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Biomedical subjects

O Takkunen

Publications and source records attributed to O Takkunen.

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

Comparison of long-term survival after repair of ruptured and non-ruptured abdominal aortic aneurysm.

Late survival rates were compared and analysed for 1070 patients undergoing repair of ruptured infrarenal abdominal aortic aneurysm (RAAA, n = 364, mean age 70.0 years, male:female ratio 5.6:1) and non-ruptured abdominal aortic aneurysm (AAA, n = 706, mean age 66.6 years, male: female ratio 5.4:1) between January 1970 and July 1992 at the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital, Finland. There was a statistically significant difference in survival rates between the RAAA and AAA groups during the first three months after repair of abdominal aortic aneurysm. Operative mortality rates were 7.4% for electively repaired abdominal aortic aneurysms and 48.7% for ruptured abdominal aortic aneurysms. For 3-month postoperative survivors there existed no statistically significant difference in late survival rates, nor did these rates differ from those of an age- and sex-matched population. Five-year survival rates for 3-month postoperative survivors were 60% in the RAAA group and 67% in the AAA group. Median survival time was 5.7 years and 7.5 years, respectively. Coronary artery disease, hypertension, chronic obstructive pulmonary disease and renal insufficiency statistically significantly reduced late survival rates after 3 months post-surgery for non-ruptured abdominal aortic aneurysm, whereas these risk factors did not alter late prognosis after successful repair of ruptured abdominal aortic aneurysm. Cerebrovascular disease reduced late survival rates both in AAA (median survival time 6.3 years) and RAAA group (median survival time 4.9 years). Of late deaths 41% were caused by coronary artery disease in the AAA group and 38% in the RAAA group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Effects of heparin on serum ionized calcium and haemodynamics during coronary artery surgery.

Heparin has been reported to possess hypotensive and vasodilating properties when given in 3 mg/kg bolus injection. The haemodynamic effect has been thought to be related to an acute lowering of serum ionized calcium levels. The effects of heparin on haemodynamics and ionized calcium were compared with saline in 30 patients during coronary artery surgery before the commencement of cardiopulmonary bypass. There were no significant differences in haemodynamics or ionized calcium levels between heparin or saline during the observation period of 10 min. The results are at variance with some previous findings, and suggest that the hypotensive reaction occasionally seen after heparin is given is not mediated by the reduction of serum ionized calcium.

Calcium↗
PubMed1988

Thiopentone reduces the haemodynamic response to induction of high-dose fentanyl-pancuronium anaesthesia in coronary artery surgical patients.

Thirty-three coronary artery bypass graft patients anaesthetized with high-dose fentanyl (50 micrograms/kg)-pancuronium-oxygen were divided into one control group receiving additional saline and two groups receiving additional 1 mg/kg or 2.5 mg/kg of thiopentone before laryngoscopy and intubation. During laryngoscopy and intubation, systemic arterial pressures, heart rate and rate-pressure-product remained at considerably elevated levels caused by pancuronium in the control group. Both doses of thiopentone reduced these haemodynamic values close to their initial levels. Cardiac index and left ventricular stroke work index were significantly decreased, especially by the higher thiopentone dose, as compared with the control group. However, there were no statistical differences between the haemodynamic changes produced by the two doses of thiopentone. Sedative or hypnotic supplementation of high-dose fentanyl anaesthesia seems to be necessary if pancuronium is used as a muscle relaxant. A small increment of thiopentone, 1 mg/kg, was enough to return haemodynamic parameters almost to their initial levels, whereas the effect of 2.5 mg/kg of thiopentone was unnecessarily strong.

Aged↗
PubMed1987

Bronchospasm during cardiopulmonary bypass--a potentially fatal complication of open-heart surgery.

