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Query: UMLS:C0007222 (cardiovascular disease)
 65,817 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Detailed cardiorespiratory studies were performed in 10 volunteers in whom general anesthesia was induced with thiopental 3 mg/kg and diazepam 0.4 mg/kg.Minimal changes in blood pressure were noted with both agents. Depression of total peripheral resistance lasted in excess of 20 minutes with diazepam but had returned to control levels with thiopental, elevations in cardiac rate and output were most evident and lasted longer with diazepam. In the healthy volunteer induction of anesthesia with diazepam causes alterations in cardiovascular parameters which are more profound than with thiopental. The data presented is in contrast to that obtained when patients with cariovascular disease are studied.With diazepam, considerable individual variation and long recovery times were confirmed.Following extensive clinical use, a detailed study demonstrated minimal cardiovascular depression following intravenous induction of sedation with diazepam, in patients who had prior cardiovascular disease. Subsequent studies suggested that diazepam would be a more suitable alternative for induction of general anesthesia in patients with cardiovascular disease. This was confirmed by Ikram and Rubin. It has been used extensively for sedative techniques in dentistry, and therefore it was logical to extend this concept to the induction of general anesthesia by intravenous diazepam. It was decided to evaluate the use of intravenous diazepam for induction of general anesthesia and to compare the detailed cardiovascular and respiratory effects of this drug with thiopental.
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PMID:Induction of general anesthesia with diazepam or thiopental: a comparison of the cardiorespiratory effects. 28 26

Sodium nitroprusside was used to induce hypotension during continuous neuroleptanalgesia in 11 neurosurgical patients aged between 13 and 53 years placed in the sitting position. No patient had cardiovascular disease. 14 patients aged between 18 and 72 years without induced hypotension were used as controls to compare the action of our standardized method of anaesthesia on the same parameters that were also monitored during blood pressure lowering. Cerebral perfusion of these 14 patients with highly elevated intracranial pressure with or without cardiovascular disease already seemed to be threatened by the upright position. Therefore, induced hypotension was not performed. The average dosage of sodium nitroprusside was 2.08 mcg/kg/min. The initial medium arterial pressure was lowered by a mean of 32.4%, associated with an average increase in pulse rate of 38.9%. The values of arterial PO2 never fell below 100 mmHg and the PCO2 remained between 25 and 35 mm Hg, indicating adequate cardiovascular function and gas exchange. Careful monitoring of the patients during and after blood pressure lowering with sodium nitroprusside made it possible to take advantage of the induced hypotension also in strictly-selected neurosurgical patients who have to be operated on in upright position.
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PMID:[Controlled hypotension with sodium nitroprosside in patients placed in the sitting position during intracranial operations (author's transl)]. 46 41

The effect of small intravenous doses of practolol (0.2 mg/kg body weight) on the circulatory response to laryngoscopy and endotracheal intubation, when administered with atropine (0.01 mg/kg b.w.) prior to anaesthesia was studied in 39 patients with and without cardiovascular disease. Practolol diminished significantly the rise of mean arterial pressure and pulse rate affected by laryngoscopy and endotracheal intubation when performed under thiopentone-succinylcholine anaesthesia. Arrhythmias were also less frequent through the statistical significance could not be ascertained in this small series. The small practolol dose used had no adverse circulatory effects. It is suggested that the administration of a small prophylactic dose of practolol is useful in preventing the excessive cardiovascular response due to laryngoscopy and endotracheal intubation.
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PMID:Circulatory responses to laryngoscopy and endotracheal intubation in patients with and without cardiovascular disease. Effect of prophylactic practolol. 60 21

Renal function and central haemodynamics were studied in eight patients, without known histories of renal or cardiovascular disease, during and immediately after upper abdominal surgery under neurolept anaesthesia. Inulin and PAH clearance, fractional sodium and fractional osmolar excretion decreased, while fractional free water reabsorption increased under anaesthesia. Cardiac output, mean systemic arterial pressure and systemic vascular resistance remained virtually unchanged both per- and postoperatively. Renal haemodynamics were promptly restored postoperatively, while fractional sodium and fractional osmolal excretion were unaltered and antidiuresis increased. It is concluded that neurolept anaesthesia, as far as renal function is concerned, is well suited for the anaesthetic management of the poor-risk patient.
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PMID:Renal function during neurolept anaesthesia. 65 56

The problems presented by persons with cardiovascular disease before and during anaesthesia are analysed. The physiology of the circulation is briefly dealt with; the role of cardiac rhythm, myocardiac contractility and peripheral vascular resistance in maintaining stable cardiovascular conditions and thereby ensuring an adequate blood supply to the tissues is reviewed. Causes, risks and treatment of cardiac arrhythmias are discussed with special reference to extrasystoles developing during anaesthesia. Anaesthesia for patients with a pace-maker is dealt with in detail. The advisability of pre-operative digitalization and means of treating acute cardiac arrest during anaesthesia are discussed. Therapeutic measures are suggested to counteract circulatory crises and acute rise of blood pressure during operation and to restore peripheral resistance to normal.
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PMID:[Management of patients with cardiovascular disease before and during anaesthesia (author's transl)]. 91 71

