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

The effects of thoracic epidural analgesia (TEA) on the circulation at rest, during, and after physical exercise were investigated in 10 volunteers. At rest, TEA did not affect oxygen consumption (VO2) or cardiac output (Q), but heart rate (HR) was, increased by 7 beats/min, and stroke volume decreased correspondingly by 13 ml. Systolic arterial blood pressure was slightly reduced, but no other changes in systemic or pulmonary circulatory parameters were produced. TEA did not change VO2 during exercise, a 2.11/min reduction of Q being accompanied by a 4.2% increase of oxygen utilization coefficient. HR showed a relative reduction of about 10%. At moderate work loads during TEA, systemic arterial blood pressures were significantly lower than during control exercise. The resulting rate pressure product (RPP) was markedly reduced, while total peripheral resistance (TPR) remained unchanged. During recovery after the termination of exercise during TEA, VO2, Q, HR, RPP and TPR fell more rapidly towards values obtained at rest. From a clinical point of view the results support the safeness of TEA and also support its use in surgical patients with heart disease.
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PMID:The influence of thoracic epidural analgesia on the circulation at rest and during physical exercise in man. 69 17

Blood loss and the incidence of emetic sequelae were assessed in 148 patients undergoing midcavity forceps delivery under continuous lumbar extradural analgesia. Five units of oxytocin i.v. was found to be as effective as ergometrine 0.5 mg i.v. in reducing blood loss at delivery. Nausea, retching or vomiting occurred in 35 (46%) of the mothers who received ergometrine and in none of those who received i.v. oxytocin. The cardiovascular side-effects of ergometrine and oxytocin are reviewed and compared with special reference to patients with hypertension and heart disease. It is suggested that 5 units of oxytocin i.v. should be preferred in these high-risk patients. Because of the absence of an emetic action, i.v. oxytocin is preferable to i.v. ergometrine for patients receiving extradural analgesia.
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PMID:Ergometrine, oxytocin and extradural analgesia. 95 92

Moderate drinking for the elderly of both genders is no more than one drink per day, where a drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits. Age does not affect the rate of absorption or elimination of alcohol. Lean body mass decreases and adipose tissue increases with age, however, resulting in a corresponding decrease in the volume of total body water. With a smaller volume of distribution, an alcohol dose identical to that administered to a younger individual of the same size and gender will produce a higher blood alcohol concentration in the elderly. Low-dose alcohol stimulates appetite and promoters regular bowel function. In the well-nourished nonalcoholic elderly, the negative impact of alcohol consumption on nutrition is minimal. Alcohol consumption improves mood by increasing feelings of happiness and freedom from care while lessening inhibitions, stress, tension, and depression. Although in the laboratory low-dose alcohol improves certain types of cognitive function in young men, in other types of task performance, alcohol induces impairment, which worsens with age. The effects of alcohol on sleep are primarily detrimental, worsening both insomnia and breathing disturbances during sleep. Although the role of alcohol consumption in mortality from heart disease has not been investigated in the elderly, moderate drinking appears safe. Under some circumstances low-dose alcohol may produce analgesia whereas in others it may worsen pain. The elderly use a significant proportion of both prescription and over-the-counter medication, a large variety of which interact with alcohol. Alcoholic beverage consumption may exacerbate cognitive impairment and dementias of other etiology. Although some studies suggest that moderate use of alcohol by institutionalized senior citizens appears to produce benefits including improved socialization, separation of the effects of the social situation from those specifically attributable to alcohol remains to be accomplished. Older individuals who want to drink, have no medical contraindications, and take no drugs (prescription or over-the-counter) that interact with alcohol, may consider one drink a day to be a prudent level of alcohol consumption. Patients should be counseled to avoid alcohol consumption immediately prior to going to bed in order to avoid sleep disturbances. They also should be cautioned against potential drug-alcohol interactions and told to avoid alcohol ingestion prior to activities such as driving. The decision to recommend a particular level of alcohol consumption in any given patient must, however, be carefully tailored not only to that individual's specific medical needs but to his or her social and environmental circumstances as well.
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PMID:Alcohol and the elderly. 157 71

