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Antithrombotic activity of NSP-513, a novel selective phosphodiesterase 3 inhibitor, on femoral arterial thrombosis induced by physical stenosis and electrical current: comparison of antithrombotic and hemodynamic effects.

NSP-513, a novel potent and selective phosphodiesterase 3 (PDE 3) inhibitor, and cilostazol, a previously developed PDE 3 inhibitor, were compared with respect to antiplatelet, antithrombotic, and hemodynamic effects. In the in vitro antiplatelet aggregation studies, NSP-513 and cilostazol inhibited collagen-induced canine platelet aggregation with median inhibitory concentration (IC50) values of 0.093 and 3.1 miccroM, respectively, and inhibited adenosine diphosphate (ADP)-induced canine platelet aggregation with IC50 values of 0.15 and 12 microM, respectively. For ADP-induced platelet aggregation, the presence of prostaglandin E1 (PGE1; 3 and 10 nM) further decreased the IC50 values for NSP-513 to 0.11 and 0.032 microM, respectively. In ex vivo antiplatelet aggregation studies, orally administered NSP-513 (0.03-1 mg/kg) and cilostazol (50 mg/kg) inhibited collagen-induced canine platelet aggregation. In an in vivo canine femoral arterial thrombosis model, intraduodenally administered NSP-513 (0.01-0.03 mg/ kg) dose-dependently prevented thrombus formation without any changes in blood pressure, heart rate, or bleeding time. In conscious dogs, NSP-513 at oral doses of > or =0.3 mg/kg produced hemodynamic changes such as decreased blood pressure and increased heart rate and LVdP/dt(max). Thus the minimal hemodynamically effective dose of NSP-513 was 0.3 mg/kg, and the hemodynamic effects of this dose were comparable to those of 50 mg/kg of cilostazol. In conclusion, these data suggest that NSP-513 has in vivo selectivity for antiplatelet and antithrombotic activities over hemodynamic activity, and that the selectivity of NSP-513 is higher than that of cilostazol in dogs.

3',5'-Cyclic-AMP Phosphodiesterases↗

Hemodynamic changes in arterial feeders and draining veins during embolotherapy of arteriovenous malformations: an experimental study in a swine model.

OBJECTIVE: Transcatheter assessment of changes in draining vein (DV) flow velocity has been proposed recently as a potentially useful procedure for hemodynamic monitoring of the progression of embolotherapy in cerebral arteriovenous malformations (AVMs). We compared and contrasted changes in hemodynamic parameters of arterial feeders (AFs) and DVs during experimental AVM embolotherapy. METHODS: Carotid-jugular fistula-type AVM models were surgically created in eight swine. Pre- and postembolization transcatheter mean AF and DV pressures, DV-time average spectral peak velocity, and AF and DV pulsatility indices were assessed. An expression, the peak systolic velocity minus end-diastolic velocity (Vs - Ved), was also used in evaluating the transvenous Doppler spectra. Pre- and postembolization hemodynamic parameters were compared statistically. RESULTS: Pre-embolization DV flow was pulsatile (Vs - Ved, 12 +/- 4.8 cm/s), with a mean DV velocity of 39.3 +/- 11.4 cm per second. Postembolization, this changed to a less/nonpulsatile pattern (Vs - Ved, 5.4 +/- 2.7 cm/s; P = 0.0035) with a lower mean DV-average spectral peak velocity of 7.0 +/- 3.1 cm per second (P = 0.0001). The mean DV pressure was also reduced from 52.0 +/- 8.2 to 45.5 +/- 8.7 mm Hg (P = 0.0023). The mean AF pressure increased from a mean of 79.5 +/- 15.5 to 96.8 +/- 16.2 mm Hg (P = 0.0004). The DV pulsatility index values also increased from a mean of 0.3 +/- 0.2 to 1.1 +/- 0.5 (P = 0.0003). Periembolization objective hemodynamic changes were detected in the DVs earlier than were the visually subjective angiographic changes observed within the nidus. CONCLUSION: This preliminary study indicates that transvenous assessment of average spectral peak velocity and wave pattern (Vs - Ved) may be useful in the hemodynamic evaluation of AVM shunting. The convergence of these two parameters to a range less than 10 cm per second after nidus embolization may afford a theoretical advantage over AF pressure measurements when used for objective and quantitative monitoring of endovascular embolotherapy.

