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R J McCarthy

Publications and source records attributed to R J McCarthy.

At least 19 recordsLinked to original sources
PubMed2006

A comparison of the SNAP II and BIS XP indices during sevoflurane and nitrous oxide anaesthesia at 1 and 1.5 MAC and at awakening.

BACKGROUND: Monitoring level of consciousness during anaesthesia, with the ability to predict the intentional or unintentional return to consciousness, is desirable. The purpose of this study was to compare two processed electroencephalographic depth of anaesthesia monitors (SNAP II and BIS XP) during sevoflurane and sevoflurane/nitrous oxide anaesthesia. METHODS: In total, 42 subjects received an interscalene block, followed by general anaesthesia with sevoflurane or sevoflurane/nitrous oxide. The indices were recorded at baseline, at 1.5 and 1.0 minimum alveolar concentration (MAC) equivalents, and during emergence. RESULTS: The SNAP and BIS indices decreased from baseline at 1.5 and 1.0 MAC equivalents, but there was no difference within groups between subjects who received nitrous oxide and those who did not. The SNAP index returned to baseline by 1 min before awakening and was higher than baseline at eye opening, but the BIS index remained below baseline at awakening. There was a bias of -1 (95% CI: -3 to 1) between the SNAP and BIS at baseline; this increased to 21 (95% CI: 19-23) during maintenance of anaesthesia and was 6 (95% CI: 4-8) at awakening. CONCLUSIONS: The SNAP index tracks loss of consciousness and emergence from sevoflurane and sevoflurane/nitrous oxide anaesthesia. There is significant bias between the SNAP and BIS indices and therefore, the indices are not interchangeable. The SNAP index returns to baseline before awakening, whereas the BIS index remains below baseline at awakening, suggesting that the SNAP index may be more sensitive to unintentional awareness.

Adolescent↗
PubMed2004

Patient satisfaction for carotid endarterectomy performed under local anaesthesia.

OBJECTIVES: To develop, validate and use a procedure specific questionnaire to evaluate patient experience and satisfaction following carotid endarterectomy (CEA) under either general (GA) or local anaesthesia (LA). METHODS: Twenty post-CEA patients were interviewed. Data were content analysed and recurrent themes used to generate the specific carotid endarterectomy experience questionnaire (CEA-EQ). The CEA-EQ consists of 15 pre-op and 13 postoperative questions. Validity was established by correlation with the FRS Patient Satisfaction with Surgical Services (SSSQ) and State form of the State Trait Anxiety Inventory (STAI-S) in 69 patients (35 LA, 34 GA). Subsequently 88 patients randomised to GA CEA and 88 to LA CEA received the CEA-EQ. A local anaesthetic intraoperative experience questionnaire (LA-EQ) was also developed and given to LA patients only. RESULTS: Validity was confirmed through significant correlations with the STAI-S (r=0.67, p<0.001) and the SSSQ (r=0.44, p<0.001). In the randomised prospective study response rates were greater than 90%. Overall experience and satisfaction with CEA was high. There was no statistically significant difference in anxiety, satisfaction or overall experience between anaesthetic techniques. LA CEA was associated with a significantly better perception of recovery. The majority of LA patients found the procedure acceptable. CONCLUSIONS: The CEA-EQ is a valid tool to assess qualitative aspects of CEA patient care. Overall satisfaction and experience with CEA is good and not related to anaesthetic technique. LA CEA is not associated with any increased anxiety, is tolerated by the majority of patients and is associated with a better perception of recovery.

Aged↗
PubMed2004

Efficacy and side effect profile of varying doses of intrathecal fentanyl added to bupivacaine for labor analgesia.

The purpose of this randomized, double blinded and controlled study was to determine the optimal dose of intrathecal fentanyl when combined with bupivacaine 2.5 mg for initiation of labor analgesia. Parous parturients with cervical dilation between 3 and 5 cm were randomized to receive intrathecal fentanyl 0 (control), 5, 10, 15, 20 or 25 micrograms, combined with bupivacaine 2.5 mg, followed by a lidocaine/epinephrine epidural test dose. Visual analog pain scores (VAPS) and the presence of side effects were determined every 15 min until the parturient requested additional analgesia. Fetal heart rate (FHR) tracings were compared between groups. All parturients who received fentanyl >/= 15 micrograms had VAPS < 20 mm and duration of analgesia > 15 min, but this was not true for all parturients with fentanyl doses < 15 micrograms. Duration of analgesia was shorter for fentanyl groups 0, 5 and 10 micrograms, compared to groups 15, 20 and 25 micrograms, but there was no difference between the 15, 20 and 25 micrograms groups. There was no difference in the incidence of nausea and vomiting, or in FHR tracing changes. The incidence of pruritus was greater in all fentanyl groups compared to control. These data suggest that, when combined with intrathecal bupivacaine 2.5 mg, fentanyl 15 micrograms provides satisfactory analgesia to all parturients. Higher fentanyl doses produced no additional benefit in duration or quality of analgesia.

