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PubMed2005

[Changes in oxygen metabolism in hepatitis B gravis in peri-operative stages of orthotopic liver transplantation].

OBJECTIVE: To investigate the changes in oxygen metabolism in peri-operative stages in hepatitis B gravis and non-hepatitis B gravis undergoing orthotopic liver transplantation (OLT). METHODS: Twelve patients undergoing OLT for hepatitis B gravis (experimental group) and 10 patients without hepatitis B gravis (control group) were enrolled for study. Anesthesia was induced by propofol, fentanyl and vecuronium bromide, and maintained with isoflurane. Arterial catheter was inserted into the left radial artery. Swan-Ganz catheter was inserted through the right internal jugular vein. Arterial partial pressure of oxygen (PaO(2)), mixed venous partial pressure of oxygen (PvO(2)), arterial oxygen content (CaO(2)), mixed venous oxygen content (CvO(2)), arterial-venous oxygen content difference (Ca-vO(2)), oxygen delivery (DO(2)), index of oxygen delivery (DO(2)I), oxygen consumption (VO(2)), index of oxygen consumption (VO(2)I), index of oxygen extract (O(2)EI), oxygen extract rate (O(2)ER) were determined before skin incision (T1), 10 minutes before anhepatic phase (T2), 25 minutes after liver was removed (anhepatic phase, T3), 30 minutes in neohapitic phase (T4), and the end of operation (T5). RESULTS: (1) In the experimental group, PvO(2) increased, Ca-vO(2) decreased, DO(2) and VO(2) showed no change, and O(2)EI and O(2)ER decreased in T2. In preanhepatic period, PvO(2) increased, Ca-vO(2) decreased, DO(2) and VO(2) did not change. In anhepatic period, DO(2), DO(2)I, VO(2) and VO(2)I decreased obviously, DO(2) decreased by 43%, while VO(2) decreased by 21%, and O(2)ER increased obviously. In reperfusion period, PaO(2) and PvO(2) increased, CaO(2) and Ca-vO(2) decreased, DO(2) and DO(2)I increased, VO(2) and VO(2)I recovered to base level. After termination of operation, PvO(2), DO(2), DO(2)I were still high. (2) In the control group: PvO(2) increased, O(2)EI and O(2)ER decreased, but no significant changes were found in DO(2) and VO(2) in T2. DO(2), DO(2)I, VO(2), and VO(2)I all decreased in T3, while DO(2) reduced by 25% and VO(2) reduced by 12%. In T4, PvO(2), DO(2) and DO(2)I all increased, while Ca-vO(2), VO(2) and VO(2)I reached the pre-operative levels in T4. DO(2) and DO(2)I levels were higher than those of pre-operation in T5. CONCLUSION: The decrease in DO(2) is more obvious than VO(2) in anhepatic period during OLT in hepatitis B gravis patients. In neohepatic period, DO(2) increases while VO(2) returns to base level.

Adult↗
PubMed1981

[Effectiveness and current principles of pharmacologic diagnosis of epileptic focus using short- and ultrashort-acting analeptics and barbiturates].

An analysis of the results of examining 50 operated epileptic patients has shown that the use of short- and ultrashort-acting analeptics and barbiturates makes it possible to specify not only the location of the epileptic focus, but also to disclose the character of the interrelations between the elements of the epileptic system. Especially valuable data can be obtained with the use of brietal. The use of analeptics is the most promising in the course of operation, and, therefore, it should be limited to the preoperational period. It is suggested that the method of implanting permanent intracerebral electrodes acquires now not only diagnostic, but primarily therapeutic importance.

Amygdala↗
PubMed1990

Changes in alveolar-arterial oxygen partial pressure difference during orthotopic liver transplantation.

Changes in the alveolar-arterial oxygen partial pressure difference (PAO2-PaO2) were measured in 39 patients undergoing orthotopic liver transplantation without veno-arterial or veno-venous bypass. The operation can be divided into an initial dissection phase, an anhepatic phase when the hepatic artery, portal vein and vena cava are clamped, and a post-anhepatic phase after the vascular clamps are released. There was an initial increase in (PAO2-PaO2) during the dissection phase, followed by an immediate decrease when the liver was removed. This decrease continued throughout the anhepatic period, but a further increase in (PAO2-PaO2) occurred after release of all the vascular clamps and during abdominal closure.

Adolescent↗
PubMed1990

Metabolic and hormonal changes associated with arthroscopic surgery in the horse.

