increased 13 +/- 1.4 mm Hg in 22 of 40 patients; diastolic arterial pressure (DAP) increased 7.8 +/- 1.1 mm Hg in 4; and mean arterial pressure (MAP) increased 7.7 +/- 1.6 mm Hg in 9 patients. In the second group, SAP increased 16.0 +/- 1.7 mm Hg in 24 of 26 patients, DAP increased 6.0 +/- 1.4 mm Hg in 5, and MAP increased 7.0 +/- 0.7 mm Hg in 18 of 26 patients. In the model, base pressure at 94 mm Hg, the pressures were 1.2 to 28.1 mm Hg lower for flows ranging from 10 to 122 ml/min at the 54-cm distance (wrist equivalent). CONCLUSION: The systemic-radial artery pressure gradient seen at the end of cardiopulmonary bypass seems to be a phenomenon common to patients with decreased hand vascular resistance. Wrist compression decreases or abolishes the gradient in most cases. It does not produce false positives, so an increase indicates a greater aortic than radial pressure. The difference is likely to be only temporary.

Anesthesia, General↗
PubMed1994

Cardiopulmonary bypass and forearm blood flow.

STUDY OBJECTIVE: To assess the effect of cardiopulmonary bypass (CPB) on muscle blood flow (MBF) when measured in the forearm by venous occlusion plethysmography. DESIGN: This was a prospective study. SETTING: Operating room area of a tertiary care university medical center. PARTICIPANTS: Twenty-seven patients (25 men and 2 women), aged 62 +/- 1.5 years, undergoing elective coronary bypass grafting. INTERVENTIONS: Measurements were made during the surgical procedure: before, during cold and warm, and after discontinuation of CPB. MEASUREMENTS AND RESULTS: Changes in forearm blood flow (FBF), derived forearm vascular resistance (FVR), mean arterial pressure (MAP), and cardiac output (CO) were evaluated by repeated measures analysis of variance. The control FBF (measured before CPB) was found to be approximately 50 percent lower than that previously reported for awake volunteers and patients. The FVR was similarly higher. From these low values, the FBF increased significantly (p < 0.001) during normothermic bypass and after CPB. Forearm vascular resistance decreased significantly (p < 0.001) throughout the cold, warm, and postbypass periods. Only during the warm and the postbypass periods did FBF and FVR reach normal values. Mean arterial pressure decreased significantly (p < 0.01) throughout. There was no statistically significant association between any of the variables and FBF or FVR. After correcting for patient and surgical phase variability, only MAP had a statistically significant effect (p = 0.042) on FVR; blood temperature, skin temperature, hematocrit level, PaCO2, serum potassium, and systemic vascular resistance (SVR) had no effect on either FBF or FVR when tested singly or in combination. When correction for multiple comparisons was applied, the lowest probability value became greater than 0.25. There was no correlation between combinations of covariates and FBF or FVR after adjustments for the surgical phase of the study either. CONCLUSION: These findings indicate that the increase in MBF seen during warm and the post-CPB periods is only a recovery toward normal blood flow. The role of this change in the low SVR that usually accompanies CPB is equivocal.

Blood Pressure↗
PubMed1993

Mitral valve operation via an extended transseptal approach.

The extended transseptal approach to the mitral valve has been used for 71 consecutive procedures. Four patients died; none had complications directly attributable to the exposure. Twenty underwent a primary reparative procedure; 30, a primary replacement procedure; and 21, a repeat procedure. Despite division of the sinus node artery, 26 of 32 patients with sinus rhythm preoperatively had sinus rhythm postoperatively; 4 had atrial fibrillation postoperatively. Twenty-seven of 37 patients with atrial fibrillation preoperatively had atrial fibrillation postoperatively; 8 had sinus rhythm postoperatively. Because the exposure provided by this extended transseptal approach is superior to that of standard approaches, we now use it routinely for mitral valve operations.

Adult↗
PubMed1993

Combined inotropic effects of amrinone and epinephrine after cardiopulmonary bypass in humans.