Severe bronchospasm at the termination of cardiopulmonary bypass is an unusual but dangerous complication of open-heart surgery. We report two cases. In both of them the final etiology remained unsettled. In one of the cases vigorous and immediate bronchodilatory therapy resulted in a favourable remission. In the second case bronchospasm contributed to a very harmful bulging of the left lung through the opened mediastinal pleura, stretching and damaging the left internal mammary artery graft, which obviously contributed to the fatal outcome. We emphasize especially the following points: 1) a carefully evaluated medical history of patients scheduled for open-heart surgery may reveal some details pointing to an increased risk of bronchospasm during cardiopulmonary bypass; in such cases prophylactic measures may be indicated; 2) immediate vigorous bronchodilatory therapy early at the onset of bronchospasm during the weaning from cardiopulmonary bypass may reverse the alarming situation.

Bronchial Spasm↗
PubMed1987

Cardiorespiratory function after correction of tetralogy of Fallot. Modifying effect of previous shunt operation.

Of 28 patients with total surgical correction of tetralogy of Fallot in adult life, 22 had previously undergone Blalock-Taussig shunt operation. Possible modifying effects of the shunt on pulmonary ventilation and perfusion and on exercise tolerance were investigated with spirometry, radiospirometry and bicycle ergometry. The observed ventilatory volumes and capacities and diffusing capacity were significantly lower than the predicted values. Vital capacity was significantly reduced in patients with adverse NYHA or haemodynamic classification. Between the various NYHA or haemodynamic groups no statistically significant difference was demonstrable in pulmonary function or diffusing capacity or in airway resistance. Ventilatory obstruction was found also in patients without previous shunt. Other lung function tests showed no significant difference between the shunt and the non-shunt group. Nor was distribution of lung perfusion significantly affected by shunt. No correlation was seen between lung function and bicycle ergometric findings. However, in non-shunt patients who had ventilatory obstruction or impaired diffusing capacity, exercise tolerance was significantly higher than in patients who had had palliative shunt.

Adult↗
PubMed1987

Correlation of NYHA classification, bicycle ergometry and right heart haemodynamics after total correction of tetralogy of Fallot in adults.

Thirty-two patients who had undergone correction of Fallot's tetralogy in adult life were examined on average 6.3 years postoperatively, at mean age 25.8 years. Palliative shunt operation had been performed in childhood in 28 cases. The clinical condition was good in 25 patients (78%). 13 of whom had mean gradient between right ventricle and pulmonary artery 16.0 +/- 4.2 mmHg and systolic right ventricular pressure 39.0 +/- 10.0 mmHg, while 12 had right ventricular pressure 62.6 +/- 16.3 mmHg. In these groups the maximum exercise capacity was, respectively, 136.7 +/- 36.1 and 106.1 +/- 30.8 W/min. Three other patients were in satisfactory, and four in poor clinical condition, with right ventricular systolic pressure, respectively, 74.3 +/- 10.9 and 91.5 +/- 60.0 mmHg. The gradient from right ventricle to pulmonary artery averaged 58.5 +/- 10.4 mmHg in the latter group but, despite the obstructed pulmonary outflow tract, the exercise capacity (116.7 +/- 28.9 W/min) was similar to that in the groups with better clinical results. It is concluded that in most patients with palliative surgery in childhood, tetralogy of Fallot can be successfully corrected in adult life. The causes of right ventricular impairment do not significantly reduce the exercise capacity.

Adult↗
PubMed1986

Tracheobronchomalacia in an adult with metaphyseal chondrodysplasia.

Anaesthetic complications such as obstruction of airways by submucosal cartilage-bone protuberances, immobility of the neck or instability of the atlanto-axial joint have been described earlier in paediatric patients with congenital osteochondral disorders. This report concerns a case in which tracheal collapse due to tracheobronchial malacia in an adult patient with metaphyseal chondrodysplasia evidently caused severe ventilatory difficulties in the induction of anaesthesia. The management of the patient on three subsequent occasions is described. During the first operation, support of the upper respiratory tract was performed. For this procedure, awake tracheal intubation with local anaesthesia applied to the larynx, vocal cords and trachea was used. After surgical correction of the bronchus of the right upper lobe and the stem bronchus, subsequent anaesthesias for surgical treatment of scoliosis could be conducted safely. The possibility of co-existing tracheobronchial malacia in patients with osteochondrodysplasias should be considered and tracheal intubation under local anaesthesia is recommended.