The effect of general anaesthesia and arthroscopic surgery on blood glucose and lactate, plasma non-esterified fatty acids, insulin, beta-endorphin and cortisol was investigated in seven horses. Animals were premedicated with xylazine and anaesthesia was induced with guaifenesin and sodium thiamylal and maintained with halothane vaporised in oxygen. Blood samples were collected in the pre-, intra- and post operative period. Induction of anaesthesia was associated with a transient hyperglycaemia and a significant rise in plasma insulin levels. Plasma insulin values fell during surgery but showed a significant increase post operatively. Surgery stimulated a small but significant rise in plasma beta-endorphin and cortisol values but these had returned to baseline values in the early post operative period. No changes in blood lactate were recorded.

Anesthesia, General↗
PubMed1991

Oxygen uptake and mixed venous oxygen saturation during aortic surgery and the first three postoperative hours.

This study was designed to determine the significance of changes in mixed venous oxygen saturation (SVO2) associated with aortic surgery. In 12 patients undergoing aortic aneurysm repair, SVO2 was monitored using a fiberoptic pulmonary arterial catheter, and oxygen uptake (VO2) was measured at 2-min intervals by a mass-spectrometer system. Excluding the phase of aortic clamping, VO2, hemoglobin, and arterial oxygen saturation were moderately stable during anesthesia, and changes in SVO2 were correlated with changes in cardiac output (CO). SVO2 remained stable during infrarenal aortic clamping, but increased during supraceliac aortic clamping. During the first three postoperative hours, changes in SVO2 were opposite to changes in VO2 and CO. They were especially marked in the patients whose preoperative left ventricular ejection fraction was less than 50%. We conclude that SVO2 changes are an indicator of same-direction changes in CO during general anesthesia except during periods of aortic clamping. The interpretation of SVO2 changes is more complex during aortic clamping and during the immediate postoperative period, two critical periods during which simultaneous changes in VO2 and CO occur.

Aged↗
PubMed1994

[Significance of perioperative elevation of blood viscosity in patients with esophageal or cardiac carcinoma].

The blood viscosity of 21 patients with esophageal or cardiac carcinoma during preoperative period was measured and compared with that of 25 healthy persons. The results indicate that the blood viscosity in patients is higher than that in the control group (P < 0.001) immediately and one day after operation. Elevation of blood viscosity is not only related to myocardial infarction, but also may be one of the causes for the poor therapeutic effect in patients with carcinomas. It is suggested that proper measures should be taken to control the elevating blood viscosity in patients, especially the elderly ones during the perioperative period. Colloid fluid which is believed to increase blood viscosity should be avoided within the first two days after operation to prevent cardiac complications.

Aged↗
PubMed1997

Haemostatic changes during surgery for primary brain tumours.

OBJECTIVE: Primary brain tumours may be associated with coagulation disorders which can pose intraoperative and postoperative management difficulties. The aim was to evaluate the coagulation profile of patients with brain tumours undergoing surgery using thromboelastography (TEG) in combination with simple laboratory tests. METHODS: Fifty adult patients with primary brain tumours larger than 4 cm in maximum diameter and no history of coagulation disorders were studied in a prospective, observational manner over a one year period. Preoperative, intraoperative, and postoperative measurements included haemoglobin concentration, platelet count, prothrombin and partial thromboplastin times, fibrin(ogen) degradation product concentration, D-dimer concentration, and TEG. RESULTS: Eleven patients (22%) had abnormal intraoperative TEGs, of whom six (12%) subsequently developed haematomas requiring surgical evacuation. The coagulopathy seemed to be hyperfibrinolysis in two cases (4%) and disseminated intravascular coagulation in four (8%). There was no preoperative difference in reaction time (R time) for clot formation between the non-haematoma and haematoma groups(mean 11.44 (SD 3.42) v 12.33 (2.50) min, P=0.46). However, when other preoperative indices were compared, in the non-haematoma group, K time (time to reach a clot amplitude of 20 mm) was shorter (6.72 (2.15) v 10.56 (3.50) min, P=0.001), rate of clot growth (å) was faster (43.67 degrees (7.53) v 27.11 degrees (5.42), P<0.0001) and maximum amplitude of clot strength (MA) was greater (52.64 (7.85) v 40.33 (6.59) mm, P<0.001). Intraoperatively, R time was significantly shortened in the non-haematoma group, (7.67 (1.78) min, P<0.0001) unlike the haematoma group (10.67 (1.58) minutes, P=0.11). CONCLUSIONS: Although these results indicate a general hypercoagulability during brain tumour surgery, in certain cases, a predisposition towards hypocoagulability may exist even before surgery, detectable only when the physical characteristics of clot formation are studied by TEG. Judicious replacement of clotting factors, platelets, and antifibrinolytic agents should be considered intraoperatively if the TEG is abnormal, without waiting for laboratory test results.

