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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carbon dioxide production and ventilatory efficiency were measured during undisturbed anaesthesia with intermittent positive pressure ventilation in 34 children about to undergo closed or open cardiac surgery. Anaesthesia was provided with fentanyl or halothane and nitrous oxide. There were 15 cyanotic and 19 acyanotic children. Children with cyanotic heart disease produced approximately 20% less carbon dioxide per unit body weight than acyanotic children, but ventilation was approximately 20% less efficient. Adequate ventilation should therefore be obtained when "normal" ventilation in relation to body weight is used in cyanotic children.
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PMID:Carbon dioxide production in cyanotic children during anaesthesia with controlled ventilation. 314 2

A seven-month-old child with complex cyanotic heart disease desaturated dramatically following induction of anaesthesia. While a degree of hypoxaemia would have been acceptable in this infant, pulse oximetry detected an abrupt desaturation prompting the anaesthetist to consider other less common causes of cyanosis. This episode of desaturation subsided with the removal of a 12 french oesophageal stethoscope which had been inserted following induction. Further attempts to re-insert this oesophageal probe led to repeated episodes of desaturation. The most likely cause of this desaturation was a reduction in pulmonary blood flow due to compression by the oesophageal probe of an aorto-pulmonary collateral posterior to the oesophagus.
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PMID:Hypoxaemia produced by an oesophageal stethoscope: a case report. 316 34

In a prospective study of postoperative complications, strokes occurred in 6 out of 2463 patients (0.2%) who underwent non-cardiac, non-carotid artery surgery. The patients who experienced cerebrovascular accidents, including three cases of transient ischemic attack, were significantly older than the rest of the group (mean age 79 years versus 65 years) and had manifestations of atherosclerosis in at least one organ preoperatively. Significant predictors of risk for postoperative cerebrovascular accidents were previous cerebrovascular disease, heart disease, peripheral vascular disease, and hypertension. Cerebrovascular accidents occurred late in the postoperative period, 5-26 days after surgery, and were not directly related to surgery and anesthesia. They were more frequent after acute than after elective operations. Precipitating factors for some of the stroke incidents were rapid atrial fibrillation and postoperative dehydration.
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PMID:Postoperative cerebrovascular accidents in general surgery. 321 96

Anesthesia and surgery have a wide range of effects on the cardiovascular system. Even in healthy patients having minor operations, anesthetic agents can cause significant cardiac depression and hemodynamic instability. Virtually all anesthetic agents have intrinsic myocardial depressant properties, although some may mask this with sympathetic stimulation. The vasodilatory effects of the volatile agents can result in serious hypotension when combined with this negative inotropy. In the patient with pre-existing cardiac disease, these cardiovascular anesthetic effects become much more serious. These patients will not tolerate wide swings of hemodynamic variables, and the cardiodepressant effects of anesthetics are more pronounced in them. The stress of anesthesia and surgery frequently unmasks previously undiagnosed heart disease. Surgery itself provides many insults to the cardiovascular system, and these may be additive with the effects of anesthesia. These include loss of blood and other volume shifts, release of various substances into the circulation, hypothermia, sudden changes in cardiac preload and afterload, myocardial ischemia, and effects of drugs or blood products given for surgical reasons. The signs and symptoms of these surgical stresses to the cardiovascular system are often masked by anesthesia.
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PMID:Cardiovascular effects of anesthesia and operation. 333 99

A case report is presented of supraventricular tachycardia (SVT) associated with metoclopramide administration in the early postpartum period in a 37-year-old woman. The patient was scheduled for elective laparoscopic tubal ligation 4 hours after an uncomplicated spontaneous vaginal delivery. The preoperative evaluation revealed that the patient's only significant past medical history was a total of 4 spontaneous vaginal deliveries. A review of systems was noncontributory, and the patient denied any untoward effects from drugs. Metoclopramide, 10 mg, was administered intravenously to facilitate gastric emptying and as an anti-emetic. Within 1 minute, the heart rate rose to 170 bpm. She was in no distress, being unaware of any change in her status. Arterial blood pressure remained in the 130-140 mmHg (systolic) range throughout the ensuing period. Various approaches, i.e., valsalva, carotid sinus massage, ocular pressure, were used to increase vagal tone without a decrease in the heart rate. After determining that the PR interval was grossly normal, she received 2 boluses of verapamil (10 mg intravenously) over a 10-minute period without change in heart rate. She then was given alphaprodine and droperidol for sedation. The patient then was administered Digoxin approximately 20 minutes after the administration of metoclopramide. This was followed by a gradual decrease in her heart rate to 130 bpm over the next 5 minutes. The patient was transferred to a telemetry unit for a 24-hour period, where her arterial blood pressure remained stable and her heart rate was noted to be in the 90-110 range. 12-lead EKG revealed sinus tachycardia with "nonspecific" ST changes. PR, QRS, and QTC intervals were within normal limits. Chest radiograph was without pathology. The patient was reinterviewed on several occasions and continued to deny a history of SVT, palpitations, syncope, or any other cardiac symptomatology. 2 days following the initial episode, she underwent successful laparoscopic tubal ligation under spinal anesthesia and sedation. In sum, a stable postpartum patient without history of SVT or evidence of structural heart disorder developed SVT immediately following metoclopramide administration. This may be because of the cardioactive properties of metoclopramide or to an underlying predisposition from her peripartum state, or a combination of factors.
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PMID:Supraventricular tachycardia associated with postpartum metoclopramide administration. 333 65