Angiography↗

Effects of immunosuppressant FTY720 on renal and hepatic hemodynamics in the rat.

BACKGROUND: FTY720 is a novel immunomodulator that may provide an opportunity for a reduction in calcineurin inhibitor dosage in transplant recipients with renal/hepatic side effects. However, the effects of FTY720 on renal or hepatic hemodynamics are unknown. The aim of this study was to establish the hemodynamic and renal actions of FTY720 at therapeutically relevant dosages. METHODS: The effects of acute and repeat oral administration of FTY720 on systemic, renal, and hepatic hemodynamics were investigated in the anesthetized male Lewis rat. Renal function and renal tubular parameters were examined in animals that received repeat high dosage of FTY720. RESULTS: Seven-day oral administration of FTY720 did not cause any significant changes in markers of hepatocyte injury, nor did it cause any reduction in renal function (elevated urea and creatinine). Histological examination of liver and kidney from animals treated with repeat FTY720 for 1 or 3 weeks did not reveal any sclerosis, tubular changes, infiltrates, or fibrosis. Hepatocyte, vascular, and biliary structures were normal. Compared with the vehicle (saline), oral administration of FTY720 at dosages up to 5 mg/kg/day for 1 week did not have any significant effects on systemic, hepatic, or renal hemodynamics. Five min after intravenous FTY720 administration (1 mg/kg), mean arterial pressure (MAP) rose to 114+/-3.3% of baseline (P <0.01) before returning to the normal range within 30-45 min. Lower doses of FTY720 (0.3 and 0.5 mg/kg, i.v.) did not affect MAP. Renal cortical perfusion, renal artery blood flow, and renal vascular resistance were not altered by FTY720 at i.v. doses up to 1 mg/kg. Animals that received FTY720 (5 mg/kg/day) for 3 weeks showed a significant reduction in body weight (-4.8+/-1% of baseline at 3 weeks, P <0.001); however, weight-adjusted creatinine clearance, 24 h urine production, and urine osmolality were not different from those in control animals (0.71+/-0.1 vs. 0.74+/-0.1 ml/min/100 g, 2.63+/-0.2 vs. 3.12+/-0.2 ml/100 g, and 2003+/-33 vs. 1966+/-56 mOsm/kg, respectively). FTY720 at the same repeat oral dosage was, nevertheless, associated with a significantly lower 24 h sodium excretion and a significantly lower fractional excretion of sodium compared with those in control animals (223.4+/-35 vs. 304.5+/-50 micromol/100 g and 1.75+/-0.3 vs. 2.23+/-0.3%, respectively; P <0.05). CONCLUSIONS: Our data indicate that, at least in the short term, oral FTY720 does not cause any significant adverse effects on renal or hepatic hemodynamics, nor does it cause any reduction in glomerular perfusion and thus may provide reasonable rescue/add-on therapy in calcineurin-inhibitor treated transplant recipients. At high repeat oral dosages, however, FTY720 may alter renal handling of sodium.

Administration, Oral↗

Effects of two calculated plasma sufentanil concentrations on the hemodynamic and bispectral index responses to Mayfield head holder application.