Adolescent↗
PubMed1993

Velocity profiles and phasic flow patterns in the non-stenotic human left anterior descending coronary artery during cardiac surgery.

OBJECTIVE: The aim was to investigate the phasic characteristics of normal human left coronary artery flow and velocity profiles across the vessel. METHODS: The phasic characteristics of flow in the human left anterior descending coronary artery, the centreline flow velocities, and the velocity profiles were measured in 10 patients during corrective surgery for atrial septal defect after closure of the defect. None of these patients had any detectable coronary artery stenosis or left ventricular hypertrophy. Measurements were made with a 20 MHz 80 channel pulsed Doppler velocimeter. RESULTS: The velocity waveform displayed a diastolic-predominant pattern with a systolic to diastolic velocity ratio of 0.29(SD 0.17). Reverse flow was observed in early systole in five patients and in mid to late systole in six patients. The values of peak Reynolds number, unsteadiness parameter, and pulsatility index were 504(198), 2.5(0.6), and 5.9(4.4) respectively. The velocity profiles during diastole showed considerable variability in shape, ranging from symmetrical to skewed to M shaped patterns. The peak wall shear rate was 765(250) s-1 on the epicardial wall of the vessel and 712(301) s-1 on the myocardial wall; the difference was not statistically significant. CONCLUSIONS: The velocity waveform displayed a diastolic-predominant pattern. Considerable variability in shape of the velocity profile was found and was perhaps due to the time evolution of the velocity profile within the diastolic time period.

Adolescent↗
PubMed2001

Perioperative activation of hemostasis in vascular surgery patients.

BACKGROUND: Perioperative activation of hemostasis could play an important role in the occurrence of postoperative cardiac events. The authors conducted a prospective study to assess platelet function, coagulation, and fibrinolysis status during and after infrarenal aortic surgery. METHODS: Seventeen patients were studied. Excluded were patients with preoperative coagulopathies or liver disease, or cardiac or renal insufficiency; patients receiving anticoagulant treatment, antiplatelet agents, nonsteroidal antiinflammatory agents, fresh frozen plasma, or platelet concentrates; and patients undergoing reoperation and septic patients. Blood samples were drawn before induction (T1), 1 h after incision (T2), 1 h after extubation (T3), 24 h postoperatively (T4), 48 h postoperatively (T5), and at day 7 (T6). The following tests were performed: platelet count, platelet aggregation, platelet flow cytometry for CD62 and CD63, usual coagulation tests, thrombin--antithrombin complexes, plasminogen activator inhibitor 1. RESULTS: A significant increase of adenosine diphosphate--induced platelet aggregation was observed postoperatively at T4 and T5. This was not associated with a change of flow cytometry profile. No increase of thrombin--antithrombin complex levels was observed. A higher fibrinogen rate was detected at T5 and T6. Greater amounts of plasminogen activator inhibitor 1 were detected at T3 and T4. Thus, thrombin generation was limited and fibrinolysis was impaired postoperatively. Platelets were not activated in the postoperative period, as shown by flow cytometry, but were prone to be activated, as shown by aggregation studies. CONCLUSION: The association of more easily activated platelets with a higher fibrinogen rate and a temporary shut down of fibrinolysis during the early postoperative period may indicate an increased thrombotic risk in patients undergoing major vascular surgery.

Aged↗
PubMed1998

Is aspiration necessary before tympanostomy tube insertion?

Aspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause-and-effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty-one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow-up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.

Adolescent↗
PubMed1989

A new method of analgesia for relief of circumcision pain.

A prospective, randomised, double-blind study was designed to determine whether topical application of 2% lignocaine is effective in decreasing analgesic drug requirements during and after circumcision surgery. General anaesthesia with halothane and nitrous oxide 60-70% in oxygen was administered via a facemask and a Bain system. Administration of halothane was stopped after removal of the foreskin; lignocaine (2%) or placebo was applied topically as drops to the surface of the penis to two groups of patients. Halothane was restarted if the anaesthesia was ineffective. The intra-operative consumption of halothane was significantly less (p less than 0.05) in the treated group as compared with the placebo group (0 and 17, SEM 3, % x minute). The treated group required significantly less (p less than 0.002) pethidine after operation (5 and 10 patients), and the pain-free period was significantly longer (p less than 0.01) (41, SEM 6 and 6, SEM 2 minutes) as compared with the placebo group.

