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PubMed2001

Effects of volatile and intravenous anesthetics on the uptake of GABA, glutamate and dopamine by their transporters heterologously expressed in COS cells and in rat brain synaptosomes.

Although the neurotransmitter uptake system is considered a possible target for the presynaptic action of anesthetic agents, observations are inconsistent concerning effects on the transporter and their clinical relevance. The present study examined the effects of volatile and intravenous anesthetics on the uptake of GABA, glutamate and dopamine in COS cells heterologously expressing the transporters for these neurotransmitters and in the rat brain synaptosomes. Halothane and isoflurane, but not thiamylal or thiopental, significantly inhibited uptake by COS cell systems of GABA, dopamine and glutamic acid in a concentration-dependent manner within clinically relevant ranges for anesthesia induced by these agents. Similarly, in synaptosomes halothane and isoflurane but not thiopental significantly suppressed the uptake of GABA and glutamic acid, respectively. These results do not support the hypothesis that volatile and intravenous anesthetics exert their action via specific inhibition of GABA uptake to enhance inhibitory GABAergic neuronal activity. Rather, they suggest that presynaptic uptake systems for various neurotransmitters including GABA may be the molecular targets for volatile anesthetic agents.

ATP-Binding Cassette Transporters↗
PubMed1989

High-performance liquid chromatographic method for determining thiopental concentrations in twelve rat tissues: application to physiologic modeling of disposition of barbiturate.

A sensitive, selective and reproducible high-performance liquid chromatographic assay of thiopental concentrations in twelve rat tissues was developed using thiamylal as the internal standard. Samples were homogenized in phosphate buffer, extracted into pentane and chromatographed on a microparticulate octadecyl reversed-phase column using ultraviolet detection at 290 nm. A simple digestive step with collagenase prior to homogenization facilitated analysis of thiobarbiturate in skin. Thiopental extraction recovery from fat exceeded 90%. Assay sensitivity was greater than 1 microgram/ml for tissue and plasma samples as small as 50 microliters. This assay has been applied to physiologic pharmacokinetic studies. The paper also presents typical concentration-time profiles of thiopental in four tissues taken from 74 rats given 20 mg/kg thiopental.

Adipose Tissue↗
PubMed1989

Llama anesthetic programs.

Llamas are anesthetized conveniently with guaifenesin thiamylal mixes, or, for short periods of time, with xylazine/ketamine. Small individuals must be accurately weighed. Estimating weight without experience is dangerous in this species. The greatest levels of safety and control, especially for critical patients, is afforded by inhalation anesthesia techniques using small animal equipment. All neonates and juveniles can be masked readily but in adults intravenous induction is most satisfactory. Intubation is aided by a long blade laryngoscope. Blood pressure monitoring is best accomplished with an arterial line in the ear artery. However, doppler equipment on the tail or distal leg usually works well.

Age Factors↗
PubMed2001

Increased sensitivity to vecuronium and prolonged duration of its action in patients with end-stage renal failure.

STUDY OBJECTIVES: To determine whether the duration of action of vecuronium is influenced by chronic renal failure. DESIGN: Prospective clinical comparison. SETTING: Operating room, Hokkaido University Hospital. PATIENTS: 7 adult ASA physical status II and III patients with impaired renal function undergoing living-related renal transplantation (Group A), 5 adult ASA physical status II and III patients with impaired renal function undergoing elective surgery other than renal transplantation (Group B), and 13 adult ASA physical status I and II patients with normal hepatorenal function undergoing elective surgery (Group C). INTERVENTIONS: Anesthesia was induced with thiamylal 5 mg x kg(-1) and fentanyl 100 microg IV and maintained with 60% nitrous oxide and 1% isoflurane. An initial dose of vecuronium was administered and patients' tracheas were intubated. MEASUREMENTS: Neuromuscular function was monitored by acceleration of thumb adduction with train-of-four stimulation. Vecuronium 60 microg x kg(-1) was administered as the initial dose via a central catheter, and if the first twitch was more than 3% of the control, another dose of vecuronium 20 microg x kg(-1) was given as necessary. Both onset time and duration of action until 25% recovery were measured. Plasma vecuronium and its metabolite, 3-desacetyl-vecuronium, levels were measured at onset and at 25% recovery in Groups A and C. MAIN RESULTS: The total dose of vecuronium and initial concentration of vecuronium showed no significant difference between Group A and Group C. Duration of action was significantly prolonged in Group A and Group B compared with Group C. CONCLUSIONS: Duration of action of vecuronium is prolonged in patients with end-stage renal failure mainly due to higher sensitivity to vecuronium.