The effects of two calculated plasma sufentanil (SUF) concentrations on the hemodynamic and bispectral index (BIS) responses to Mayfield head holder (MH) application were studied in 20 patients scheduled for intracranial surgery. Premedication consisted of hydroxyzine, alprazolam, and atropine given orally 1 hour before surgery. Anesthesia was provided with propofol (PPF) and SUF using a target-controlled infusion device. Patients were randomly assigned to one of two groups according to calculated plasma concentrations: 3 microg/mL(-1) of PPF and 0.5 ng/mL(-1) of SUF in group I (GI) and 3 microg/mL(-1) of PPF and 1 ng/mL(-1) of SUF in group II (GII). The MH was fixed 33.0+/-6.6 minutes (mean +/- SD) after induction. Systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as well as heart rate (HR) and BIS were recorded 1 minute before pinning (baseline) as well as 1 minute (P1), 2 minutes (P2), and 3 minutes (P3) after pinning. Multivariate repeat-measured analyses of variance were applied to the baseline-subtracted measurements of hemodynamic and BIS values. Groups were compared using the Student's t test, and P < .05 was considered to be statistically significant. Patients' characteristics, baseline hemodynamic values, and BIS values were similar in both groups. A significant overall time effect was observed for all variables, but no significant overall SUF effect was detected. Increases in SAP, MAP, DAP, and HR did not differ significantly between groups. The increase in hemodynamic variables did not exceed 20% of baseline value in either group. In contrast, at P1, the increase in BIS over the baseline value was significantly higher in GI (15.0+/-7.9) than in GII (6.7+/-6.5). In conclusion, MH application was associated with a significant, although not clinically relevant, increase in hemodynamic variables whatever the calculated plasma SUF concentration (0.5 or 1.0 ng/mL(-1)). In contrast, the increase in BIS observed at pinning was significantly higher in patients with the lowest calculated plasma SUF concentrations. This suggests that the BIS response to noxious stimulation is modulated by the analgesic regimen.

Alprazolam↗

Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study.

STUDY DESIGN: Prospective randomized study of patients undergoing spine surgery. OBJECTIVE: To compare changes in hemodynamic and cardiac function after prone positioning using different prone positioners. SUMMARY OF BACKGROUND DATA: Prone positioning decreases blood pressure and cardiac function. Several studies have evaluated changes in cardiac function after prone positioning, and linked them to reduced venous return and ventricular compliance. This study compares different prone positioners using transesophageal echocardiography, and determines their effect on cardiac function and hemodynamics. METHODS: After correction of fluid deficits with the patient under stable anesthesia, hemodynamic and cardiac performance was measured using transesophageal echocardiography. After prone positioning, repeat measurements were performed, and comparisons were made between prone and supine positions. RESULTS: No intergroup differences in demographics, fluid deficit, baseline hemodynamics, or differences from supine to prone position were noted. Cardiac output decreased with the Wilson (Union City, CA) and Siemens AG (Munich, Germany) frames, while cardiac index and stroke volume decreased with the Andrews (Hollywood, CA), Wilson, and Siemens systems. Cardiac preload decreased using the Andrews frame. The Jackson spine table (Hollywood, CA) and bolsters had the least effect on cardiac performance. CONCLUSION: Adequate fluid replacement reduced hypotension and hemodynamic instability after prone positioning. The Jackson spine table and longitudinal bolsters had minimal effects on cardiac function, and should be considered in patients with limited cardiac reserve.

Adult↗

Hemodynamic assessment in a pregnant and peripartum patient.

PATHOPHYSIOLOGY: Critical care in obstetrics has many similarities in pathophysiology to the care of nonpregnant women. However, changes in the physiology of pregnant woman necessary to maintain homeostasis for both mother and fetus, especially during critical illness, result in complex pathophysiology. Understanding the normal physiologic changes during pregnancy, intrapartum, and postpartum is the key to managing critically ill obstetric patients with underlying medical diseases and pregnancy-related complications. HEMODYNAMIC MONITORING: When the pathophysiology of critically ill obstetric patients cannot be explained by noninvasive hemodynamic monitoring and the patient fails to respond to conservative medical management, invasive hemodynamic monitoring may be helpful in guiding management. Most important, the proper interpretation of hemodynamic data is predicated on knowledge of normal values during pregnancy and immediately postpartum. Invasive hemodynamic monitoring with pulmonary artery catherization has been used in the obstetric population, particularly in patients with severe preeclampsia associated with pulmonary edema and renal failure.