Amrinone, a phosphodiesterase inhibitor, and epinephrine, an alpha- and beta-adrenergic receptor agonist, are inotropic drugs used during cardiac surgery to reverse myocardial depression after cardiopulmonary bypass. However, these drugs have not been compared separately, or in combination, in this patient population. We hypothesized that the combination might have complementary actions in improving myocardial function. We, therefore, compared amrinone, epinephrine, and the combination of amrinone and epinephrine in a randomized, blinded, placebo-controlled study in patients undergoing coronary artery bypass grafting. Forty patients with ejection fractions > 0.45 were studied. Right ventricular ejection fraction pulmonary artery catheters and radial arterial catheters were inserted before fentanyl-midazolam anesthesia. After separation from bypass, patients received either a placebo (n = 20) or amrinone bolus (1.5 mg/kg, n = 20) at time 0 and a placebo (n = 20) or epinephrine (30 ng.kg-1.min-1, n = 20) infusion at time 5 min. This resulted in four study groups, n = 10 in each group. Data were collected every 2.5 min for 10 min. Epinephrine, amrinone, and the combination of both drugs significantly increased cardiac output, stroke volume, O2 delivery, and left ventricular stroke work. The increase in stroke volume (P < 0.05) was 12 +/- 6, 16 +/- 4, and 30 +/- 4 mL/beat with epinephrine, amrinone, and the combination of amrinone and epinephrine, respectively. The amrinone-epinephrine combination increased stroke volume as much as the sum of amrinone and epinephrine given separately. Systemic vascular resistance and pulmonary vascular resistance decreased with amrinone and amrinone-epinephrine, but not with epinephrine. Epinephrine increased mean arterial and mean pulmonary arterial pressures. Right ventricular ejection fraction did not significantly increase (P = 0.09) with epinephrine, but increased significantly with amrinone (0.45 to 0.53, P = 0.01), and with the combination (0.43 to 0.55, P = 0.006). These data indicate that amrinone and epinephrine effectively increase myocardial performance during cardiac surgery. Right ventricular function especially was improved with amrinone and the combination of amrinone and epinephrine. The combined effects of amrinone and epinephrine may be useful in patients recovering from the ischemia and reperfusion injury resulting from coronary artery bypass grafting.

Amrinone↗
PubMed1992

Magnetic resonance imaging evaluation of recipient for cryopreserved aortic allograft.

Aortic valve replacement with a cryopreserved aortic allograft is the procedure of choice for many patients with aortic valvular heart disease. We have used magnetic resonance imaging preoperatively to determine annular size and coronary artery orientation in the recipient, which not only has enabled us to select an allograft of appropriate size from a distant tissue bank, but also has helped us to identify preoperatively the recipient with a truly bicuspid valve in which the coronary arteries are oriented 180 degrees apart. Sixteen consecutive patients were evaluated preoperatively, the aortic annulus being measured with both magnetic resonance imaging and echocardiography. Cryopreserved aortic allografts were ordered on the basis of the magnetic resonance imaging measurement. Annular size was then measured intraoperatively with calibrated sizers. Magnetic resonance imaging annular measurements correlated highly with those found at operation (r = 0.92), whereas echocardiographic measurements correlated less well (r = 0.69). Coronary orientation was accurately predicted in every case (r = 1.0). Therefore, we have found magnetic resonance imaging to be useful in the preoperative evaluation of patients for aortic valve replacement with a cryopreserved aortic allograft.

Adolescent↗
PubMed1992

Is calcium or ephedrine superior to placebo for emergence from cardiopulmonary bypass?

To determine whether ephedrine or CaCl2 improves hemodynamics in cardiac surgery patients emerging from cardiopulmonary bypass, three sequential doses of either CaCl2 (200 mg/dose; n = 12), ephedrine (5 mg/dose; n = 12), or placebo (n = 12) were administered in a prospective, randomized, double-blind fashion. Thermodilution volumetric catheters were used to calculate right ventricular (RV) volumes and ejection fraction. The first dose of ephedrine improved RV stroke volume from 57 +/- 3 to 63 +/- 4 mL/beat (P < 0.05) and ejection fraction from 44 +/- 2% to 49 +/- 2% (P < 0.05). Subsequent doses maintained this improvement but without further change. In contrast, placebo and CaCl2 had minimal effects on RV end-systolic volume, stroke volume, and ejection fraction. After the third injection of ephedrine, mean arterial pressure had significantly increased from 78 +/- 2 to 93 +/- 4 mmHg (P < 0.05) in contrast to insignificant increments with placebo and CaCl2. Serum ionized calcium increased by 6% to 8% after each CaCl2 bolus but remained stable in the ephedrine and placebo groups. CaCl2 failed to improve RV performance in mildly hypocalcemic patients during separation from cardiopulmonary bypass. In patients with normal preoperative ventricular function, ephedrine more effectively improved RV performance and arterial blood pressure than placebo or CaCl2, and is a suitable short-acting drug to assist separation from cardiopulmonary bypass.

Adult↗
PubMed1992

Dobutamine increases heart rate more than epinephrine in patients recovering from aortocoronary bypass surgery.