Adult↗
PubMed2001

Small dose of prostaglandin E(1) increases cardiac output without altering blood volume.

STUDY OBJECTIVE: To investigate the effect of small dose of intravenous (IV) prostaglandin E(1) (PGE(1)) on blood volume (BV) and cardiac output (CO) by pulse dye-densitometry (PDD) in patients administered isoflurane anesthesia. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: 14 ASA physical status I and II adult patients undergoing elective neurosurgery. INTERVENTIONS: Patients were randomly assigned to either the PGE(1) group (n = 7) or the control group (n = 7). Anesthesia was induced with thiamylal, fentanyl, and vecuronium, and maintained with isoflurane and nitrous oxide. When the cardiovascular system stabilized after craniotomy and incision of the dura mater, we administered a small dose of PGE(1) at a rate of 0.02 microg/kg/min (PGE(1) group) or saline at a rate of 2 mL/min (control group). MEASUREMENTS AND MAIN RESULTS: Blood volume, CO, and mean transit time (MTT) were measured by PDD before and 60 minutes after the start of administration. At the same timing, mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) were measured, and systemic vascular resistance (SVR), cardiac index (CI), and CO/BV were computed. As for MAP, there was no significant difference within a group and between groups. In the PGE(1) group, significant increases were noted in CI from 2.54 +/- 0.46 to 3.24 +/- 0.83 (mean +/- SD) L/min/m(2) (p < 0.05), in CO/BV from 0.90 +/- 0.24 to 1.19 +/- 0.33 (p < 0.05), and in HR from 65.7 +/- 10.1 to 74.9 +/- 12.1 bpm (p < 0.05), and a significant decrease was observed in MTT from 22.3 +/- 6.5 to 18.2 +/- 5.1 seconds (p < 0.05 ). Cardiac index and CO/BV in the PGE(1) group increased higher than in the control group, while BV, CVP and SVR remained consistent in both groups. CONCLUSIONS: A small dose of PGE(1), low enough not to provoke hypotension, increased CO without alterations in BV. The increase in CO seemed to be mainly due to an increase in HR.

Alprostadil↗
PubMedDate not supplied

Serum and urine inorganic fluoride levels following prolonged low-dose sevoflurane anesthesia combined with epidural block.