Adult↗
PubMed1986

Continuous infusion of fentanyl or alfentanil for coronary artery surgery. Plasma opiate concentrations, haemodynamics and postoperative course.

Nine patients received a mean total dose of 110 micrograms kg-1 of fentanyl and 10 patients received alfentanil 1379 micrograms kg-1 as a continuous infusion during coronary artery bypass grafting (CABG). Circulatory stability was well maintained through the induction of anaesthesia and a similar cardiovascular course was achieved with both agents, with the exception of small differences in heart rate and cardiac index immediately before tracheal intubation. Similar haemodynamic responses to sternotomy, cardiopulmonary bypass and awakening from anaesthesia were found with both analgesics. Although the times to awakening and extubation were somewhat shorter in patients receiving alfentanil, the differences between the groups were not significant. With the continuous infusion techniques, plasma opiate concentrations could be maintained well above the awakening values during cardiopulmonary bypass. In a total dose ratio of 1:13, fentanyl and alfentanil produced similar haemodynamic profiles and clinical courses in patients undergoing CABG.

Adult↗
PubMed1986

Continuous infusion of fentanyl or alfentanil for coronary artery surgery. Effects on plasma cortisol concentration, beta-endorphin immunoreactivity and arginine vasopressin.

Plasma cortisol, beta-endorphin immunoreactivity (PBEir) and arginine vasopressin (AVP) responses during and after the continuous infusion of fentanyl or alfentanil were studied in 19 patients undergoing coronary artery bypass grafting (CABG). Plasma cortisol concentration decreased significantly in both groups during the anaesthesia and surgery before cardiopulmonary bypass (CPB); an increase was evident during CPB in both groups, but a statistically significant increase was not observed during the rest of the study, including the awakening from anaesthesia. PBEir increased with both opiates immediately after initiation of CPB and remained so during the rest of the study. There were no significant changes in plasma AVP concentrations during anaesthesia and surgery. After discontinuation of opiate infusions, an increase in AVP concentration commenced earlier in the alfentanil group than in the fentanyl group. At awakening from anaesthesia, a significant correlation was observed between log plasma AVP concentration and systemic vascular resistance. It is concluded that, with continuous fentanyl and alfentanil infusions in a total dose relationship of 1:13 in patients undergoing CABG, cortisol and AVP responses to surgery and CPB can be suppressed. However, during recovery from anaesthesia, the attenuating effect of alfentanil seems to wear off more rapidly than that of fentanyl. PBEir response to CPB and emergence from anaesthesia could not be prevented with either analgesic.

Adult↗
PubMed1985

Increased pulmonary artery diastolic-pulmonary wedge pressure gradient after cardiopulmonary bypass.

In 29 patients undergoing elective coronary artery bypass grafting, the diastolic pulmonary arterial pressure-pulmonary capillary wedge pressure gradient (DPAP-PCWP) and related haemodynamic parameters were determined before and after induction of anaesthesia, immediately after cardiopulmonary bypass (CPB) and one and three hours after CPB. The DPAP-PCWP gradient remained unchanged after induction of anaesthesia but was significantly increased after CPB. A gradient of 5 mmHg or greater was observed in 16 patients after CPB, whereas none of the patients showed such a gradient before CPB. A significant correlation was found between the change in DPAP-PCWP and the change in pulmonary vascular resistance (PVR). It is concluded that DPAP should not be used as a substitute of PCWP in the early postbypass period without frequent confirmation of the presence of the normal small DPAP-PCWP gradient. Since an increase of PVR may impair right ventricular ejection, we recommend the routine measurement of DPAP-PCWP gradient in the postbypass period.

Anesthesia, General↗
PubMed1985

Haemodynamic response to nitrous oxide during high-dose fentanyl pancuronium anaesthesia.