Maternal lung edema due to the use of beta-mimetic tocolytic agents is a well-documented complication. The risk increases if several other factors are present: infectious diseases, the use of inhaled anesthetics, EPH gestosis, hydramnios, twin gestation and preexisting cardiovascular disease. The complications induced by beta-mimetic tocolytic agents can be reduced by remembering their side effects and contraindications and restricting fluid intake. During obstetric general anesthesia in patients undergoing tocolysis, the infusion of large amounts of saline, as is widely practised today, is strictly contraindicated.
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PMID:[Maternal pulmonary edema as an anesthesia complication after intravenous tocolysis and stimulating of lung maturation]. 135 38

Two total intravenous anaesthesia techniques were compared in an open study of 80 ambulatory patients undergoing ENT endoscopic procedures randomly assigned to two groups: Group I midazolam-flumazenil n = 40, Group II propofol n = 40. The mean doses including induction were 0.75 +/- 0.31 mg kg-1 h-1 for midazolam and 171 +/- 64 micrograms kg-1 min-1 for propofol for 46.3 +/- 17.7 min and 50.3 +/- 24.8 min respectively. At the end of the procedure flumazenil 8.1 +/- 1.9 micrograms kg-1 was administered to Group I patients followed by a flumazenil continuous infusion at a minimal arousal rate (MAR) of 0.24 +/- 0.1 micrograms kg-1 min-1, and propofol discontinued in Group II patients. Baseline mean arterial pressure (MAP) and heart rate (HR) were similar in both groups and remained so during the procedure and recovery. In patients with cardiovascular disease, large variations (greater than or equal to 40% of baseline values) occurred more frequently in the propofol group whereas large variations in patients with no cardiovascular disease occurred more frequently in the midazolam group (P less than 0.05). Early recovery was more rapid after midazolam (P less than 0.05) whereas late criteria for recovery (maze and ambulation tests) were met more rapidly after propofol (P less than 0.05). It is concluded that with the midazolam-flumazenil sequence, early recovery is faster and haemodynamic stability better maintained in poor cardiovascular risk patients, whereas with propofol, street-fitness is more rapidly obtained, and haemodynamic stability better maintained in good risk patients.
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PMID:Midazolam-flumazenil vs. propofol in ambulatory ENT endoscopic procedures. 139 24

Patients with primary hyperparathyroidism are often elderly with cardiovascular disease and in some an operation might be hazardous owing to anaesthetic complications. A technique for operation for primary hyperparathyroidism under local anaesthesia is described. The method uses a unilateral approach. Seventeen consecutive patients operated on under local anaesthesia were compared with a group of 15 patients undergoing surgery under general anaesthesia. Normocalcaemia was achieved in 14 patients in each group. There was no difference in the extent of pain or the overall well-being between the two groups as determined by a visual analogue scale. Patients receiving local anaesthesia, however, experienced significantly less nausea after operation (P < 0.01). There was more fluctuation in blood pressure and heart rate in the general anaesthesia group compared with the other group. Surgery for primary hyperparathyroidism can be performed safely under local anaesthesia, and could be offered to patients if general anaesthesia were not suitable or involved an increased perioperative risk. It should not be recommended for routine use in patients who are fit for general anaesthesia.
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PMID:Surgery for primary hyperparathyroidism performed under local anaesthesia. 142 61

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

Opioids (narcotic analgesics) are widely used in the practice of anesthesia for preanesthetic medication, systemic and spinal analgesia, supplementation of general anesthetic agents, and as primary anesthetics. The last use is particularly widespread for major surgical operations, especially those involving patients with cardiovascular disease. The use of opioids in anesthetic doses is based on the absence of cardiac depression by the opioids. As with all anesthetic drugs, the opioids have limitations and side effects, but for the most part, these are easily managed on the basis of knowledge of their pharmacology. The key to their efficient use is careful titration of dose according to the individual patient's responses to the drug as well as to noxious stimulation. Although there is a very wide margin of safety, allowing administration of enormous doses intraoperatively when the patient's ventilation is supported mechanically, the disadvantage of using doses far in excess of the individual patient's need is a prolonged recovery from anesthesia with the risk of postoperative ventilatory depression. Titration of the dose can be facilitated by computer-controlled infusion pumps with the benefit that the recovery time from anesthetic doses can be appropriate for the individual patient and surgical procedure, and postoperative analgesia can be continued by patient-controlled analgesia, which is another example of computer-controlled opioid infusion. Although specific opioid antagonists are available, their use to antagonize residual anesthetic effects is potentially hazardous.
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PMID:Opioids: clinical use as anesthetic agents. 151 51


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