STUDY OBJECTIVES: To determine whether serum and urine inorganic fluoride levels with prolonged (more than 7 hours) low-dose (0.8 to 2.0 vol %) sevoflurane anesthesia plus epidural anesthesia were increased as compared with isoflurane anesthesia plus epidural anesthesia. To measure the urine tubular enzymes N-acetyl-beta-glucosaminidase (NAG), alpha 1-microglobulin (alpha 1-M), and beta 2-microglobulin (beta 2-M) for renal tubular injury in both groups. DESIGN: Randomized, prospective study. SETTING: University hospital. PATIENTS: 15 ASA physical status I and II adults (7 males, 8 females) who were scheduled for prolonged laparotomy (lasting 9.5 to 10.2 hours) with general anesthesia. MEASUREMENTS AND MAIN RESULTS: Epidural anesthesia was administered before induction of general anesthesia. General anesthesia was induced with thiamylal administered intravenously (IV), and the trachea was intubated following administration of vecuronium IV. It was maintained with either sevoflurane or isoflurane in nitrous oxide and oxygen. Standard monitoring was used in all patients. Serum and urine inorganic fluoride and urine tubular enzymes were measured periodically. Serum inorganic fluoride was 54 mumol/L at 4.3 minimum alveolar concentration (MAC) hours of sevoflurane; the peak level for isoflurane was 8 mumol/L at the same MAC hours. Sevoflurane also increased urine inorganic fluoride excretion to 96 mumol/hr 8 hours. NAG excretion started to increase after inhalation of either sevoflurane or isoflurane. alpha 1-M and beta 2-M excretion increased markedly postoperatively. Even though fluoride levels and tubular enzymes were high, there was no evidence of postoperative renal dysfunction. CONCLUSIONS: There was no increase in urinary enzymes, which are indicators of tubular injury, specific to sevoflurane. There was no postoperative renal dysfunction, as indicated by unchanged serum creatinine and blood urea nitrogen levels.

Acetylglucosaminidase↗
PubMed1998

Comparative effects of Ringer's acetate and lactate solutions on intraoperative central and peripheral temperatures.

STUDY OBJECTIVES: To compare the effects of Ringer's lactate (LR) and Ringer's acetate (AR) solutions on core body and peripheral temperatures during isoflurane or sevoflurane anesthesia. DESIGN: Prospective, randomized study. SETTING: Operating rooms of a university hospital. PATIENTS: 60 ASA physical status I and II patients undergoing general surgery. INTERVENTIONS: Following induction with 5 mg/kg of thiamylal and 0.1 mg/kg of vecuronium, patients were randomly assigned to one of four groups (15 patients per group). They received inhalation anesthetics (66% nitrous oxide [N2O] and 1.0% to 2.0% isoflurane or 1.3% to 2.6% sevoflurane) and LR or AR. MEASUREMENTS AND MAIN RESULTS: Tympanic membrane (central) temperatures, forearm temperatures, and fingertip temperatures were recorded during surgery every 30 minutes. Tympanic membrane temperatures in the patients given AR were significantly higher than those given LR during isoflurane anesthesia 5 and 30 minutes after induction of anesthesia. However, this was not the case for sevoflurane anesthesia. There were no significant differences in forearm and fingertip temperatures or fingertip bloodflow among the four groups. CONCLUSION: There was no significant difference between AR and LR in the preservation of heat during either sevoflurane or isoflurane anesthesia. However, AR may be superior to LR for maintaining central temperature during the early period of isoflurane anesthesia.

Acetates↗
PubMed1996

Positive end-expiratory pressure during one-lung ventilation improves oxygenation in patients with low arterial oxygen tensions.

OBJECTIVE: The application of 10 cm H2O of positive end-expiratory pressure (PEEP10) to the ventilated lung during one-lung ventilation (OLV) has an unpredictable effect on PaO2. It was hypothesized that patients with a low PaO2 (< 80 mmHg) during OLV may benefit from application of PEEP. DESIGN: Prospective, open. SETTING: A university medical center. PARTICIPANTS: Eighteen patients were studied who were undergoing OLV for pulmonary resection. All were anesthetized with thiamylal, N2O/O2 (50%/50%), isoflurane, and pancuronium. INTERVENTIONS: Application of PEEP10 during one-lung ventilation. MEASUREMENTS AND MAIN RESULTS: Hemodynamics and oxygenation were measured during two-lung ventilation in the lateral position, OLV, and OLV plus application of PEEP10. Overall, PEEP10 during OLV failed to produce significant changes in PaO2, Qs/Qt%, cardiac output (CO), SvO2, or mean arterial pressure. However, in 11 patients whose PaO2 was less than 80 mmHg during OLV, application of PEEP10 significantly increased PaO2, decreased Qs/Qt%, and decreased CO (p < 0.05). In the 7 patients whose PaO2 was greater than 80 mmHg on OLV, the authors did not find a significant effect of PEEP10 on the hemodynamic or oxygenation parameters measured. CONCLUSIONS: In patients with a low PaO2 (< 80 mmHg) during OLV with F1O2 = 0.5, PaO2 is increased by the application of PEEP10. This maneuver may be useful in situations in which application of continuous positive airway pressure (CPAP) to the nonventilated lung is not possible.