To determine whether epinephrine might prove to be a cost-effective substitute for dobutamine, two 8-minute infusions of either epinephrine (10 and 30 ng/kg/min, n = 28) or dobutamine (2.5 and 5 micrograms/kg/min, n = 24) were administered to 52 patients recovering in the intensive care unit (ICU) after aortocoronary bypass (CABG) surgery. At the higher dose, both drugs significantly (P < .05) increased cardiac index (CI), epinephrine from 2.8 +/- 0.1 at baseline to 3.3 +/- 0.1 L/min/m2, and dobutamine from 3.2 +/- 0.1 at baseline to 4.1 +/- 0.2 L/min/m2. Epinephrine increased CI significantly less than dobutamine. Both drugs significantly increased stroke volume index (SVI), epinephrine from 32 +/- 1 at baseline to 36 +/- 1 mL/beat/m2, and dobutamine from 36 +/- 1 at baseline to 40 +/- 2 mL/beat/m2. At the higher dose, the effects of the two drugs on SVI were indistinguishable. On the other hand, while the higher dose of both drugs significantly increased heart rate (HR), epinephrine from 88 +/- 2 at baseline to 90 +/- 2 beats/min and dobutamine from 89 +/- 2 at baseline to 105 +/- 3 beats/min, the increase following the higher dose of dobutamine was significantly greater than that seen after epinephrine. Effects of the two drugs on mean arterial pressure, central venous pressure, pulmonary artery occlusion pressure, systemic vascular resistance, pulmonary vascular resistance, and left-ventricular stroke work did not significantly differ. Similar results were obtained in the subset of patients with baseline CI less than 3 L/min/m2 who more closely resembled patients who might acutely require inotropic drug administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1992

A randomized, blinded, placebo-controlled evaluation of calcium chloride and epinephrine for inotropic support after emergence from cardiopulmonary bypass.

Forty hemodynamically stable patients were randomized to receive an intravenous bolus of either calcium chloride (5 mg/kg) (n = 20) or placebo (n = 20) (phase I). Six minutes later, they received either an epinephrine (30 ng.kg-1.min-1) (n = 20) or placebo (n = 20) infusion (phase II). Hemodynamic and ionized calcium measurements were obtained in phase I at baseline and at 3 and 6 min after the bolus, and in phase II, at 3 and 6 min (study times 9 and 12 min) after initiation of the infusion. Compared with placebo, calcium did not significantly increase cardiac index but significantly increased mean arterial pressure. Calcium improved cardiac index from 2.46 +/- 0.12 (mean +/- SEM) to 2.74 +/- 0.12 L.min-1.m-2; likewise, placebo improved cardiac index from 2.51 +/- 0.15 to 2.74 +/- 0.15 L.min-1.m-2. Mean arterial blood pressure increased with calcium from 74 +/- 2 to 82 +/- 3 mm Hg compared with a placebo change of 74 +/- 2 to 76 +/- 2 mm Hg. Patients who received the epinephrine infusion (n = 20) demonstrated a significant increase in cardiac index at time 12 min compared with patients receiving only placebo (n = 20). Cardiac index of the epinephrine group increased from 2.56 +/- 0.15 to 2.92 +/- 0.22 L.min-1.m-2, whereas in the placebo group it decreased from 2.86 +/- 0.13 to 2.78 +/- 0.12 L.min-1.m-2. Prior administration of calcium did not alter the subsequent response to epinephrine (n = 10) compared with patients receiving epinephrine alone (n = 10). We conclude that cardiac index improves with time without drug therapy after bypass. Calcium chloride increases mean arterial blood pressure but not cardiac index immediately after cardiopulmonary bypass, whereas low-dose epinephrine significantly increases both cardiac index and mean arterial blood pressure without causing tachycardia in these patients. Calcium chloride (5 mg/kg) did not augment or inhibit the hemodynamic response to an epinephrine infusion.

Calcium↗
PubMed1992

Does radial artery pressure accurately reflect aortic pressure?

