Enoximone is a selective inhibitor of the phosphodiesterase-III enzyme (PDE-III) and possesses positive inotropic and vasodilatory properties. The PDE-inhibitor amrinone has been associated with adverse effects on coagulation by decreasing platelets. To investigate the influence of enoximone on hemostasis, 18 patients undergoing elective aorto-coronary bypass grafting and receiving enoximone were compared to a control group (n = 18). In addition, the plasma levels of enoximone and its major metabolite (enoximone-sulfoxide) were studied following a single injection (0.5 mg/kg) and during a continuous infusion (5 and 10 micrograms/kg.min) before, during and after extracorporeal circulation (ECC). No difference between study and control groups was found for the parameters of coagulation during the investigation period; in particular there were no differences in platelet count and platelet function (thrombelastography). Following the single bolus, peak plasma levels decreased during ECC to ineffective levels. Continuous infusion, however, maintained effective plasma levels of enoximone; sulfoxide levels were twice as high as enoximone concentrations up until the end of the investigation period. It is concluded that enoximone can be judged to be safe in respect to its effects on coagulation even following ECC and at relatively high doses. The use of continuous infusion results in plasma levels which remain at an effective concentration through to the time that the patient is transferred to the intensive care unit.

Aged↗

PubMed1990

Therapeutic reciprocity: a caring phenomenon.

Fully realizing the power that caring can create in practice demands attention to those aspects of nurse-client relations that promote effective caring. The thesis of this article is that therapeutic reciprocity, as one phenomenon of caring, allows both the nurse and the client to benefit from their relationship in a mutually empowering manner. Through concept analysis it becomes evident that therapeutic reciprocity extends commitment to an ethic of caring from a morally correct position to a nourishing life force in professional nursing. The riches of caring are affirmed, and one path to their realization is illuminated.

Altruism↗

PubMed1988

Interactions between nimodipine and general anaesthesia--clinical investigations in 124 patients during neurosurgical operations.

Haemodynamic, respiratory, metabolic and endocrine investigations were performed in a total number of 124 patients, divided into four different groups, during opiate anaesthesia for neurosurgical operations in order to characterize general effects of nimodipine, a calcium channel blocking agent with a preferential cerebrovascular action. These studies led to the following conclusions: Nimodipine is a vasodilator drug with a hypotensive action, which is especially obvious in hypertensive patients and in combination with similarly acting agents, such as sodium nitroprusside or nitroglycerin. This vascular hypotensive effect may be also enhanced by combined cardiodepressive activity if nimodipine is applied together with inhaled anaesthetics, such as halothane or isoflurane. Nimodipine as well as other vasodilator drugs may lead to increased pulmonary shunting in patients with artificial ventilation, which, however, can be reduced by adequate positive end-exspiratory pressure. With high doses the decrease of oxygen extraction and consumption, seen with nimodipine, is accompanied by a moderate rise of lactate. Determination of stress hormones did not reveal analgesia potentiation of nimodipine, as has been assumed in other studies.

Anesthesia, General↗

PubMed1988

Primary cardiac tumors--clinical experiences and late results in 48 patients.

Between 1971 and 1987 48 patients (35 female and 13 male) underwent operations at the Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, for primary cardiac tumors. The age of the patients ranged from 21 to 71 years. Clinical symptoms were congestive heart failure, cardiac murmurs and findings similar to mitral stenosis, chest pain, arrhythmias, arterial embolism, myocardial infarction and pericarditis. 39 of the tumors were benign and 9 were malignant. Diagnosis was confirmed by echocardiography and/or cineangiocardiography. The left atrium was most commonly involved, followed by the right atrium. Surgery was performed in all cases using cardiopulmonary bypass. Benign tumors were totally removed, including attachment to the atrial septum or the free wall. In one case the tumor resection was carried out by autotransplantation of the heart. During the perioperative period we lost one of the 39 patients with benign tumors due to low cardiac output. Observing a mean follow up period of 48 months, no recurrence of tumors was noted and all patients are doing well now. The malignant neoplasms could not be removed completely, and in 4 cases only a reduction of the tumor mass was possible. Three of the 9 patients died during the postoperative period. Only one patient survived longer than 48 months. Whereas surgical therapy of malignant cardiac tumors is still a matter of discussion based upon these discouraging results, benign or semimalignant cardiac neoplasms have a very favourable prognosis when the surgical intervention can be performed prior to the occurrence of severe complications, such as congestive heart failure and arterial embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

[Effect of the calcium antagonist nimodipine on hemodynamics, gas exchange and endocrine parameters in opiate anesthesia].

During opiate anesthesia (standardized dosage of fentanyl) for operation of cerebral aneurysms after subarachnoid hemorrhage, different hemodynamic, respiratory, metabolic, and endocrine parameters were determined before (1 in Fig. 1-4), after (6), and during consecutive stages of induced hypotension (systolic blood pressure 100 mmHg (2), 90 mmHg (3), 80 mmHg (4, 5) during an interval of 20 min), comparing two groups with different vasodilating drugs. In the first group (nimo/NNP in Figs. 2-4) a constant infusion of nimodipine was applied (1.2 micrograms/kg b.w. X min-1), while sodium nitroprusside (NNP) was added in small amounts as necessary to achieve the respective values of systolic blood pressure. In the second group (NNP in Figs. 2-4) induced hypotension was done with NNP alone (maximal dosage: 8 micrograms/kg X min-1). Each group consisted of 11 patients. Additional nimodipine (in the first group), a calcium antagonist commonly recommended for preventing vasospasm and consequent neurologic deficits after subarachnoid hemorrhage, not only reduced the need for NNP, a vasodilating drug with potential toxicity, by 70%-80% as compared to the second group (Table 1). In addition, the cardiovascular situation was more stable in patients with nimodipine infusion: rapid variations of blood pressure and heart rate as well as tachyphylaxis and rebound, typical for NNP-induced hypotension, were avoided. Nevertheless, comparing the hemodynamic data at fixed stages of hypotension, there were only minor differences between both groups (Fig. 2). Reduction of blood pressure was due to a decrease in vascular resistance and was accompanied by an increase in cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗

PubMedDate not supplied

Advanced treatment directives input invited.

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Alberta↗

PubMedDate not supplied

Review of AARN practice telephone consults as of June 10, 1994.

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Alberta↗

PubMedDate not supplied

Abuse in the workplace: a symptom that signs alone won't cure.

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Aggression↗