Anesthesia↗
PubMed1980

I.V. lignocaine in reflex and allergic bronchoconstriction.

The protection against bronchospasm afforded by infusions of lignocaine was tested in dogs anaesthetized with thiamylal by challenge with aerosols of citric acid (CAA) or ascaris antigen (AAA). During the infusion of lignocaine, the response to CAA was blocked or markedly attenuated, but AAA still elicited a large increase in pulmonary resistance (RL). In untreated dogs, CAA increased RL from 0.14 +/- 0.05 (mean +/- SEM) kPa litre-1 s to 1.09 +/- 0.18, whereas in dogs treated with lignocaine, RL was 0.19 +/- 0.09 before challenge with CAA and 0.44 +/- 0.13 after challenge. AAA increased RL from 0.14 +/- 0.06 kPa litre-1 s to 3.01 +/- 0.65 in untreated dogs, and from 0.34 +/- 0.10 kPa litre-1 to 1.85 +/- 0.69 in dogs treated with lignocaine. Blood concentrations of lignocaine were 1.5 +/- 0.3 and 2.5 +/- 0.6 microgram ml-1 during challenge with CAA and AAA, respectively. We conclude that lignocaine, at blood concentrations which will reduce the risk of cardiac arrhythmia, markedly reduces reflex bronchonconstriction, but has relatively little effect on that initiated by allergic mediators.

Animals↗
PubMed1990

Effect of nicardipine on the cardiovascular response to tracheal intubation.

We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received nicardipine 15 micrograms kg-1 or 30 micrograms kg-1, or saline placebo 60 s before the start of laryngoscopy. Anaesthesia was induced with thiamylal 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. Patients receiving saline showed a significant increase in mean arterial pressure (MAP) and rate-pressure product (RPP) associated with tracheal intubation. The increases in MAP and RPP following tracheal intubation were reduced in both groups of patients who received nicardipine.

Anesthesia, Inhalation↗
PubMed1992

Seizure-like movements during induction of anaesthesia with sevoflurane.

Clonic and tonic seizure-like movements of the extremities were observed during induction of anaesthesia with sevoflurane in a 9-yr-old girl. The tonic movements were associated with respiratory alkalosis and were not abolished by an i.v. injection of thiamylal 75 mg. Arterial pressure, heart rate and body temperature remained normal during the episode. Ventilation was assisted easily and then controlled via a face mask. No neurological abnormalities were obvious after the anaesthesia. The movements may have been the result of seizure activity in the central nervous system, or myoclonus of the extremities.

Alkalosis, Respiratory↗
PubMed1995

Effects of clonidine premedication on the pressor response to alpha-adrenergic agonists.

It has been suggested that postjunctional alpha 1-adrenoceptor mediated vasoconstriction is enhanced by clonidine. We have examined in humans if the pressor responses to noradrenaline and phenylephrine are enhanced by clonidine premedication. Seventy-seven patients were allocated randomly to either clonidine (n = 38) or control (n = 39) groups. Patients in the clonidine group received approximately 5 micrograms kg-1 with famotidine 20 mg, while the control group received famotidine 20 mg alone orally, 90 min before induction of general anaesthesia with thiamylal. In all patients the lungs were ventilated mechanically via tracheal tubes and anaesthesia maintained with 1% end-tidal enflurane and 67% nitrous oxide in oxygen. When a stable haemodynamic state was obtained, either noradrenaline 0.5 microgram kg-1 (n = 40) or phenylephrine 2 micrograms kg-1 (n = 37) was administered randomly i.v. as a bolus, while arterial pressure and heart rate were measured noninvasively at 1-min intervals for 10 min. Although noradrenaline caused significantly greater increases in mean arterial pressure (MAP) in the clonidine group (from 2 to 4 min after i.v. injection) compared with the control group, there were no significant differences in the mean maximal increment in MAP or area under the MAP curve between the two groups. However, i.v. phenylephrine produced a significantly greater increase in MAP from 2 to 7 min (P < 0.05), and greater mean maximal increase in MAP from the baseline value (21 (9) vs 14 (7) mm Hg; P < 0.05) in the clonidine than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Production of chronic congestive heart failure by rapid ventricular pacing in the rabbit.