Adult↗
PubMed2003

Infrainguinal bypass graft patency and limb salvage rates in critical limb ischemia: influence of the mode of presentation.

Rest pain, ulceration, and gangrene are often considered together in studies describing outcomes in patients with critical limb ischemia. A retrospective analysis of prospectively collected data of 152 infrainguinal bypass grafts performed on 128 patients with chronic critical limb ischemia over a 6-year period was carried out. Grafts were classified according to the mode of presentation and were followed up by regular clinical and duplex examinations. Mean follow-up period was 29 months (range 12 to 60 months). Patients' demographics, risk factors, and graft characteristics were not statistically different between the groups. The 5-year cumulative primary patency rates were 33%, 52%, and 51% for gangrene, ulceration, and rest pain, respectively (p = 0.04). The 5-year cumulative primary assisted patency rates were 46%, 70%, and 72% for gangrene, ulceration, and rest pain, respectively (p = 0.01). The 5-year cumulative secondary patency rates were 48%, 76%, and 75% for gangrene, ulceration, and rest pain, respectively (p = 0.003). The 5-year cumulative limb salvage rates were 59%, 87%, and 83%, for gangrene, ulceration, and rest pain, respectively (p = 0.01). Gangrene is a distinct subcategory of critical limb ischemia with a worse prognosis than ulceration and rest pain and should be classified as such when reporting results of infrainguinal bypass grafts.

Aged↗
PubMed2003

Recommendations for screening intervals for small aortic aneurysms.

BACKGROUND: The aim was to determine the optimum rescreening interval for small abdominal aortic aneurysms (AAAs). METHODS: Data from 12 years of population screening of 65-year-old men were analysed and 1121 small AAAs (less than 4.0 cm in initial diameter) were divided into groups: group 1 (2.6-2.9 cm; n = 625), group 2 (3.0-3.4 cm; n = 330) and group 3 (3.5-3.9 cm; n = 166). Expansion rate and the cumulative proportions to expand to over 5.5 cm, or require surgery, or rupture were calculated. RESULTS: Expansion rate was related to initial aortic diameter: 0.09 cm per year in group 1, 0.16 cm per year in group 2 and 0.32 cm per year in group 3 (P < 0.001). Aneurysms in 2.4 per cent of patients in group 1 exceeded a diameter of 5.5 cm or required surgery within 5 years; there were no ruptures. In group 2, no aorta exceeded 5.5 cm but at 3 years 2.1 per cent had reached 5.5 cm and 2.9 per cent had required surgery. The rupture rate at 3 years was zero. In group 3, the aneurysm diameter exceeded 5.5 cm in 1.2 per cent of patients, but no patient required surgery or experienced rupture within 1 year; at 2 years 10.5 per cent of aneurysms had exceeded 5.5 cm in diameter or required surgery and 1.4 per cent had ruptured. CONCLUSION: The appropriate rescreening interval can be determined by initial aortic diameter in screened 65-year-old men. AAAs of initial diameter 2.6-2.9 cm should be rescanned at 5 years, those of 3.0-3.4 cm at 3 years and those of 3.5-3.9 cm at 1 year.

Aged↗
PubMed2002

The role of pedometers in the assessment of intermittent claudication.

OBJECTIVES: to evaluate the role of pedometers in the assessment of patients with intermittent claudication by comparing them with treadmill testing, post-exercise ankle brachial pressure index (ABPI) and physical function questionnaires. PATIENTS AND METHODS: fifty patients with intermittent claudication were prospectively assessed by treadmill examination measuring maximum walking distance (MWD) and post-exercise ABPI. Three physical function questionnaires: (1) Medical Outcome Study Short Form-36 (MOS SF-36), Physical Function (PF). (2) MOS SF-36 Role limitation due to Physical Problems (RP). (3) Walking Impairment Questionnaire (WIQ) were completed. Pedometers were used for one week and the daily average number of steps taken by each patient recorded. Pedometers scores were compared with MWD, post-exercise ABPI and physical function questionnaires scores using Spearman correlation test. RESULTS: pedometers estimation of daily physical activity moderately correlated with MWD (Rho=0.35, p=0.01), post-exercise ABPI (Rho=0.35, p=0.01), MOS-SF 36 PF (Rho=0.31, p=0.02), MOS-SF RP (Rho=0.28, p=0.05) and with WIQ (Rho=0.42, p=0.003). CONCLUSIONS: they moderately correlate with treadmill testing, post-exercise ABPI, and with physical function questionnaires. Pedometers may provide a simple and cheap alternative for the assessment of physical and functional disability in intermittent claudication.