A review of 100 femoral artery embolectomies performed on 88 consecutive patients during a 10-year period was conducted to establish immediate and long-term results. There were 48 (55%) male and 40 (45%) female patients. Ages ranged from 33 to 97 years (mean, 73 years). Local anesthesia was used in 84 (84%) cases. Fifteen (17%) patients died within 30 days of the procedure. Major limb amputation was required within 30 days of operation in 16 (16%) patients. Mortality rate in the group of patients needing early amputation was 50% compared with 11% for those who underwent successful embolectomy procedures (p less than 0.001). Current follow-up was established for all patients. Five-year and 10-year survival rates for the entire group were 40% and 35%, respectively. The most frequent causes of late death after femoral artery embolectomy were arteriosclerotic heart disease (26%), cerebrovascular accident (26%), and advanced carcinoma (21%). All 39 remaining survivors were located 8 to 126 months (mean, 48 months) after discharge to complete a questionnaire designed to assess quality of life and symptoms of vascular insufficiency. Thirty-five (90%) survivors were fully ambulatory and 27 (70%) lived in their own homes. Although early survival is decreased after femoral embolectomy, long-term survivors can be expected to live independently with excellent limb salvage and function.
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PMID:Late results after femoral artery embolectomy. 334 83

To determine the effects of premedication on arterial oxygen saturation (SaO2) and heart rate (HR), 11 children (ages three to seven years) scheduled for elective repair of cyanotic congenital heart defects were studied. Patients were premedicated with oral or rectal pentobarbitone 2 mg.kg-1 90 minutes prior to induction of anaesthesia followed by intramuscular morphine 0.2 mg.kg-1 and atropine 0.02 mg.kg-1 60 minutes prior to induction. The SaO2 and HR of each child were monitored continuously using a Nellcor pulse oximeter during two 90 minute periods: a control period commencing 25.5 hours preoperatively (day 1) and a post premedication period commencing 1.5 hours preoperatively (day 2). Data were compared at time 0 (corresponding to the time of administration of pentobarbitone on day 2), 30 (corresponding to the administration of intramuscular morphine and atropine on day 2), 60 and 90 minutes (the latter corresponding to the time of induction on day 2) after the administration of pentobarbitone. There were no significant differences in SaO2 or HR between day 1 and day 2 at time 0, 60, and 90 minutes. The SaO2 (mean +/- SD) decreased significantly immediately following intramuscular premedication at time 30 minutes on day 2 (72.7 +/- 5.9 per cent) compared to the corresponding time on day 1 (83.9 +/- 2.9 per cent) (p less than 0.05). The duration of this desaturation was 2.5 +/- 1.9 minutes. Heart rate (mean +/- SD) increased from 109.2 +/- 21.3 beats.min-1 at time 30 minutes on day 1 to 142 +/- 20.4 beats.min-1 on day 2 (p less than 0.05). We conclude that administration of intramuscular premedication preceded by oral or rectal pentobarbitone causes transient arterial desaturation and tachycardia in children with cyanotic congenital heart disease.
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PMID:Arterial oxygen saturation following premedication in children with cyanotic congenital heart disease. 334 56

The maternal mortality associated with cesarean section in the presence of congenital cyanotic heart disease is high. We report the anesthetic management of a 26-year-old pregnant patient with transposition of the great vessels and a functional single ventricle whose child was delivered by elective cesarean section under continuous epidural anesthesia. There were no hemodynamic problems and the outcome was successful for both mother and child, who could be discharged from the hospital on the 17th postoperative day. Elective cesarean section may be an acceptable method of delivery, and lumbar epidural block proved to be an appropriate procedure for this patient. The cooperation of cardiologists, anesthesiologists, and obstetricians was necessary to assure maternal and fetal survival. Continuous invasive hemodynamic monitoring and use of small epidural top-up doses (2-3 ml) of local anesthetic were of utmost importance in maintaining the hemodynamic stability.
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PMID:[Anesthesiologic management of cesarean section in a patient with transposition of the great vessels]. 335 27

The efficiency of spontaneous ventilation during halothane anaesthesia was investigated in 18 infants and children with congenital heart disease presenting either with hyperperfusion and left-to-right shunt (group LR: n = 10, body weight 3.7-16 kg) or with hypoperfusion and right-to-left shunt (group RL: n = 8, body weight 3.4-12 kg). Minute ventilation (VE) and tidal volume (VT) were greater in group RL than in group LR (P less than 0.05) while ventilatory rates were similar. Dynamic compliance and total pulmonary resistance were of the same magnitude in the two groups. Alveolar ventilation (VA) calculated from arterial carbon dioxide tensions (PaCO2) was the same in both groups while corresponding deadspace ventilation (VD) was higher in group RL (P less than 0.01). VE/VCO2 and VD/VT ratios were higher in children with a diminished pulmonary blood flow than in children with an increased pulmonary blood flow (P less than 0.05 and P less than 0.01, respectively) indicating a less efficient gas exchange in children with a right-to-left shunt. This was compensated for by an increased inspiratory drive as reflected by higher VT/TI ratio (P less than 0.01) and a more pronounced airway occlusion pressure (P less than 0.05).
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PMID:Congenital heart malformations and ventilatory efficiency in children. Effects of lung perfusion during halothane anaesthesia and spontaneous breathing. 356 93

A 2-year-old girl with cyanotic congenital heart disease needed to undergo gastrostomy. To avoid the use of general anesthesia, a percutaneous gastrostomy was performed as an interventional radiologic procedure with the patient under sedation and with the use of local anesthesia. The placement of a nasogastrocutaneous guide wire under fluoroscopic guidance provided a stable tract for placement of the gastrostomy tube.
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PMID:Percutaneous gastrostomy in a child. 371 40


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