OBJECTIVE: The aim was to produce a model of low output congestive heart failure by rapid pacing in rabbits. METHODS: To perform rapid pacing in rabbits, a custom made pacemaker was developed which is light (about 80 g) and can pace at up to 400 beats.min-1 for more than two weeks. A thoracotomy was done and two electrodes were sutured onto the left ventricle. A central venous pressure line was chronically implanted. With the use of this pacemaker, rabbits were paced at 350-400 beats.min-1 for several weeks. RESULTS: Central venous pressure increased from 1.4(SEM 0.2) to 6.4(0.5) mm Hg (p < 0.01, n = 14). After pacing for 16.1(1.6) d, haemodynamic studies were performed under anaesthesia with thiamylal sodium. Left ventricular end diastolic pressure was higher in the paced rabbits (n = 10) than in the control rabbits which underwent sham operation but were not paced (n = 6), at -0.6(0.6) v 19.3(2.0) mm Hg (p < 0.01). Cardiac output [673(56) v 536(45) ml.min-1, p < 0.10] and +dP/dt [1433(97) v 722(51) mm Hg.s-1, p < 0.01] were lower in the paced rabbits (n = 7-8) than in the control rabbits (n = 6). The paced rabbits had more ascites [1.9(1.0) v 45.9(18.9) ml, p < 0.05] and pleural effusion [0.4(0.3) v 12.9(6.7) ml, p < 0.10] than control rabbits. Plasma noradrenaline was higher in the paced rabbits (n = 11) than in the control rabbits (n = 7), at 1.59(0.43) v 0.60(0.05) ng.ml-1 (p < 0.05). The ratio of wet heart weight or lung weight to body weight was higher (p < 0.01) in the paced rabbits than in the control rabbits. CONCLUSIONS: Chronic biventricular congestive heart failure can be produced in rabbits by rapid pacing.

Animals↗
PubMed1996

The effects of sevoflurane, isoflurane, halothane, and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans.

A rapid increase in isoflurane or desflurane concentration induces tachycardia and hypertension and increases-plasma catecholamine concentration. Little information is available as to whether sevoflurane, halothane, and enflurane induce similar responses during anesthesia induction via mask. Fifty ASA physical status I patients, aged 20-40 yr, and scheduled for elective minor surgery, received one of four volatile anesthetics: sevoflurane, isoflurane, halothane, or enflurane. Anesthesia was induced with thiamylal, followed by inhalation of 0.9 minimum alveolar anesthetic concentration (MAC) of the anesthetic in 100% oxygen via mask. The inspired concentration of anesthetic was increased by 0.9 MAC every 5 min to a maximum of 2.7 MAC. Heart rate (HR) and systolic blood pressure (SBP) were measured before and every minute for 15 min during anesthetic inhalation. In the sevoflurane and isoflurane groups, venous blood samples were drawn to determine the concentrations of plasma epinephrine and norepinephrine 3 min after each increase in anesthetic concentration. Sustained increments in HR were observed after increases in inspired isoflurane concentration to 1.8 MAC and 2.7 MAC (peak changes of 15 +/- 3 and 17 +/- 3 bpm, respectively). Isoflurane also increased SBP transiently after the inspired concentration was increased to 2.7 MAC (peak change of 10 +/- 4 mm Hg). Enflurane increased HR after the inspired concentration was increased to 2.7 MAC (peak change of 9 +/- 2 bpm). In contrast, changes in sevoflurane and halothane concentrations did not induce hyperdynamic responses. Plasma norepinephrine concentration in the isoflurane group was significantly higher than that in the sevoflurane group during 2.7 MAC (P = 0.022). We propose that there is a direct relationship between airway irritation of the anesthetic and immediate cardiovascular change during an inhaled induction of anesthesia.