Aged↗
PubMed2002

The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia.

OBJECTIVE: to review the current role and results of angioplasty in the management of critical limb ischaemia (CLI) in a single institution. METHODS: data on 526 patients with 608 ischaemic limbs, treated between January 1994 and December 1999 was collected prospectively and analysed retrospectively. Patients were divided into 3 groups according to the date of presentation: group 1 (1994-95), group 2 (1996-97) and group 3 (1998-99). The groups were comparable in terms of demographics, mode of presentation and level of disease. RESULTS: Revascularisation was attempted in 87%, 81% and 91% for groups 1, 2 and 3 respectively (NS). Primary percutaneous transluminal angioplasty (PTA) rates increased from 44% (1994-95) to 69% (1998-99) (p < 0.001), and surgical revascularisation rates decreased correspondingly (p<0.01). Overall cumulative patient survival and limb salvage rates were 82% and 89% for 1 year and 45% and 87% for 5 years, respectively. No statistically significant difference existed between the three groups regarding patient survival, limb salvage rates and mean hospital stay (19, 12 and 12 days, respectively). CONCLUSION: PTA is increasingly replacing bypass surgery in the treatment of CLI, without compromising patient survival or limb salvage rates.

Aged↗
PubMed2002

Physiological advantages of cerebral blood flow during carotid endarterectomy under local anaesthesia. A randomised clinical trial.

OBJECTIVE: to examine the effects of type of anaesthesia on cerebral blood flow during carotid endarterectomy (CEA). DESIGN: prospective randomised study. METHODS: thirty-four CEA procedures under local anaesthesia (LA) are compared to 33 procedures under general anaesthesia (GA). Mean middle cerebral artery velocity (MCAV(mean)) was monitored using Transcranial Doppler (TCD) and mean arterial pressure (MAP) assessed by continuous intra-arterial blood pressure transducer. RESULTS: pre-op MCAV(mean) and MAP were similar in both groups. Pre-clamp MCAV(mean) was similar in both groups and did not differ from pre-op values. With carotid clamping the MCAV(mean) significantly dropped in both groups. The post-clamp MCAV(mean) was significantly less in the GA group (p < 0.05), and the percentage reduction in MCAV(mean) significantly more for GA procedures (p < 0.05). Pre-clamp MAP was significantly elevated in LA procedures and significantly lowered in GA procedures. Pre-clamp MAP was significant less for GA procedures (p < 0.001). Post clamp MAP did not differ from pre-clamp levels in either group. There was no correlation between MCAV(mean) and MAP. Complication rate, combined death/stroke rates were similar in each group. CONCLUSION: LA CEA is associated with better preservation of the ipsilateral cerebral circulation and increased tolerance of the effects of carotid clamping. Changes in MCAV(mean) cannot be explained by variations in blood pressure between the two techniques.

Aged↗
PubMed2001

The value of transcranial Doppler in predicting cerebral ischaemia during carotid endarterectomy.

OBJECTIVES: transcranial Doppler (TCD) measurement of middle cerebral artery velocity (MCAV) is an indirect method of assessing cerebral blood flow and therefore predicting patients at risk of stroke during carotid endarterectomy (CEA), and may be used to determine the need for shunting. This study evaluates the accuracy of three accepted TCD criteria in predicting the need for a shunt. DESIGN: prospective study. METHODS: one hundred and twenty consecutive CEA were performed under loco/regional anaesthesia. Patients monitored by TCD and Awake neurological examination were included. Shunts were inserted if there was neurological deterioration. Awake patient monitoring was compared with the three TCD criteria. RESULTS: inadequate TCD recordings were obtained in 16 operations (13%). In the remainder (104 cases), 12 developed symptoms of cerebral ischaemia and required a shunt (12%). Comparisons with the three accepted criteria were as follows: (1) m MCAV <30 cm/s had a sensitivity, specificity, PPV and NPV of 92%, 49%, 19%, and 98%, respectively; (2) clamp/pre-clamp ratio <0.6 had a sensitivity, specificity, PPV and NPV of 92%, 75%, 33% and 99%, respectively; (3) greater than 50% reduction in m MCAV had a sensitivity, specificity, PPV and NPV valves of 83%, 77%, 32% and 97%, respectively. CONCLUSIONS: TCD flow velocities are not a reliable method for detecting cerebral ischaemia and therefore determining the need for a shunt in CEA.