Disorders of ventilation and postoperative bronchial and pulmonary infections still create serious problems in general surgery. Three factors determine these complications: (1) the transient and usually resolutive repercussions of anaesthesia on ventilation; (2) the sometimes deep and prolonged alteration of lung function directly due to the surgical procedure, and (3) the patient's underlying condition. In practice, this last group of surgical patients can be divided into fragile subjects (elderly people, pregnant women), subjects at risk (smokers, malnourished or obese patients) and disabled subjects suffering from chronic obstructive or restrictive lung disease, asthma or heart disease. Preoperative clinical, radiological and, chiefly, functional evaluation leads to preventive measures. Preparation for surgery relies, to a great extent, on respiratory physiotherapy which, if needed, may be integrated in a pneumological therapeutic program. Combined with an efficient postoperative analgesia and with an optional anaesthesia technique, respiratory physiotherapy is essential to the prevention of respiratory complications in surgery.
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PMID:[Respiratory risk of general surgery in adults]. 188 56

Xylazine (0.05 mg/kg of body weight diluted to a 5-ml volume, using 0.9% NaCl) or 5 ml of 0.9% NaCl was administered epidurally into the first caudal intervertebral space (Co1-Co2) in 8 cows (mean +/- SD body weight, 583 +/- 150 kg). Cows were observed for responses to deep needle pricking of the caudal dermatomes (S3 to Co), sedation, and ataxia. Heart rate, respiratory rate, body temperature, rate of ruminal contractions, coccygeal arterial blood pressure, pHa, blood gas tension (PaO2, PaCO2), base excess, total solids concentration, and PCV were determined before and after xylazine administration. Epidurally administered xylazine induced sedation and selective (S3 to Co) analgesia for at least 2 hours. Mild ataxia of hind limbs was observed in 6 cows, but all cows remained standing. Heart rate, respiratory rate, rate of ruminal contractions, arterial blood pressure, PaO2, PCV, and total solids concentration were significantly (P less than 0.05) decreased, and PaCO2, base excess, and bicarbonate concentration were significantly (P less than 0.05) increased after xylazine administration. Epidurally administered 0.9% NaCl did not alter sensory perception to needle pricking and did not affect any of the physiologic variables determined. Although epidural administration of xylazine induced analgesia and sedation in healthy cows, it should be avoided for epidural analgesia in cattle with heart disease, lung disease, and/or gastrointestinal disease because of its potent cardiopulmonary and ruminal depressant effects.
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PMID:Caudal epidural analgesia induced by xylazine administration in cows. 238 20

This article summarized the effects of combined acupuncture-epidural anaesthesia (n = 37) and epidural anaesthesia (n = 37) for operations of patients being in a critical, old, weak or special condition. And, the effects were compared between the two different anaesthetic methods in a similar clinical condition. The patients studied were almost complicated with coronary arteriosclerotic heart disease, hypertension or other types of disease excepting the surgical condition. There were different degrees of functional disturbance in their important visceral organs. The states of the body were all belong to critical or weak condition. This might be a difficulty of considerably great for anaesthesia and operation. By using combined acupuncture-epidural anaesthesia, the advantages of acupuncture anaesthesia and epidural anaesthesia were brought into fully play, and, the defect of incomplete analgesia as well as inadequate muscle relaxation was remedied. By acupuncture for 30 to 40 minutes, the EGGs that were originally abnormal had shown some improvement in parts of case and recovered to normal in individual patient. Even though the EGGs had not shown improvement in some cases, but, took no further steps to deteriorate, although undergoing harmful effects in operative process, such as exploration, hemorrhage or others. In some cases, the circulative function showed stabilization exceeding one's expectations. The result showed that acupuncture has a regulative role on the cardiovascular system, thus enhancing the safety in anaesthetic process.
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PMID:[A summary on effects of combined acupuncture anaesthesia for critical, old, week, special patients]. 251

