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Biomedical subjects

R C Wetzel

Publications and source records attributed to R C Wetzel.

At least 55 records · Page 3Linked to original sources
PubMed1987

The acute effects of intravenous isosorbide dinitrate during cardiac surgery.

The acute effects of intravenous isosorbide dinitrate during open heart surgery were studied in 15 adult patients. Consistent and significant (p less than 0.001) reductions in pulmonary vascular resistance (25% before, 23% after, cardiopulmonary bypass) and mean pulmonary artery pressure (14% before, 13% after, cardiopulmonary bypass) were observed in the absence of significant changes in cardiac index, mean systemic arterial pressures or right or left atrial filling pressures. These findings indicate that after cardiopulmonary bypass, when right ventricular dysfunction with raised pulmonary vascular resistance may occur, selective reduction of right ventricular afterload with isosorbide dinitrate may prove beneficial.

Blood Pressure↗
PubMed1987

Penile nerve block for newborn circumcision.

Circumcision in neonates is performed, almost universally, without anesthesia or analgesia. It is associated with pain, crying, agitation, and physiologic stress. Twenty infants receiving penile nerve block for circumcision were compared with ten infants having circumcision without anesthesia. Heart rate and blood pressure rose 34 and 15%, respectively, in unblocked infants, and were unchanged in infants receiving local anesthesia. Oxygen saturation declined 16% in unanesthetized infants compared with 6% in blocked infants (P less than .03). Anesthetized infants were less agitated and cried less. Peak plasma concentrations of the local anesthetic lidocaine averaged 0.51 +/- 0.17 microgram/mL (range 0.1-1.6), well below accepted toxic levels. There were no local or systemic complications.

Blood Pressure↗
PubMed1986

A comparison of nitroglycerin and nitroprusside for inducing hypotension in children: a double-blind study.

Intravenous nitroglycerin (NTG) and sodium nitroprusside (SNP) were compared as hypotensive agents in anesthetized children and adolescents. The drugs were studied in a prospective, randomized, double-blind fashion in 14 patients anesthetized with nitrous oxide: oxygen, morphine, and thiopental. NTG in doses as high as 40 micrograms X kg-1 X min-1 was ineffective at decreasing mean arterial pressure (MAP) below 55 mmHg or causing a decrease in MAP greater than one-third of baseline values. SNP was uniformly successful at inducing hypotension in all patients, including those patients in whom NTG failed. The dose of SNP required to induce hypotension was 6-8 micrograms X kg-1 X min-1. Both NTG and SNP decreased systemic vascular resistance, although SNP did so to a much greater degree than NTG (64% vs. 29%; P less than 0.01). Only SNP increased cardiac index significantly (2.27 +/- 0.35 to 4.44 +/- 1.36; P less than 0.003). Both drugs reflexly increased heart rate, necessitating the use of intravenous propranolol (range from 1 to 3 mg) in all patients. Both drugs produced small decreases in arterial oxygen tension and increases in the average alveolar-arterial oxygen tension gradient (SNP, 44 +/- 13 vs. NTG, 41 +/- 6). SNP use was associated with a slight metabolic acidosis (pH = 7.38 +/- 0.01; base excess [BE] = -6 +/- 1). Neither drug produced any other untoward reaction. SNP appears to be the agent of choice for the reliable and sustained induction of deliberate hypotension in children and adolescents.

Adolescent↗
PubMed1986

Effects of indomethacin on estradiol-induced attenuation of hypoxic vasoconstriction in lamb lungs.

To determine whether cyclooxygenase products mediated the attenuation of hypoxic pulmonary vasoconstriction induced by estradiol, we measured pulmonary arterial pressure at a flow of 50 ml X min-1 X kg-1 (Ppa50) during steady-state exposures to inspired O2 tensions (PIO2) between 0 and 200 Torr in isolated lungs of juvenile ewes. Intramuscular estradiol (10 mg) 44-60 h before study significantly decreased perfusate concentrations of 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha), the stable metabolite of the pulmonary vasodilator, prostacyclin, but did not significantly affect the stimulus-response relationship between PIO2 and Ppa50. Estradiol (20 mg) 3-5 days before study increased 6-keto-PGF1 alpha concentrations and decreased Ppa50 at PIO2 of 10, 30, and 50 Torr. Indomethacin added to the perfusate of these lungs reduced 6-keto-PGF1 alpha to undetectable levels and altered the estradiol-induced attenuation, increasing Ppa50 at PIO2 of 10 and 30 Torr, but decreasing Ppa50 at PIO2 of 200 Torr. Despite these effects, Ppa50 remained lower than the values measured in lungs not treated with estradiol. These results suggest that the estradiol-induced attenuation of the hypoxic stimulus-response relationship was mediated only in part by cyclooxygenase products, the net effects of which were vasodilation at PIO2 of 10 and 30 Torr, but vasoconstriction at PIO2 of 200 Torr.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

Pulse oximetry in critically ill children.