Aged↗
PubMed2001

Patient and hospital benefits of local anaesthesia for carotid endarterectomy.

OBJECTIVES: this study reviews and compares carotid endarterectomy (CEA) performed under local anaesthesia (LA) with CEA performed under general anaesthesia (GA) in a single institution. METHODS: data were collected prospectively from 240 CEA procedures. 140 GA CEA procedures are compared to 100 LA CEA procedures in terms of outcome, operative techniques, complications, and length of stay. RESULTS: the groups were similar for age, gender distribution and preoperative risk factors. There were more asymptomatic patients in the LA group. There were no significant differences in death, stroke or death/stroke rate between the two techniques. LA CEA was associated with lower shunt rate (LA 13%, GA 50%, p < 0.001), lower incidence of intraoperative hypotension (LA 8%, GA 40%, p < 0.001), decreased hospital stay (median (IQ); LA 2 (1-2), GA 3 (1-4), and a cost saving of pound235 per CEA procedure. CONCLUSIONS: carotid endarterectomy can be performed safely under local anaesthesia with the advantage that LA CEA enables the surgeon to monitor and selectively shunt patients more accurately. In addition LA CEA is associated with a shorter hospital stay and important cost savings.

Adult↗
PubMed2000

Short-term results of femoropopliteal subintimal angioplasty.

BACKGROUND: Subintimal angioplasty may be more successful than conventional (intraluminal) angioplasty for treatment of long femoropopliteal occlusions. This study assessed the clinical and haemodynamic outcome of subintimal angioplasty. METHODS: All patients with femoropopliteal occlusions treated by subintimal angioplasty over a 3-year period at two centres were reviewed. Clinical assessment and colour duplex imaging were carried out. RESULTS: Sixty-nine procedures were performed in 33 men and 33 women of median age 74 (range 47-92) years. Indications for treatment were intermittent claudication in 26 (38 per cent) and critical limb ischaemia in 43 (62 per cent). Median occlusion length was 10 (range 2-50) cm. Primary technical success was achieved in 51 occlusions (74 per cent). There were 11 complications (16 per cent); the majority were minor but surgical intervention was required in two patients (3 per cent). At 6 months the cumulative symptomatic and haemodynamic primary patency rates were 60 and 51 per cent respectively, analysed on an intention-to-treat basis. The symptomatic and haemodynamic patency rates for technically successful procedures were 80 and 77 per cent respectively. CONCLUSION: In this series the short-term clinical success of subintimal angioplasty was poor because of a high incidence of reocclusion and restenosis, despite a relatively high initial technical success rate.

Aged↗
PubMed2000

Magnesium sulfate potentiates morphine antinociception at the spinal level.

UNLABELLED: Intrathecal magnesium sulfate coinfusion with morphine increases antinociception in normal rats; however, because magnesium also delays the onset of tolerance, it is not clear whether this additional antinociception is a result of potentiated analgesia or tolerance abatement. We examined the antinociceptive interaction of intrathecal (IT) bolus magnesium sulfate and morphine in morphine naive rats and those with mechanical allodynia after a surgical incision. After intrathecal catheter implantation, rats were given preinjections of magnesium or saline, followed by injections of morphine or saline. In morphine naïve rats, IT bolus magnesium sulfate 281 and 375 microg followed by IT morphine 0.25 or 0.5 nmol enhanced peak antinociception and area under the response versus time curve two-to-three-fold in the tail-flick test as compared with morphine alone. Likewise, in rats with incisional pain, IT bolus magnesium sulfate 188 and 375 microg followed by morphine 0.5 nmol reduced mechanical allodynia, whereas morphine 0.5 nmol alone did not. This study suggests that IT magnesium sulfate potentiates morphine at a spinal site of action. IMPLICATIONS: Magnesium sulfate potentiates morphine analgesia when coadministered intrathecally in normal rats, and in an animal model of mechanical allodynia after a surgical incision. These results suggest that intrathecal administration of magnesium sulfate may be a useful adjunct to spinal morphine analgesia.