STUDY OBJECTIVE: Our objective was to determine whether the systolic, diastolic, and mean arterial pressures measured in the radial artery accurately reflect corresponding pressures in the ascending aorta in narcotic-anesthetized patients with known obstructive coronary artery disease, before being subjected to cardiopulmonary bypass (CPB). DESIGN: This was a prospective study. SETTING: The cardiac operating room of a large, tertiary-care university medical center. PARTICIPANTS: Fifty-one patients (45 men and six women; age range, 48 to 77 years) with documented atherosclerotic coronary artery disease were studied. All patients underwent elective coronary artery bypass grafting after the study. INTERVENTIONS: Patients were premedicated with lorazepam and morphine 60 min before administration of Fentanyl-pancuronium anesthesia. The radial artery was cannulated before induction of anesthesia and the aorta approximately 45 min later. Comparisons of radial and aortic pressures were then performed. MEASUREMENTS AND RESULTS: Radial and aortic pressures were recorded through standard, fluid-filled, high-pressure, 91-cm (36-in) long tubing and disposable transducers, meticulously cleared of air bubbles. Additional measurements included cardiac output, central venous pressure, core temperature, blood gas levels, and hematocrit reading. Radial-aortic pressure differences were as follows: systolic arterial pressure (SAP), 12 +/- 1 mm Hg; mean arterial pressure (MAP), -0.8 +/- 0.3 mm Hg; and diastolic arterial pressure (DAP), -1.0 +/- 0.3 mm Hg. All were significant (p < 0.001), but the SAP difference was more than ten times that of either the MAP or the DAP values. The coefficients of determination (r2) indicated that the radial-aortic dependence was 0.44 for the SAP, 0.90 for the DAP, and 0.98 for the MAP relationship. Plotting the respective differences against the arithmetic mean of simultaneously measured pressures indicated that the radial SAP was 4 to 35 mm Hg higher than the aortic in 42 patients (82 percent) and was 10 to 35 mm Hg higher in 26 patients (51 percent); radial-aortic MAP differences clustered within 3 mm Hg in 47 patients (92 percent); radial DAP was +/- 3 mm Hg different from the aortic in 46 patients (90 percent). The largest MAP difference was -6 mm Hg in one patient. The largest DAP difference was +/- 5 mm Hg in three patients. CONCLUSIONS: In this group of patients, who were studied before undergoing CPB, the radial SAP gave a poor estimate of that present in the ascending aorta, since in more than 50 percent of the cases, the radial SAP was 10 to 35 mm Hg higher than that in the aorta. The radial MAP and DAP are reliable, since in 90 percent and 92 percent of the patients, respectively, the pressure differences were within +/- 3 mm Hg of those in the aorta.

Aged↗
PubMed1991

Effect of desmopressin on vein graft patency in a microvascular model.

Desmopressin acetate decreases blood loss after cardiac surgery by activating platelets. We studied whether this effect was detrimental to small-caliber vein grafts in rats. Thirty minutes before femoral artery grafting with 0.75-mm-diameter reverse autogenous saphenous vein grafts, 20 rats received desmopressin acetate intravenously at 1.0 micrograms/kg over 10 minutes, and 20 control rats received normal saline intravenously over 10 minutes. In each group, 10 rats received a 6-mm-long graft and 10 an 18-mm-long graft. Graft patency was evaluated at 20 minutes, 24 hours, and 30 days. Intimal thickening was assessed by light and scanning electron microscopy. At 30 days, 9 short grafts and 8 long grafts in the desmopressin-treated group were patent, whereas only 8 short control grafts and only 6 long control grafts were patent. Intimal thickening and platelet deposition were the same in both groups. These data show no detrimental effects of desmopressin acetate on saphenous vein graft patency.

Animals↗
PubMed1991

Improved lung preservation with cold air storage.

Conventional topical slush cooling limits lung transport to 4 to 6 hours. For this canine study of an alternate air cooling system, 37 canine lungs were removed: 24 were placed in plastic bags, and inserted in a Transplanthermm container at core air temperatures (n = 6 lungs each) of (A) 4 degrees C, (B) 8 degrees C, (C) 12 degrees C, and (D) 20 degrees C; 6 were stored conventionally in ice slush (E); and 7 were transplanted immediately (F). After 8 hours, the stored lungs were transplanted and the contralateral pulmonary artery was ligated. Survival, arterial oxygen tension, and extravascular lung water were monitored at 15 minutes and every hour for 4 hours. Four-hour survival was 100% in groups A, B, and F; 83% in group C, 50% in group D, and 17% in group E. The mean arterial oxygen tension at 1 hour was lower in group E (6.4 +/- 2.4 kPa) than in group A (39.8 +/- 13.2 kPa) (p = 0.0002) or in group F (42.0 +/- 16.2 kPa) (p = 0.0035). Extravascular lung water in group E was higher at 15 minutes (15.44 +/- 5.63 mL/kg) than in group A (3.76 +/- 0.63 mL/kg) (p = 0.0001) and group F (4.69 +/- 1.65 mL/kg) (p = 0.003). Cold air storage appears to provide better lung preservation than hypothermic immersion in ice slush.