Nine hundred twelve patients received continuous epidural analgesia administered through an indwelling plastic catheter while undergoing vascular reconstruction of a lower extremity. During a portion of the operative event, the patients were totally, transiently anticoagulated with heparin. None of the patients had an untoward neurologic event that could be attributed to an epidural hematoma. Our results and those of others show that this form of regional analgesia is safe and far outweighs theoretic contraindications when anticoagulation with heparin is planned as a part of the operative event. In the patients with impaired pulmonary ventilation or a cardiac disorder, this method of analgesia offers many advantages over a general anesthetic, such as obviating aspiration pneumonitis and averting prolonged support in the recovery period after completion of the surgical procedure. The regional vasodilation ensuing from the epidural blockade is an additional advantage in patients undergoing vascular reconstruction for lower extremity ischemia.
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PMID:Continuous epidural analgesia in the heparinized vascular surgical patient: a retrospective review of 912 patients. 361 64

Seventeen infants were treated with inhaled nitric oxide for critical pulmonary artery hypertension after operations for congenital heart defects. In all 17 patients conventional medical therapy consisting of hyperventilation, deep sedation/analgesia, and correction of metabolic acidosis had failed. All children were monitored with a transthoracic pulmonary artery catheter inserted at operation. Pulmonary artery hypertension was defined as an acute rise in pulmonary pressure associated with a decrease in oxygen arterial or venous saturation. After failure of conventional medical therapy, 20 ppm of inhaled nitric oxide was administered to the patient. In all patients the pulmonary pressures decreased (mean pulmonary arterial pressure decreased by -34% +/- 21%) without significant change in systemic arterial pressure, whereas the oxygen arterial saturation and oxygen venous saturation increased by 9.7% +/- 12% and 37% +/- 28%, respectively. Fifteen children were discharged from the intensive care unit at 10 +/- 6 days (range 3 to 26 days) and two died. This study demonstrates that inhaled nitric oxide exerts a selective pulmonary vasodilation without decreasing systemic arterial pressure in children with congenital heart disease. The increased values of mixed venous oxygen saturation and urinary output suggest that this selective lowering of pulmonary vascular resistance improved the overall hemodynamics. The potential toxic effects of nitric oxide and nitrogen dioxide necessitate careful consideration of the risks and benefits of inhaled nitric oxide therapy.
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PMID:Inhaled nitric oxide as a therapy for pulmonary hypertension after operations for congenital heart defects. 815 35

Data were collected from a retrospective audit in anaesthetists members of the French Association of Anaesthetists in Paediatrics (ADARPEF) and from the prospective study of the author's practice of appendectomy using open or laparoscopic surgery. Retrospective data obtained in 9 of the 16 answering centres show that contraindications include respiratory disability, cardiopathy and age lower than 5 years when surgical instruments of proper size are not available. Monitoring included electrocardioscope, non invasive arterial pressure, pulse oximetry and capnography. Three centres excluded halothane due to possible cardiovascular concern. In two institutions N2O was omitted to limit the size of potential gas embolism. Intraoperative events included high PETCO2 (37%), high arterial pressure (10%), low arterial pressure (3%), bradycardia (1%), hypoxia (0.5%) and one case of pneumothorax. In the appendectomy series, laparoscopy increased the duration of the procedure, and therefore intraoperative opioids requirements. Arterial pressure was higher in this group, irrespective to intraabdominal pressure and to PETCO2. No significant improvement in postoperative analgesia was found. It is therefore recommended to pay special attention to intraoperative anaesthetic and surgical management of children undergoing laparoscopic surgery, particularly in newborns and infants. The high incidence of minor intraoperative adverse events should be balanced by increased postoperative benefit to the patient which has not yet been demonstrated in children.
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PMID:[Laparoscopic surgery in pediatrics: the point of view of the anesthetist]. 837 18

A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.
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PMID:Arrhythmia during extracorporeal shock wave lithotripsy. 843 16


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