To confirm the clinical applicability of a commercial pulse oximeter, we compared arterial hemoglobin saturation values determined by in-vitro oximetry and pulse oximetry in 15 critically ill children. One hundred ninety-two paired hemoglobin saturations were determined by both noninvasive pulse oximetry and direct measurement of arterial blood samples. The correlation between these two methods of measurement was statistically significant (r = 0.895; p less than 0.001). The mean percentage difference between the two measurements was 1.8%. Pulse oximetry was found to be safe and less cumbersome than other methods of monitoring arterial oxygen content. Overall, pulse oximetry was precise and provided a clinically satisfactory noninvasive method for continuously monitoring arterial hemoglobin saturation in critically ill children.

Child↗
PubMed1985

Arterial blood gas derived variables as estimates of intrapulmonary shunt in critically ill children.

Oxygen transport data, prospectively collected from 52 critically ill children, were analyzed to determine whether any derived variable accurately estimated intrapulmonary shunt (Qsp/Qt). Arterial hemoglobin saturation was more closely correlated with Qsp/Qt than was PaO2, alveolar-arterial oxygen gradient, arterial mixed venous oxygen difference (C[a-v]O2), arterial/alveolar oxygen ratio, and the ratio of PaO2 to inspired oxygen (FIO2) (r = 0.8, p less than .0001). When C(a-v)O2 was normal, hemoglobin saturation became a very accurate (r = 0.96) assessment of Qsp/Qt. We conclude that various arterial blood gas derived variables do not accurately reflect Qsp/Qt in critically ill children. In these patients, a pulmonary artery catheter is needed to accurately assess intrapulmonary shunt.

Child↗
PubMed1985

High-frequency ventilation attenuation of hypoxic pulmonary vasoconstriction. The role of prostacyclin.

In order to determine the effects of high-frequency ventilation on the pulmonary vascular response to hypoxia, we assessed pulmonary vascular resistance at 2 levels of inspired oxygen tension (PlO2), 200 and 30 mmHg, during conventional and high-frequency ventilation in the isolated, blood-perfused lungs of 10 sheep, 5 treated with indomethacin (40 micrograms/ml of perfusate) and 5 untreated. Resistance was assessed by measuring pulmonary artery pressure-flow curves generated over a wide range of flows (20 to 140 ml X min-1 X kg body wt-1). Conventional ventilation was provided by an animal ventilator at a rate of 10 min-1 and a tidal volume of 10 ml X kg body wt-1. High-frequency ventilation was provided by a flow interrupter at a rate of 1,200 min-1 and a tidal volume less than 1.5 ml X kg body wt-1. In the 5 untreated lungs, the normoxic pressure-flow curve was unaltered by high-frequency ventilation, but the hypoxic pulmonary vasoconstrictor response was significantly attenuated. Furthermore, the net rate of change of 6-keto-prostaglandin F1 alpha concentration in the perfusate during hypoxia was significantly greater with high-frequency ventilation (65.4 +/- 8.9 pg X ml-1 X min-1) than with conventional ventilation (2.8 +/- 18.7 pg X ml-1 X min-1). In the 5 indomethacin-treated lungs, production of 6-keto-prostaglandin F1 alpha was markedly depressed, and the attenuation of the hypoxic vasoconstrictor response by high-frequency ventilation was abolished.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Prostaglandins and estradiol-induced attenuation of hypoxic pulmonary vasoconstriction.

Pretreatment with estradiol (20 mg IM) attenuated vasoreactivity to decreases in inspired PIO2, lowered baseline resistance measured under conditions of maximal vasodilation (PIO2 = 0 mm Hg), and appeared to increase prostaglandin release in isolated, blood-perfused lungs of juvenile female sheep. Indomethacin (40 micrograms/ml) inhibited prostaglandin release and restored hypoxic vasoreactivity in estrogen-treated lungs, but did not alter the estrogen-induced decrease in baseline resistance. These results suggest that estradiol enhanced the production of prostaglandins which secondarily attenuated hypoxic vasoreactivity. The estradiol-induced decrease in baseline resistance, however, must have been mediated by some other mechanism.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

Hemodynamic responses in brain dead organ donor patients.

Because we have noticed dramatic hemodynamic responses in brain dead patients undergoing surgery for organ donation, we analyzed the anesthetic records of cadaver organ donors. Ten records contain complete data for heart rate, blood pressure, central venous pressure, and time of incision. Systolic pressure increased by a mean of 31 torr (P less than 0.01), diastolic pressure by 16 torr (P less than 0.02), and heart rate by 23 beats/min (P less than 0.01) in response to surgical stimulation. These results demonstrate the occurrence of significant hemodynamic responses to surgical stimuli in patients who fulfill the criteria of brain death, responses that do not, however, invalidate the current criteria for the diagnosis of brain death.