Catheterization, Swan-Ganz↗

Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography.

BACKGROUND: This descriptive study was designed to evaluate maternal hemodynamics and cardiovascular responses to delivery during cesarean section (CS) under spinal anesthesia. We also assessed the feasibility of a noninvasive and continuous method of measuring cardiac output, namely whole-body impedance cardiography (ICG(WB)), during elective CS. Because of the techniques used in previous studies, only fractionated data on maternal hemodynamics during CS are available to date. METHODS: We studied 10 healthy women with normal pregnancies and two pregnant women with heart disease undergoing elective CS. Mean arterial pressure (MAP), heart rate (HR), stroke index (SI), cardiac index (CI) and systemic vascular resistance index (SVRI) were recorded continuously during CS, during the period of dissipation of anesthesia and on the second to fifth postpartum day. Analysis of variance for repeated measurements (anova) and the paired sample t-test were used in statistical analysis. RESULTS: The hemodynamic parameters could be registered continuously during the whole procedure. At the point of delivery, a 47% increase in CI and a 39% decrease in SVRI were recorded, while MAP remained stable. These changes occurred within 2 min of delivery of the newborn and persisted on average for 10 min. CONCLUSION: Sudden and significant hemodynamic changes take place at the moment of delivery. Intact physiological cardiovascular compensation mechanisms are needed to adapt to these challenges. Whole-body impedance cardiography may offer a useful noninvasive tool to monitor hemodynamics during cesarean section.

Adult↗

Clinical and hemodynamic findings following prosthetic valve replacement for mitral valve disease. A study of patients with the new Björk-Shiley tilting disc valve.

Clinical and hemodynamic results have been evaluated 12--24 months after mitral valve replacement with the new Björk-Shiley tilting disc valve prosthesis. After operation, most patients were improved symptomatically and were classified as I-II (N.Y.H.A.). No patient became worse. Hemodynamic status at rest showed significant reduction in pulmonary capillary venous pressure, pulmonary artial pressure and significant increase in cardiac output when compared with the preoperative values, but postoperative hemodynamic abnormalities remained. Exercise produced a rise in pressures in the pulmonary circuit and in cardiac output. The increase in cardiac output was less than expected from the increase in oxygen consumption, with a few exceptions. Apparently, there was no close relationship between the symptomatic improvement and the hemodynamic results. Thus, the present study points to the importance of hemodynamic data in the objective assessment of the results of cardiac surgery.

Adult↗

Hemodynamic and neurohormonal effects of flosequinan in patients with heart failure.

In a double-blind, placebo-controlled study, the central and peripheral hemodynamic effects of 100 mg oral flosequinan and the impact of this drug on neurohormonal activation were noninvasively evaluated in 18 patients with congestive heart failure, after the first administration and after 10 days of treatment. No significant hemodynamic and neurohormonal changes were observed after acute administration. After 10 days, flosequinan produced central and peripheral hemodynamic improvement characterized by an increase in left ventricular circumferential fiber shortening velocity (+12%), a decrease in total systemic resistance (-36%), and an increase in leg blood flow (+37%). No significant changes were observed in heart rate and arterial pressure in patients receiving flosequinan, though a slight increase in heart rate (+17%) was recorded. Despite these favorable hemodynamic effects, flosequinan significantly increased plasma norepinephrine (+38%) and plasma renin activity (+13%) after 10 days of treatment. Thus, the beneficial central and peripheral hemodynamic effects of flosequinan are accompanied by activation of the sympathetic and reninangiotensin systems. This might be related to the unfavorable effects of the drug on survival in patients with heart failure.

Adult↗

Continuous computerized monitoring of hemodynamic parameters during acetate dialysis, bicarbonate dialysis, and acetate-free biofiltration.