Analgesics, Opioid↗
PubMed2000

Long-term testing of an intracranial pressure monitoring device.

OBJECT: Long-term monitoring of intracranial pressure (ICP) is limited by the lack of an implantable sensor with low drift. The goal of this study was to demonstrate that a new capacitive transducer system will produce accurate and stable ICP records over extended periods. METHODS: Intracranial pressure sensors were implanted into the frontal white matter of four dogs. In addition, a fluid-filled catheter was placed in the cisterna magna (CM) to measure cerebrospinal fluid (CSF) pressure. The animals were tested using standard physiological maneuvers such as jugular vein compression, head elevation, and CSF withdrawal from and saline injection into the CM to verify that the ICP sensor precisely matched CSF pressure changes. The mean ICP pressure and CM pressure were compared for months to demonstrate that the transducer system produced minimal drift over time. The change in the ICP sensor record closely duplicated that of the CSF waveform in the CM in response to well-known physiological stimuli. More important, mean ICP pressure remained within 3 mm Hg of CM pressure for months, with a mean difference of less than 0.3 mm Hg. Histological examination of the dog brains revealed only minimal tissue reaction to the presence of the sensor. CONCLUSIONS: The authors demonstrate a new implantable solid-state sensor that reliably measures ICP for months, with minimal drift. The clinical application of this sensor and its telemetry is for long-term monitoring of patients with head injury, mass lesions, and hydrocephalus.

Animals↗
PubMed1999

Aprotinin pretreatment diminishes postischemic myocardial contractile dysfunction in dogs.

UNLABELLED: We evaluated the effect of aprotinin, administered before the onset of acute regional myocardial ischemia, on reversible contractile dysfunction induced by ischemia and reperfusion in pentobarbital-anesthetized dogs. Animals were randomized to receive either aprotinin 30,000 kallikrein inactivator units (KIU)/kg and 7000 KIU x kg(-1) x hr(-1) (n = 8) or equivalent volumes of 0.9% sodium chloride (n = 7) IV 60 min before a 15-min interruption of circumflex coronary artery blood flow and then reperfusion. There were no intra- or intergroup differences in hemodynamic variables or regional myocardial mechanics (sonomicrometry) before onset of ischemia. Immediately before reperfusion, systolic dysfunction characterized by significantly decreased percent systolic shortening was present in the circumflex coronary artery area of both study groups. After reestablishment of perfusion, aprotinin animals had preserved percent systolic shortening whereas saline animals exhibited regional systolic dysfunction. Regional myocardial contractility as assessed by the slope Mw of the preload recruitable stroke work relation was preserved during reperfusion in animals who received aprotinin but depressed in the control group. We conclude that functional recovery from myocardial ischemia-reperfusion injury at normothermia is improved by IV administration of aprotinin before the onset of acute regional myocardial ischemia in physiologically intact dogs. IMPLICATIONS: Administration of clinically relevant doses of aprotinin IV before the onset of regional myocardial ischemia, in contrast to control conditions, preserved regional systolic function and contractility at baseline values after reestablishment of myocardial perfusion in dogs.

Animals↗
PubMed1998

Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulfate and morphine in rats.

UNLABELLED: N-methyl-D-aspartate (NMDA) antagonists, such as MK801, delay the development of morphine tolerance. Magnesium, a noncompetitive NMDA antagonist, reduces postoperative morphine requirements. The present study was designed to evaluate the effects of intrathecal co-administration of magnesium sulfate with morphine on antinociceptive potentiation, tolerance, and naloxone-induced withdrawal signs. Magnesium sulfate (40-60 microg/h) co-administration for 7 days, similar to MK801 (10 nmol/h), prevented the decline in antinociceptive response compared with morphine (20 nmol/h). Magnesium sulfate (60 microg/h) produced no antinociception, but co-infused with morphine (1 nmol/h), it resulted in potentiated antinociception compared with morphine throughout the 7-day period. Probe morphine doses after 7-day infusions demonstrated a significantly greater 50% effective dose value for morphine 1 nmol/h (109.7 nmol) compared with saline (10.9 nmol), magnesium sulfate 60 microg/h (10.9 nmol), and magnesium sulfate 60 microg/h plus morphine 1 nmol/h (11.2 nmol), which indicates that magnesium had delayed morphine tolerance. Morphine withdrawal signs after naloxone administration were not altered by the co-infusion of magnesium sulfate. Cerebrospinal fluid magnesium levels after intrathecal magnesium sulfate (60 microg/h) for 2 days increased from 17.0 +/- 1.0 microg/mL to 41.4 +/- 23.6 microg/mL, although serum levels were unchanged. This study demonstrates antinociceptive potentiation and delay in the development of morphine tolerance by the intrathecal coinfusion of magnesium sulfate and morphine in the rat. IMPLICATIONS: The addition of magnesium sulfate, an N-methyl-D-aspartate antagonist, to morphine in an intrathecal infusion provided better analgesia than morphine alone in normal rats. These results suggest that intrathecal administration of magnesium sulfate may be a useful adjunct to spinal morphine analgesia.