Adult↗
PubMed1997

Uric acid excretion increases during propofol anesthesia.

We compared the effect of propofol with that of sevoflurane anesthesia on uric acid (UA) excretion in ASA physical status I and II patients with normal renal function. A propofol group (n = 11) received propofol-nitrous oxide-fentanyl after induction of anesthesia by propofol, while a sevoflurane group (n = 12) received sevoflurane-nitrous oxide-fentanyl after induction of anesthesia by thiamylal. UA, creatinine (Cr), and urea nitrogen concentrations in serum and urine were measured before induction of anesthesia, 1, 2, and 3 h after induction, and on Postoperative Day 1. N-acetyl-beta-D-glucosaminidase, beta2-microglobulin concentrations, and pH in urine were also examined. Plasma clearance of UA (CUA) and Cr (CCr) were calculated. The hourly concentration and excretion of urine UA were significantly higher than those of the sevoflurane group (P < 0.01). Significant correlations were noted between the hourly urine volume and UA concentration (r = 0.58, P < 0.01 for the propofol group; r = 0.51, P < 0.01 for the sevoflurane group). The CUA of the propofol group was significantly higher than that of the sevoflurane group (22.9 +/- 10.6 vs 5.9 +/- 3.4 mL/min, mean +/- SD, P < 0.05). There were no significant differences in other renal variables between the two groups. The present study demonstrated that the UA excretion increased during propofol anesthesia, while it remained stable during sevoflurane anesthesia.

Anesthetics, Combined↗
PubMed1998

Oral clonidine premedication reduces the awakening concentration of isoflurane.

UNLABELLED: Because clonidine has analgesic and sedative properties, it may influence the awakening concentration or dose of an anesthetic. To investigate the effects of oral clonidine premedication on emergence from isoflurane anesthesia, we studied 61 ASA physical status I or II patients undergoing superficial operations. They were randomly allocated to one of three groups according to the dose of clonidine they received: the clonidine-2.5 group (n = 21), clonidine-5 group (n = 20), and control group (n = 20) received approximately 2.5, 5, or 0 microg/kg oral clonidine, respectively, in addition to 20 mg of famotidine 90 min before general anesthesia induction. Anesthesia was induced by thiamylal 5 mg/kg, and tracheal intubation was facilitated with succinylcholine 1.5 mg/kg I.V. Anesthesia was maintained with a 1.1% end-tidal isoflurane concentration and 67% N2O in oxygen, while ventilation was controlled to maintain end-tidal CO2 tension between 33 and 38 mm Hg. After surgery, N2O was discontinued while the end-tidal isoflurane concentration was maintained at 1.1%. After confirming the end-tidal N2O concentration of 0%, isoflurane was discontinued. The end-tidal isoflurane concentration at the time when patients responded to a standardized verbal command to open their eyes was recorded as MAC-Awake. The MAC-Awake values in the clonidine-5 group (0.22% +/- 0.09% [mean +/- SD]) was significantly less than those in the clonidine-2.5 and control groups (0.28% +/- 0.07% and 0.30% +/- 0.07%, respectively, P < 0.05). The wake-up time, from discontinuance of isoflurane until arousal, was longer in the clonidine-2.5 and clonidine-5 groups than in the control group (17.3 +/- 8.0, 16.9 +/- 7.0, and 10.6 +/- 5.3 min, respectively; P < 0.05). In conclusion, oral clonidine premedication 5 microg/kg decreases the awakening concentration of isoflurane, and arousal from isoflurane anesthesia is prolonged with oral clonidine in a dose of 2.5-5 microg/kg. IMPLICATIONS: Preanesthetic medication with oral clonidine, 2.5-5 microg/kg, is associated with prolonged recovery from isoflurane anesthesia in adults.