The effects of continuous, computerized, non-invasive hemodynamic monitoring on the appearance of intradialytic symptoms, aided by preventive therapeutic maneuvers, were evaluated in 30 critically ill patients undergoing regular acetate dialysis. The hemodynamic behavior was assessed by a system that interfaces a personal computer with a blood pressure monitor and to a transthoracic electrical impedance-measuring instrument. Monitoring allowed us to reduce significantly the frequency of some important intradialytic symptoms such as nausea, vomiting, and hypotension. The same monitoring system was used acutely to characterize differing hemodynamic behaviors during acetate dialysis (AD), bicarbonate dialysis (BD), and acetate-free biofiltration (AFBF). AD showed a prevalent vasodilation effect with a compensatory increase in heart rate and higher cardiac output values, which were not sufficient to maintain blood pressure stability. BD and AFBF were characterized by a more efficient vasoconstrictor effect and good hemodynamic stability. AFBF, despite a 1 h reduction in session length compared to BD, did not present significant differences in hemodynamic response resulting from session shortness or other technical changes.

Acetates↗

Hemodynamic effects of atropine and glycopyrrolate in isoflurane-xylazine-anesthetized dogs.

Alterations in parasympathetic tone are partially responsible for xylazine's hemodynamic effects. The purpose of this study was to evaluate and compare the hemodynamic changes caused by the administration of intravenous (IV) atropine or glycopyrrolate after IV xylazine in isoflurane-anesthetized dogs. Six healthy beagles (8.2 to 10.7 kg) were used in two trials separated by 7 days. Anesthesia was induced and maintained with isoflurane in 100% oxygen with controlled ventilation. Once constant end-tidal isoflurane (1.8%) and arterial partial pressure of carbon dioxide (35 to 45 mm Hg) values were reached, baseline data were recorded and xylazine (0.5 mg/kg, i.v.) was given. In trial 1 atropine (0.1 mg/kg, i.v.) was given 5 minutes after xylazine, and in trial 2 glycopyrrolate (0.025, mg/kg, i.v.), was given 5 minutes after xylazine. Hemodynamic variables were recorded 3 minutes after xylazine and 3 minutes after anticholinergic administration. In trial 2, bilateral vagotomies were performed 10 minutes after glycopyrrolate, and hemodynamic variables were recorded 3 minutes later. Heart rate, cardiac index, and stroke index decreased; arterial pressure and systemic vascular resistance increased after xylazine. Heart rate, cardiac index, and rate pressure product increased after anticholinergic administration. Significant differences between atropine and glycopyrrolate were not observed in any of the hemodynamic parameters. Similarly, significant differences between glycopyrrolate and bilateral vagotomy were not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗

Hemodynamic effects of different temporary pacing modes for the management of bradycardias complicating acute myocardial infarction.

Twelve patients requiring temporary pacing following acute myocardial infarction (AMI) (10 heart block, 2 junctional bradycardia) had hemodynamic measurements taken with ventricular demand pacing at 80 ppm (VVI80), ventricular demand pacing at the atrial rate (VVIa), physiological pacing (DDD), and spontaneous (intrinsic) rhythm. VVI80 mode did not improve any hemodynamic parameter compared with spontaneous rhythm. VVIa mode improved diastolic and mean arterial pressures only. DDD mode improved most hemodynamic parameters compared with spontaneous rhythm (cardiac output by 29% [P less than 0.0001]; blood pressure: diastolic by 24% [P less than 0.01], systolic by 19% [P less than 0.01], mean by 21% [P less than 0.005]; pulmonary wedge pressure by 10% [P = 0.057] and right atrial pressure by 24% [P less than 0.005]) and also significantly improved some parameters compared with VVIa (cardiac output by 20% [P less than 0.001], systolic blood pressure by 11% [P less than 0.01] and right atrial pressure by 15% [P less than 0.01]). Physiological pacing is hemodynamically superior both to ventricular pacing and spontaneous rhythm for patients requiring temporary pacing following AMI. Ventricular pacing at 80 ppm has little hemodynamic advantage over spontaneous rhythm.

Adult↗

Intermediate-term results of biventricular pacing in heart failure: correlation between clinical and hemodynamic data.