Analgesia↗
PubMed1998

Intrathecal bupivacaine reduces pruritus and prolongs duration of fentanyl analgesia during labor: a prospective, randomized controlled trial.

UNLABELLED: Pruritus is a frequent complication (40%-100%) of intrathecal (IT) fentanyl 25 microg (F) for labor analgesia. The addition of IT bupivacaine 2.5 mg (B) to F has been reported in a nonrandomized series to have a 17.3% incidence of pruritus. This study prospectively evaluated the incidence and distribution of pruritus in laboring parturients receiving IT F + B. Sixty-five laboring parturients were randomly assigned to receive IT F, B, or F + B as part of a combined spinal-epidural technique. Visual analog scores, sensory level, motor strength, and pruritus were recorded before injection and at intervals thereafter. When present, the distribution of pruritus was evaluated. The duration of analgesia was determined as the time from IT drug administration until the patient requested supplemental analgesia. The median duration of analgesia in the F, B, and F + B groups was 62.5, 55.0, and 94.5 min, respectively. Compared with F alone, the combination of F + B led to a decreased frequency of pruritus (36.4% vs 95%). The incidence of facial pruritus (25%) was same in the F + B and F groups; however, the occurrence of pruritus distributed over the rest of the body was significantly more frequent in the F compared with the F + B group. The combination of F + B prolongs the duration of labor analgesia compared with IT F or B alone. F + B also leads to a decreased incidence of pruritus, except in the facial region. IMPLICATIONS: When administered intrathecally with fentanyl 25 microg in laboring parturients, bupivacaine 2.5 mg attenuates the frequency of pruritus on all parts of the body except the face. This combination also results in a rapid onset and prolonged duration of labor analgesia compared with either drug alone.

Adult↗
PubMed1998

Randomized, blinded, placebo-controlled trial of tissue factor pathway inhibitor in porcine septic shock.

This study tested the hypothesis that tissue factor pathway inhibitor (TFPI) would improve mortality and morbidity evoked by peritonitis-induced bacteremia in pigs. Secondarily, it sought to determine if TFPI treatment would attenuate cardiodynamic abnormalities produced by this septic model. 32 pigs were chronically instrumented with intracardiac transducers to measure left ventricular pressure and diameter, pulmonary and aortic pressures, and cardiac output. At least 5 days after surgery to implant transducers, basal cardiovascular readings and blood samples were obtained. Using a randomized, blinded study design, either purified, reconstituted TFPI (1 mg/kg bolus, 10 mg/kg/min for 48 h), placebo (arginine buffer), or saline was administered to pigs immediately after Escherichia coli 0111.B4 (3.0-11 x 10(9) colony-forming U/kg)-laden fibrin clots were implanted intraperitoneally, producing peritonitis and bacteremia. Pigs did not receive antibiotics or supportive therapy. No significant differences in primary or secondary endpoints were noted between the arginine and saline groups, so these data were combined into a control group (N = 20). 5 of 12 TFPI pigs survived (42%), while 5 of 20 control pigs survived (25%); this difference was not significant (p = .714, Fisher's exact test). TFPI treatment augmented cardiac output in surviving pigs, but did not affect any other cardiovascular performance variable (heart rate, % diameter shortening, or systemic and pulmonary vascular resistance). In controls, peritonitis induced rapid increase in plasma tumor necrosis factor-alpha (428 +/- 771 to 5,933 +/- 559 pg/mL at 2 h) and interleukin-8 (180 +/- 153 to 1,393 +/- 145 pg/mL at 2 h). TFPI treatment significantly attenuated cytokine responses to sepsis, reducing peak tumor necrosis factor-alpha to 2,103 +/- 813 pg/mL and reducing peak interleukin-8 levels to 534 +/- 211 pg/mL at 2 h (p < .05, Tukey test, two-way ANOVA). In conclusion, TFPI treatment attenuated important mediator components of the inflammatory response but did not provide significant survival benefit.

Animals↗