Air↗
PubMed1991

Heart rate-right ventricular stroke volume relation with myocardial revascularization.

Whether increasing pacing frequency in cardiac surgical patients effectively improves right ventricular cardiac index depends on the interrelationships between heart rate, stroke volume index, and end-diastolic volume index. If an inverse relation exists between heart rate and right ventricular volume then the decrease in right ventricular ejection fraction described after bypass may be due, in part, to changes in heart rate. We evaluated the effects of pacing at 80, 95, and 110 beats/min using a thermodilution volumetric catheter in 16 patients undergoing myocardial revascularization. End-diastolic volume index, stroke volume index, and stroke work index were significantly greater after bypass than before bypass, whereas right ventricular ejection fraction remained constant. Before and after bypass, sequentially increasing pacing frequency from 80 to 110 beats/min decreased stroke volume index by 28% to 35% (p less than 0.001), end-diastolic volume index by 12% to 14% (p less than 0.001), and right ventricular ejection fraction by 18% to 24% (p less than 0.001). Right ventricular performance, assessed by comparing the stroke volume index to end-diastolic volume index and stroke work index to end-diastolic volume index relations generated during pacing, was not altered by bypass. We conclude that sequentially increasing heart rate from 80 to 110 beats/min fails to improve stroke volume index and consequently cardiac index before or after cardiac operations. Intraoperatively, in patients with normal left ventricular function, increasing pacing frequency decreases right ventricular ejection fraction due to simultaneous reductions in stroke volume index and end-diastolic volume index.

Adult↗
PubMed1990

Systolic pressure measurement in the ascending aorta: augmentation at the aortic cannula sideport.

To assess whether arterial blood pressure measured at the sideport of the aortic cannula mirrors that measured within the ascending aorta, the two pressures were compared in 10 consecutive patients undergoing cardiopulmonary bypass. The mean arterial pressures (MAP) were equal both before and after bypass, but the sideport systolic arterial pressure (SAP) was 6.0 +/- 0.8 mm Hg higher than the aortic SAP before bypass and 9.1 +/- 0.5 mm Hg higher than the aortic SAP after bypass (P less than 0.001). Hematocrit, blood temperature, cardiac output, and heart rate did not correlate with the differences in SAP, suggesting that the higher SAP seen at the sideport was generated within the tube connecting the oxygenator to the aorta. This theory was investigated by decreasing the tube length distal to the sideport in three patients in this group who had sideport SAPs higher than their aortic SAPs, a measure that decreased the SAP difference between the two sites. At the end of cardiopulmonary bypass in 20 other consecutive patients, the effect of shortening the aorta-oxygenator tube from 1.8 to 0.25 m was tested. The SAP in the sideport decreased by 4 to 12 mm Hg in 12 of the 20 patients, while the MAP was unaffected by this maneuver. It is concluded that the MAP measured at the sideport of the aortic cannula closely reflects the MAP in the ascending aorta, whereas the SAP measured at the sideport does not reflect the aortic SAP. Thus, when aortic pressure is measured at the sideport to confirm an artificially low radial arterial pressure, systolic amplification at the sideport might simulate or exaggerate radial artery hypotension.

Aorta↗
PubMed1990

Calcium does not augment phenylephrine's hypertensive effects.

Ca and phenylephrine, both of which increase mean arterial pressure (MAP), are often administered concurrently during resuscitation of critically ill patients. To determine whether the response to phenylephrine is potentiated by Ca administration, we studied eight adult patients 24 h after aortocoronary bypass surgery. Each patient received three doses of phenylephrine (150, 300, and 450 ng/kg.min), administered both with and without CaCl2 (5 mg/kg bolus followed by a 2-mg/kg.h infusion). Phenylephrine alone at 150, 300, and 450 ng/kg.min increased MAP by 2%, 6%, and 17%, respectively. Ca alone increased serum ionized Ca levels from 1.00 +/- .03 (SEM) to 1.20 +/- .02 mM (p less than .05) and increased MAP from 84 +/- 1 to 90 +/- 2 mm Hg (p less than .05), but had no effect on cardiac index (CI). When administered concurrently with Ca, phenylephrine at 150, 300, and 450 ng/kg.min increased MAP by 6%, 7%, and 13%, respectively. Phenylephrine had no effect on CI, pulmonary capillary wedge pressure, CVP, or heart rate whether or not it was administered with Ca. We conclude that concomitant Ca administration does not augment the hypertensive response to phenylephrine in normotensive patients recovering from open heart surgery.

Aged↗