Biventricular (BV) pacing acutely improves the hemodynamic status of patients with chronic heart failure (CHF) and wide QRS complex. Long-term data are few. This study examined the relationship between hemodynamic and clinical status of BV-paced CHF patients over an intermediate duration of follow-up. Forty-seven patients (mean age 64 +/- 11 years, 19% women, LVEF 0.23 +/- 0.07) with QRS > or = 140 ms received a DDD-BVP device for management of CHF due to ischemic disease in 21 (45%) patients. Clinical, electrocardiographic, exercise testing, and hemodynamic measurements were followed over an 8-month period. Seven patients died during the study, four patients suddenly. A significant decrease in NYHA class, from 3.3 +/- 0.6 before implantation, to 2.5 +/- 0.57 months after device implantation (P < 0.01) was measured, although 23% of patients reported no symptomatic improvement. Paced QRS narrowing by BVP was unchanged throughout follow-up (166 +/- 28 vs 159 +/- 23 ms, P = NS). Maximal VO2 values did not change (15.7 +/- 5 vs 16 +/- 8 mL/kg per min, P = NS). Echocardiographic parameters showed that the degree of mitral regurgitation was significantly decreased during BV pacing compared with no pacing (1.8 +/- 1.0 before implantation vs 1.3 +/- 0.7, P < 0.01). The radionuclide LVEF was not statistically different during no pacing, versus BV pacing at 3 months or 8 months after pacemaker implantation (24 +/- 9 vs 26 +/- 11 vs 25 +/- 10%, respectively, P = NS). Of nine patients whose QRS duration was prolonged by BV pacing, two were not hemodynamically and clinically improved at the end of follow-up. Patients not improved by BV pacing had the same degree of QRS shortening (203 +/- 39 vs 167 +/- 26 ms, P < 0.01) as patients who were clinically improved during follow-up (193 +/- 40 to 171 +/- 24 ms, P < 0.01). In multivariate analysis, ischemic heart disease (P = 0.025), absence of mitral regurgitation regression (P = 0.01), and older age (P = 0.04) predicted the absence of improvement by BV pacing. By standard noninvasive measures, intermediate-term BV pacing was associated with no objective hemodynamic improvement, though more than three fourths of the patients reported being clinically improved. A global improvement in left ventricular function by BV pacing may become apparent only over longer periods of observations. Patients with CHF unimproved by BV pacing are more likely to suffer from ischemic heart disease and less likely to have BV pacing induced regression of mitral regurgitation, regardless of changes in QRS duration.

Blood Flow Velocity↗

Biatrial epicardial pacing prevents atrial fibrillation and confers hemodynamic benefits after coronary artery bypass surgery.

Biatrial pacing (BIP) can be more effective than standard right atrial pacing (RAP) in preventing atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG). However, the mechanisms and hemodynamic benefits of BIP have not been studied in detail. This study examined the efficacy and hemodynamic benefits conferred by overdrive epicardial BIP in preventing post-CABG AF. After undergoing CABG, 72 patients (mean age = 66 +/- 12 years, 48 men) were randomly assigned to triggered BIP (BIP-AAT; n = 50) versus single RAP (RAP-AAI; n = 22). The hemodynamic effects of BIP were measured by right heart catheterization and echocardiography. The patients were monitored for 8.8 +/- 2.4 days after CABG to detect episodes of AF. The incidence of AF was significantly lower in the BIP-AAT group (22.0%) than in the RAP-AAI group (59.1%, P < 0.01). Cardiac output was significantly higher and pulmonary artery wedge pressure (PAWP) significantly lower during BIP-AAT than during RAP-AAI. The E-wave (65.2 +/- 37.8 vs 57.8 +/- 37.8 cm/s, P < 0.05) was significantly higher during BIP-AAT, and the interval between atrial pacing spike and the end of A-wave (241 +/- 18.4 vs 286 +/- 17.2 ms, P < 0.001) was significantly shorter during BIP-AAT than during RAP-AAI. Triggered BIP was well tolerated and significantly reduced the incidence of post-CABG AF compared to single-site RAP. The hemodynamic improvements conferred by BIP-AAT were due to a shortening of the inter-atrial conduction delay and greater contribution of left atrial contraction. These hemodynamic benefits may play a role in lowering intra-atrial pressure and in preventing AF.