Administration, Topical↗
PubMed1983

Cardiovascular responses to verapamil during coronary artery bypass graft surgery.

The cardiovascular effects of verapamil administration during coronary artery bypass graft surgery were studied in patients with normal left ventricular function. Anesthesia consisted of morphine, diazepam, and nitrous oxide. Before atrial cannulation for cardiopulmonary bypass, 16 patients received either verapamil (N = 8) 0.075 mg X kg-1 or an equal volume of its solvent (N = 8) administered intravenous over 1 min. Hemodynamic functions and serum verapamil levels were measured over the succeeding 10 min. Verapamil produced rapid reductions in systemic vascular resistance, systemic arterial blood pressure, and left ventricular stroke work index. The PR interval increased slightly and two of the patients who had a baseline PR interval of 200 msec developed a mild first degree heart block. Heart rate, cardiac index, pulmonary capillary wedge pressure, central venous pressure, and right ventricular stroke work index did not significantly change. No measured cardiovascular functions changed in the control group. Serum verapamil levels peaked at 346.4 +/- 143.5 ng X ml-1 0.5 min after drug administration and then rapidly declined. Both groups of patients tolerated surgery and the immediate postoperative recovery period without hemodynamic compromise. Verapamil can be safely administered before cardiopulmonary bypass in patient with good left ventricular function during narcotic-based anesthesia.

Aged↗
PubMed1983

Cortical somatosensory evoked potentials in response to hand stimulation.

Somatosensory evoked potentials were recorded from chronically implanted subdural electrodes in six patients with intractable seizures. The following conclusions were reached: 1) The initial cortical negativity-positivity (N1 with a latency of about 20 msec and P2 with a latency of about 24 msec) recorded in the postcentral area was an expression of the classical primary surface positivity, but N1 was generated by the posterior pole of an early horizontal dipole in area 3b, and P2 was generated by the positive pole of a slightly delayed vertical dipole in area 1 and 2.2) P2 permitted the most accurate localization of the primary somatosensory area. 3) No potentials were elicited in the primary somatosensory area by stimulation of the ipsilateral hand. 4) No cortical potentials were seen at stimulation intensities below the sensory threshold. The cortical distribution of evoked potentials evoked by weak and strong intensities had significantly different distribution. 5) The recovery function of cortical evoked potentials showed a U-curve with an early period of facilitation (10 to 30 msec) followed by a prolonged period of subnormality which peaked at about 50 msec. The recovery curve at different cortical loci differed.

Cerebral Cortex↗
PubMed1983

Use of labetalol during anesthesia for pheochromocytoma removal.

Labetalol, an alpha and beta adrenergic blocking drug, was used during anesthesia for removal of a very large pheochromocytoma which was predominantly epinephrine secreting. The 70-year-old female patient suffered from angina pectoris and chronic bronchitis. A preoperative treatment including an alpha-adrenolytic drug was administered but beta-adrenergic blockers were avoided because of the risk of cardiac decompensation and bronchoconstriction. During the operation, hypertensive peaks were easily controlled by bolus injections of labetalol 20 mg. The removal of the tumor was followed by a transient moderate hypotension. Heart rate remained stable throughout the operation. No hemodynamic problems occurred during the postoperative period. With regard to this case, a summary of the literature concerning the properties of labetalol is presented.

Adrenal Gland Neoplasms↗
PubMed2003

Aprotinin reduces vasoactive medication use during adult liver transplantation.

STUDY OBJECTIVE: To determine whether aprotinin use during adult liver transplantation results in an improvement in hemodynamic stability. DESIGN: Review of data collected during a prospective, randomized, double-blind trial. SETTING: Liver transplantation program in a tertiary referral institution. PATIENTS: 63 adult patients undergoing orthotopic liver transplantation (OLT). INTERVENTIONS: Patients were randomized to receive either aprotinin (1,000,000 KIU loading dose, followed by an infusion of 250,000 KIU/hr) for the duration of the surgery or a placebo infusion (normal saline). MEASUREMENTS: Hemodynamic parameters (mean systemic blood pressure, cardiac output, systemic vascular resistance, mean pulmonary artery (PA) pressure, and PA occlusion pressure) were compared at set time points during the procedure. The use of vasoactive medications during and after the reperfusion period was compared. MAIN RESULTS: There were no significant differences in any of the measured hemodynamic parameters at any time point. Vasoactive infusions were used in 1 of 33 patients in the aprotinin group and in 6 of 30 patients in the control group (p < 0.05). Bolus doses of pressor medications during the recirculation period did not differ between groups. CONCLUSION: Aprotinin infusion during adult liver transplantation results in less requirement for vasoactive intervention.