Ten patients subjected to coronary by-pass surgery were studied to determine the haemodynamic effects of replacing Fio2 1.0 normoventilation with nitrous oxide in oxygen (Fio2 0.3) after induction of anaesthesia with fentanyl (50 micrograms/kg), flunitrazepam and pancuronium. In all patients the application of N2O decreased systemic arterial pressures by an average of 10% (P less than 0.001), but left pulmonary arterial pressures and systemic vascular resistance unchanged. The slight bradycardia induced was associated with moderate depression of the cardiac index and the left ventricular stroke work index (P less than 0.001) at the time when the rate-pressure product was decreased by 20% (P less than 0.001). The cardiac depression produced by N2O was most prominent in patients with left ventricular wall hypokinesia and an ejection fraction below 55%, in whom the cardiac work index was diminished by 29%. The replacement of oxygen with nitrous oxide in oxygen during high-dose fentanyl-pancuronium anaesthesia seems not to be associated with sympathetic stimulation, and the myocardial depressant effect of N2O should be weighed against the possible reduction in myocardial oxygen consumption with special care in patients with compromised myocardial function.

Adult↗
PubMed1985

Effects of mitral valve replacement on ventilation, volumes, diffusing capacity and regional perfusion of lungs in patients with mitral valve disease.

The effects of mitral valve replacement on ventilation, lung volumes, diffusing capacity and regional perfusion of the lungs were studied in eight patients with long-standing mitral valve disease. Eight patients of the same age with coronary artery disease who underwent coronary bypass operation were tested as controls. Preoperatively, the patients with mitral valve disease had significantly higher perfusion of the upper lung fields and the ratio of residual volume to total lung capacity than the control patients. Vital capacity, forced expiratory volume in one second and maximal expiratory flow at 50% of vital capacity were lower in comparison with the control group. Seven days after open heart surgery the values of all the parameters mentioned above had decreased significantly from the preoperative levels in both groups. Three months post-operatively, the values returned to preoperative levels. The abnormal overperfusion of the upper lung fields and other derangements in the ventilatory pattern did not subside even though cardiac haemodynamics were corrected by mitral valve replacement.

Adult↗
PubMed1985

Comparison of Ringer's acetate and lactate solutions as a prime for cardiopulmonary bypass.

Nineteen patients undergoing myocardial revascularization were randomly given either Ringer's lactate or acetate solution as the prime of cardiopulmonary bypass (CPB), and systemic vascular resistance (SVR) was determined before, and for 10 minutes after, the commencement of CPB. There were no significant differences in SVR or perfusion pressure between the acetate or lactate groups before or during CPB. Blood gas and acid-base values, haematocrit, serum potassium, sodium and ionized calcium concentrations as well as patient temperature were similar in the two study groups. Our results are at variance with some previous experimental findings, which have suggested that acetate has a greater vasodilative effect than lactate.

Acetates↗
PubMed1984

Cardiac tamponade and different modes of artificial ventilation.

Cardiac tamponade after open-heart surgery often occurs in a situation when the patient is still mechanically ventilated and needs circulatory support with catecholamines. To evaluate the effects of different modes of artificial ventilation and dopamine on cardiac tamponade, an experimental study was carried out in seven mongrel dogs. In pentobarbital - N2O anaesthesia, a cardiac tamponade of 20 mmHg was produced by injecting 120-200 ml of normothermic saline into the pericardium. Intermittent positive pressure ventilation (IPPV) and positive end-expiratory pressure (PEEP) ventilation with frequencies of 12 and 20 were tested before and after producing the tamponade. Cardiac tamponade produced a significant fall in arterial pressure and cardiac output, a significant rise in central venous pressure and only a slight increase in pulmonary arterial pressure. PEEP with the slower ventilation frequency of 12 produced additional, significant falls in cardiac output and systemic arterial pressure, which were not noted with the ventilation frequency of 20 and PEEP. Dopamine infusion increased the cardiac output by increasing the heart rate during tamponade. It is concluded that PEEP ventilation with a slow frequency should not be used if cardiac tamponade is suspected after open-heart surgery, and that dopamine has a favourable effect on haemodynamics even in the presence of a severe cardiac tamponade.

Animals↗
PubMed1984

Atropine vs glycopyrrolate during reversal of pancuronium block in patients anaesthetized with halothane.