Aged↗

Effect of ventricular shock strength on cardiac hemodynamics.

INTRODUCTION: The effect of implantable defibrillator shocks on cardiac hemodynamics is poorly understood. The purpose of this study was to test the hypothesis that ventricular defibrillator shocks adversely effect cardiac hemodynamics. METHODS AND RESULTS: The cardiac index was determined by calculating the mitral valve inflow with transesophogeal Doppler during nonthoracotomy defibrillator implantation in 17 patients. The cardiac index was determined before, and immediately, 1 minute, 2 minutes, and 4 minutes after shocks were delivered during defibrillation energy requirement testing with 27- to 34-, 15-, 10-, 5-, 3-, or 1-J shocks. The cardiac index was also measured at the same time points after 27- to 34-, and 1-J shocks delivered during the baseline rhythm. The cardiac index decreased from 2.30 +/- 0.40 L/min per m2 before a 27- to 34-J shock during defibrillation energy requirement testing to 2.14 +/- 0.45 L/min per m2 immediately afterwards (P = 0.001). This effect persisted for > 4 minutes. An adverse hemodynamic effect of similar magnitude occurred after 15 J (P = 0.003) and 10-J shocks (P = 0.01), but dissipated after 4 minutes and within 2 minutes, respectively. There was a significant correlation between shock strength and the percent change in cardiac index (r = 0.3, P = 0.03). The cardiac index decreased 14% after a 27- to 34-J shock during the baseline rhythm (P < 0.0001). This effect persisted for < 4 minutes. A 1-J shock during the baseline rhythm did not effect the cardiac index. CONCLUSION: Defibrillator shocks > 9 J delivered during the baseline rhythm or during defibrillation energy requirement testing result in a 10% to 15% reduction in cardiac index, whereas smaller energy shocks do not affect cardiac hemodynamics. The duration and extent of the adverse effect are proportional to the shock strength. Shock strength, and not ventricular fibrillation, appears to be most responsible for this effect. Therefore, the detrimental hemodynamic effects of high-energy shocks may be avoided when low-energy defibrillation is used.

Adult↗

The effect of compression duration on hemodynamics during mechanical high-impulse CPR.

OBJECTIVE: To determine whether shorter compression durations combined with fixed increased compression velocity during mechanical high-impulse CPR (HI-CPR) improve resuscitation hemodynamics, compared with mechanical standard CPR (SCPR). METHODS: A porcine model of ventricular fibrillation was used, with each animal serving as its own control. Twelve anesthetized swine (20-25 kg each) were instrumented for hemodynamic monitoring. Ventricular fibrillation was induced and followed, after 3 minutes, by mechanical SCPR (50% duty cycle) for 10 minutes. Mechanical HI-CPR was then applied, with compression durations varied randomly at 2-minute intervals for 20% (COM20), 30% (COM30), and 40% (COM40) of the CPR cycle. A 2-minute mechanical SCPR control phase completed the experiment. RESULTS: Hemodynamic measurements were significantly better for COM20 and COM30 vs SCPR, including, respectively: mean arterial pressure (MAP), 45 +/- 8 and 43 +/- 7 vs 36 +/- 7 torr; coronary perfusion pressure (CPP), 21 +/- 6 and 21 +/- 8 vs 16 +/- 6 torr; and end-tidal CO2 (ETCO2), 7 +/- 2 and 6.6 +/- 2 vs 5 +/- 1.4 torr. MAP, CPP, and ETCO2 during COM40 were not significantly different from those during SCPR, and there was no difference between COM20 and COM30 for any hemodynamic parameter. Aortic flow velocity was significantly better in COM20, COM30, and COM40 vs SCPR: 2.3 +/- 0.7, 2.1 +/- 0.9, and 1.95 +/- 0.9 vs 1.3 +/- 0.5 cm/sec, respectively. CONCLUSION: In a swine model of mechanical HI-CPR, shorter compression durations combined with fixed increased compression velocity significantly improve resuscitation hemodynamics, compared with those afforded by mechanical SCPR.