Administration, Oral↗
PubMed1998

Desflurane and isoflurane produce similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing one-lung ventilation during thoracotomy.

UNLABELLED: We tested the hypothesis that desflurane (DES) and isoflurane (ISO) produce similar effects on systemic and pulmonary hemodynamics and arterial oxygenation before, during, and after one-lung ventilation (OLV) in patients undergoing thoracotomy. After obtaining informed consent, anesthesia was induced with sodium thiopental or thiamylal, fentanyl, and vecuronium in 61 ASA physical status II-IV patients. Patients were randomly assigned to receive either DES (n = 30) or ISO (n = 31) in 100% O2 in separate groups. Hemodynamic data (radial and pulmonary artery [PA] catheters) were recorded, and blood gas values were obtained before and after induction; at selected intervals before, during, and after OLV; and before emergence. DES significantly (P < 0.05) increased heart rate (HR) and decreased mean arterial pressure (MAP) and cardiac output (CO). PA pressures and pulmonary vascular resistance (PVR) increased; systemic vascular resistance (SVR) was unchanged. Increases in HR and CO and decreases in MAP and SVR occurred during OLV and DES. Reductions in PaO2 (411 +/- 88 to 271 +/- 131 mm Hg 5 min after beginning OLV; mean +/- SD) and content (CaO2) and increases in shunt fraction (Qs/Qt; 0.25 +/- 0.12 to 0.40 +/- 0.19 at 5 min after beginning OLV) were also observed. ISO increased HR and PA pressures but did not alter MAP, CO, and PVR, in contrast to the findings with DES. Reductions in MAP and SVR and increases in CO and PA pressures were observed during OLV in the presence of ISO. Similar to the findings during DES, decreases in PaO2 and CaO2 and increases in Qs/Qt occurred during OLV and ISO. We conclude that DES and ISO produce very similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing OLV during thoracotomy. IMPLICATIONS: Desflurane and isoflurane produce similar cardiovascular and pulmonary effects before, during, and after one-lung ventilation in patients undergoing lung surgery.

Anesthetics, Inhalation↗
PubMed2001

An evaluation of a new two-electrode myocardial electrical impedance monitor for detecting myocardial ischemia.

The objective of this study was to determine the efficacy of a two-electrode myocardial electrical impedance (MEI) monitor in reproducibly detecting induced myocardial ischemia by comparing MEI changes with hemodynamic changes, including sonomicrometric changes. With institutional approval, 80 dogs were anesthetized with sodium thiamylal, intubated, ventilated, and had venous, arterial, and pulmonary artery catheters placed. Medial sternotomy was performed to facilitate myocardial exposure and allow the left anterior descending coronary artery (LAD) to be isolated. Two pacing electrodes were attached to the myocardium to measure MEI with a monitor. Seventy dogs were randomly assigned to the 15, 30, 45, 60, or 120 min LAD occlusion group. Sonomicrometric transducers were attached to the myocardium of the ten remaining dogs and their LAD was occluded for 36 min. MEI increased immediately after LAD occlusion to a level significantly more (P < 0.05) than baseline and returned to the baseline level upon reperfusion. Twenty dogs developed ventricular fibrillation with no attempts at resuscitation. MEI changes paralleled the sonomicrometric changes expected with ischemia. No significant cardiovascular hemodynamic changes were found with less than 45 min of LAD occlusion. Sixty and 120 min LAD occlusion resulted in significant decreases in cardiac output. The results of these experiments demonstrate that the two-electrode MEI monitor reproducibly changes in response to myocardial ischemia.

Animals↗