Atropine 0.015 mg kg-1 and glycopyrrolate 0.0075 mg kg-1 were compared as antimuscarinic agents during reversal of pancuronium block with neostigmine 0.03 mg kg-1 in 30 patients anaesthetized with thiopental-N2O-halothane and undergoing minor surgery. In patients treated with atropine-neostigmine, the frequencies of bradycardia and junctional rhythm were relatively high and about the same as those reported by us previously in patients anaesthetized with thiopental-N2O-fentanyl. As in our previous study, glycopyrrolate seemed to have advantages over atropine during reversal of pancuronium block: the incidences of bradycardia and junctional rhythm were significantly less in patients treated with glycopyrrolate. Recovery from anaesthesia, as assessed by the awakening after discontinuation of N2O and halothane administration, and the incidence of postoperative nausea and vomiting, were not significantly different between the atropine and glycopyrrolate groups.

Adult↗
PubMed1984

Local anaesthesia in carotid surgery. A prospective study of 111 endarterectomies in 100 patients.

A prospective study was carried out on 100 patients consecutively undergoing carotid endarterectomy in local anaesthesia, in order to evaluate the usefulness of clinical signs in awake patients for monitoring of cerebral function and to determine the need for internal shunt in carotid surgery. The indications for operations were transient ischemic attacks in 67 patients and major or minor stroke in 24 (16 with persistent neurologic deficit). In nine asymptomatic patients the endarterectomy was prophylactic, following detection of bruit and angiographic stenosis. Bilateral stenosis was present in 47 patients, including 13 with total occlusion of the contralateral vessel, and 60 patients had significant vertebral artery stenosis. The carotid artery was first tentatively occluded and, if this was well tolerated for 5 min, endarterectomy was done without an internal shunt. Neurologic deficit signs during the trial occlusion necessitated such shunt in 16 patients with pressure in the internal carotid stump ranging from 0 to 40 (mean 22.4) mmHg. On the other hand, 11 additional patients with stump pressure less than 35 mmHg tolerated the trial occlusion well, underwent carotid endarterectomy without internal shunt and had no deficit symptoms during or after operation. One patient died postoperatively. Hemiparesis appeared in two more patients, but resolved completely in one and gave only minor sequelae in the other. These complications were related to the preoperative condition (stroke) and the postoperative residual pressure gradient. It is concluded that trial occlusion of the carotid artery and observation of the awake patient provide reliable information on the need for an internal shunt during carotid endarterectomy.

Adult↗
PubMed1983

Cardiovascular effects of pancuronium and vecuronium during high-dose fentanyl anesthesia.

To define the role of muscle relaxants in hemodynamic responses to high-dose (75 micrograms/kg) fentanyl anesthesia, we compared the circulatory effects of pancuronium (Pc) with those of vecuronium (Vc) in patients about to undergo coronary artery bypass surgery. The first measurements were made while the patients were awake. Thereafter the patients were anesthetized with fentanyl, intubated under succinylcholine relaxation and mechanically ventilated with a mixture of oxygen in air (FIO2 0.50). Ten minutes after completion of the fentanyl injection, the second set of measurements was made. Immediately thereafter, 0.1 mg/kg of either Pc (n = 10) or Vc (n = 10) was given, and no relaxant was administered to 10 control patients. Heart rate (HR) and cardiac index (CI), which had decreased significantly after fentanyl induction, decreased further after Vc, the latter decreases being significantly greater than the decreases in HR and CI observed in control patients. After Pc, HR and CI increased to control awake levels; rate-pressure product also increased and stroke index decreased. Five of ten patients receiving Vc had a HR below 45 beats/min; HRs this low were not seen in patients given Pc. Neither Pc nor Vc affected systemic vascular resistance, but filling pressures of the heart decreased abruptly after both relaxants. We conclude that if maintenance of preanesthetic hemodynamic status is the objective of anesthetic management of patients having coronary artery bypass surgery, Pc helps to achieve this objective during high-dose fentanyl anesthesia. On the other hand, many patients with limited coronary vascular reserve may well benefit from the negative chronotropic effect of Vc.

Anesthesia, Intravenous↗