Animals↗

Effects of octreotide on central hemodynamics and systemic oxygen use in patients with viral cirrhosis.

OBJECTIVE: Octreotide has potentially beneficial effects in patients with cirrhosis. However, the effects of octreotide on central hemodynamics and oxygen use have not been established. The present study was undertaken to evaluate the effect of octreotide on central hemodynamics and oxygen use in patients with viral cirrhosis. METHODS: Twenty-five patients with cirrhosis were enrolled in the study. They were randomly assigned to receive either placebo (n = 10) or a continuous infusion of 100 microg/h of octreotide after an initial 100-microg bolus (n = 15). Hemodynamic measurements and oxygenation values were obtained before and 60 min after octreotide or placebo administration. RESULTS: Placebo administration did not have any effect on hemodynamic and oxygenation values. In patients who received octreotide, systemic hemodynamic values including cardiac index, mean arterial pressure, and systemic vascular resistance were not affected. The mean pulmonary arterial pressure tended to increase after octreotide administration but was statistically insignificant. There was a significant increase in pulmonary arterial vascular resistance, whereas the pulmonary capillary wedge pressure and right atrial pressure were significantly decreased. Arterial oxygen tension, systemic oxygen uptake, and oxygen extraction ratio were significantly decreased after octreotide administration, whereas oxygen transport as well as arterial and mixed venous oxygen contents remained unchanged. CONCLUSIONS: In patients with viral cirrhosis, octreotide administration exerted a significant effect on pulmonary circulation. It also resulted in a decrease in systemic oxygen uptake and oxygen extraction ratio. These results suggested that octreotide may impair tissue oxygenation in patients with viral cirrhosis.

Aged↗

Hemodynamic effects of a combination of prazosin and terlipressin in patients with viral cirrhosis.

OBJECTIVES: Terlipressin reduces portal pressure in cirrhotic patients mainly through intense splanchnic vasoconstriction that decrease portal venous inflow. Hepatic blood flow may also be reduced by terlipressin. Prazosin (an alpha1-adrenoceptor antagonist) has also been proposed to decrease portal pressure in cirrhotic patients possibly through a decrease in the intrahepatic vascular resistance. The current study was aimed to evaluate whether a combination of prazosin and terlipressin exerts more beneficial effects than terlipressin alone. METHODS: Patients were randomly assigned to receive either a placebo (n = 12) or an oral administration of prazosin 2 mg (n = 12). Thereafter, each patient received an intravenous injection of terlipressin 2 mg. Hemodynamic values were measured basally, 30 min after prazosin or placebo, and 30 min after terlipressin. RESULTS: Placebo administration did not affect any hemodynamic values. Terlipressin administration, on the other hand, resulted in expected changes on the hepatic venous pressure gradient, hepatic blood flow, and systemic hemodynamics. In contrast, prazosin significantly decreased hepatic venous pressure gradient with an increased hepatic blood flow and intrinsic hepatic clearance. After terlipressin administration, a further decrease in hepatic venous pressure gradient was observed with preservation of hepatic blood flow and intrinsic hepatic clearance. The magnitude of decrease in hepatic venous pressure gradient was more profound in patients receiving prazosin plus terlipressin than in those receiving terlipressin alone. However, the magnitude of changes in systemic hemodynamics was no different between the two groups of patients. CONCLUSIONS: The current study showed that a combination of prazosin and terlipressin resulted in a more profound reduction of hepatic venous pressure gradient with a preservation of hepatic blood flow and intrinsic hepatic clearance than did terlipressin alone. However, the combined therapy did not modify the systemic hemodynamic effects exerted by terlipressin.

Antihypertensive Agents↗