Aprotinin↗
PubMed2006

Perioperative glucose control in the diabetic or nondiabetic patient.

Patients with diabetes are more likely to undergo surgery than nondiabetics, and maintaining glycemic control in subjects with diabetes can be challenging during the perioperative period. Surgery in diabetic patients is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality. In addition, several observational and interventional studies have indicated that hyperglycemia is associated with adverse clinical outcomes in surgical and critically ill patients. This paper reviews the pathophysiology of hyperglycemia during trauma and surgical stress and will provide practical recommendations for the preoperative, intraoperative, and postoperative care of diabetic patients.

Blood Glucose↗
PubMed1984

[Individualized treatment of postoperative pain using a small externally portable programmable morphine pump].

After abdominal surgery, 16 patients (group I) received a bolus of 2 mg morphine hydrochloride followed by a continuous morphine infusion adapted to the patient's subjective pain, both via an epidural catheter. The initial basal rate of the infusion was 0.16 mg per hour. From the beginning of the operation, 6 patients (group II) received an epidural infusion of 2.3 +/- 0.6 mg morphine hydrochloride (mean +/- sem) until the end of the operation, and preceding the postoperative morphine infusion. The continuous injection of morphine was guaranteed by means of a small, externally portable, automatic infusion device. According to the morphine demand, additional preprogrammed doses could be released by the device. Under the treatment, continuous pain relief was observed throughout the postoperative period even with diminished morphine dose rates. Morphine demand in the immediate postoperative period was significantly reduced with the initial morphine bolus injection. Total morphine demand until 8 p.m. on the second postoperative day in group I was 9.5 +/- 0.7 mg and in group II, 12.1 +/- 1.5 mg morphine hydrochloride (mean +/- sem). Neither clinically nor by blood gas analysis symptoms of central respiratory depression could be detected. Only 2 out of 14 patients who received mepivacaine intraoperatively showed urinary retention. Under the individualized treatment with morphine, serum levels of free morphine immunoreactivity diminished continuously. There was no morphine accumulation in the blood and no tachyphylaxis. The described method for pain relief is superior to the intermittent morphine bolus injections.

Abdomen↗
PubMed1997

Lactate blood levels in the perioperative period of orthotopic liver transplantation.

To investigate whether early postoperative changes in blood lactate concentration indicate the functional recovery of the newly grafted liver, changes in oxygen supply, oxygen consumption, acid-base equilibrium, and blood lactate concentrations were prospectively studied in a group of 53 postnecrotic cirrhotic patients during the various phases of orthotopic liver transplantation (preanhepatic, anhepatic, neohepatic) and for the first 48 h following reperfusion. The patients were divided into two groups according to the quality of the early graft function, as indicated by alanine aminotransferase, bile flow, and prothrombin activity: group A (49 patients), good immediate graft function and group B (4 patients), immediate graft non-function. Lactate levels rose in the same manner during the preanhepatic and anhepatic stages and peaked after revascularization of the graft. Following reperfusion, however, distinctly different blood lactate profiles were recorded in the two groups of patients. A fall in lactate concentration was recorded in group A patients, whereas a continuous rise occurred in group B patients: the difference becoming significant by the end of surgery (P < or = 0.05). During the first 48 h following revascularization of the graft, opposite trends in lactate concentration, bile flow, alanine aminotransferase, and prothrombin activity were evident in the two groups of patients: 24 h after reperfusion, lactate levels were below 2 mmol/l in 47 of 49 patients from group A, while they plateaued above 4 mmol/l in all patients from group B. Group A patients had lower alanine aminotransferase levels (P < or = 0.001), higher prothrombin activity, (P < or = 0.01), and greater bile flow (P < or = 0.02). If validated in larger series, the blood lactate profile, probably more than the absolute level, appears to be a useful indicator of the early recovery of liver metabolic capacities in the immediate postoperative period of orthotopic liver transplantation.

Alanine Transaminase↗