Adult↗
PubMed1984

Effect of puberty and estradiol on hypoxic vasomotor response in isolated sheep lungs.

We previously reported that in isolated lungs from 6-mo-old sheep acute hypoxia caused a greater vasoconstrictor response in males than in females but that this response in castrated males was not different from noncastrated males. To determine whether a gender difference exists before puberty, we compared the steady-state stimulus-response relationship of the pulmonary circulation to graded hypoxia in isolated perfused lungs of juvenile 2-mo-old male and female sheep. The flow-resistive properties of the pulmonary vessels were assessed by pressure-flow curves generated over a wide range of flows (0-150 ml X min-1 X kg-1) at six different levels of inspired O2 tension (PIO2) between 200 and 0 Torr. The stimulus-response relationship, quantified by plotting the pulmonary arterial pressure at a flow of 50 ml X min-1 X kg-1 against PIO2 was the same in juvenile male and female sheep lungs. Furthermore, the responses of juvenile sheep were not different from those of 6-mo-old males and were greater than those of 6-mo-old females. Treatment with 17 beta-estradiol (10-20 mg im) 2-5 days prior to perfusion significantly attenuated the response in the lungs from both 2-mo-old female and 6-mo-old castrated male sheep. We conclude that the gender difference in the hypoxic stimulus-response relationship observed in isolated lungs from 6-mo-old sheep arises from attenuation in the female at the time of puberty. This attenuation may be mediated by estradiol.

Animals↗
PubMed1984

A review of the Amiel-Tison neurologic evaluation of the newborn and infant.

Because occupational therapists are becoming more involved in infant assessment and intervention, there is a need for objective, prospective, and serially applicable evaluation tools. Amiel-Tison's Neurologic Evaluation of the Newborn and the Infant provides such a tool for use in the first year of life. This evaluation was developed to detect transient and permanent abnormalities in an infant's neuromotor development. Its main focus is to examine active and passive muscle tone. The test has interobserver reliability, is reproducible, and can be readily learned by occupational therapists. Although the evaluation is not standardized, it is clinically useful in neonatal units, developmental clinics, and research settings. This evaluation detects transient neuromotor problems in the first year of life that are associated with significant behavioral, neurological, and intellectual deficits when the children reach school age. Using this test, occupational therapists frequently involved with the assessment and management of children can play a crucial role in the first year of life by diagnosing and documenting abnormalities.

Humans↗
PubMed1983

Gender differences in hypoxic vascular response of isolated sheep lungs.

We compared the steady state stimulus-response relationship of the pulmonary circulation to graded hypoxia in isolated, in situ, blood-perfused lungs of postpubertal male and female sheep and male sheep of similar age that had been castrated within 1 wk of birth. The flow-resistive properties of the pulmonary circuit were assessed by pressure-flow curves generated over a wide range of flows (0-150 ml X min-1 X kg-1 body wt-1) at six different levels of inspired oxygen tension (PIo2) between 200 and 0 Torr. The stimulus-response relationship was quantitated by determining the pulmonary arterial pressures at a flow of 50 ml X min-1 X kg-1 (Ppa50) directly from these curves. We found that this relationship was biphasic, as previously described for other species, with a peak vasoconstrictor response at a PIo2 = 30 Torr. The isolated lungs of males and castrated males achieved a greater maximal pressor response (Ppa50 = 33 +/- 3.7 and 34.5 +/- 8 Torr, respectively) than did those of females (Ppa50 = 20.2 +/- 5.6 Torr, P less than 0.01). When the pulmonary vascular bed was maximally dilated (PIo2 = 0 Torr), there were no significant differences in the Ppa50 among the groups (Ppa50 = 15.8 +/- 4.6 in males, 11 +/- 3.5 in females, and 11.5 +/- 1.9 Torr in castrated males). There were no differences between males and castrated males at any PIo2. We conclude that the hypoxic pulmonary vasomotor response was attenuated in isolated lungs of postpubertal female sheep possibly due to the effect of female hormones.

Animals↗
PubMed1983

Gypsies and acute medical intervention.

Recently, a 7-month-old, terminally ill Gypsy infant was admitted to a pediatric intensive care unit. Treating this child and her extended family was a challenging experience during which numerous culture-related problems were encountered. The Gypsy approach to acute medical care consisted of the presence of a large extended family unit, the lack of decision making by the patient's parents, and several different Gypsy traditions. There were diverse, and often derogatory, reactions and prejudices from the hospital staff. After interviewing family members, this family's needs were easier to understand, and interaction with them in culturally relevant terms was possible. When dealing with Gypsy families, identification of the responsible elder male members of the family, establishment of firm lines of communication with essential family members and the parents, and education of the medical staff concerning Gypsies are recommended.

Acute Disease↗