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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Persistent trigeminal neuralgia, herpes zoster neuralgia of the first division of the trigeminal nerve and pain caused by cancer situated in the head and neck pose frustrating problems for patients and physicians. Tractotomy and/or partial vertical nucleotomy of the subnucleus caudalis nervi trigemini offers a logical approach to the treatment of such pain, since these structures contain fibres of the Vth nerve, as well as the somatosensory fibres of the VIIth, IXth and Xth nerve. Tactile and some thermal sensitivity of the face is preserved and anaesthesia dolorosa and keratitis neuroparalytica is avoided. Over the past 30 years 370 patients with therapy-refractory trigeminal pain, pain due to cancer of the head and neck and herpes zoster trigeminal pain were treated by means of tractotomy (personal series of V. Grunert), including 30 patients who underwent partial vertical nucleotomy. The mean age of the patients was 68 years (range 54-84 years). The mortality in this series was 0.9% (4 patients; one operative mortality due to air embolism, one postoperative cardiac failure following myocardial infarction and two intracerebral haematomas). 60% of the patients with persistent trigeminal neuralgia were pain-free and 28% improved, whereas 12% were unchanged or suffered from recurrent pain. Of the patients with cancer who complained of pain derived from the Vth, VIIth, IXth and Xth nerve, 40% demonstrated marked pain relief and 60% showed no improvement. Tractotomy and partial vertical nucleotomy offer a valuable method in experienced hands for relieving pain where other methods have failed.
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PMID:[Tractotomy and partial nucleotomy as a form of therapy in refractory pain of the trigeminal nerve and cancer pain in the head and neck area]. 170 47

Little information is available about the incidence of severe adverse outcomes, and even less information is available about the identification and quantification of independent predictors of severe perioperative adverse outcomes. The purpose of this study was to identify and quantitate independent predictors of severe perioperative adverse outcomes in a prospective randomized clinical trial of general anesthesia in 17,201 patients. Twenty-nine prognostic variables for 15 severe outcomes in 847 patients were tested by multiple stepwise logistic regressions from which 20 significant (P less than 0.05) predictors were identified. A history of cardiac failure or myocardial infarction less than or equal to 1 yr; ASA physical status 3 or 4; age greater than 50 yr; cardiovascular, thoracic, abdominal or neurologic surgery; and the study anesthetics were significant predictors of "any severe outcome, including death." There were 17 significant predictors for 10 severe cardiovascular outcomes in 608 patients, including a history of ventricular arrhythmia, hypertension, cardiac failure, myocardial ischemia, myocardial infarction less than or equal to 1 yr or myocardial infarction greater than 1 yr, and smoking; ASA physical status; age; cardiovascular, thoracic, abdominal, eyes-ears-nose-throat/endocrine, neurologic, musculoskeletal, or gynecologic surgery; and the study anesthetics. There were 9 significant predictors for 4 severe respiratory outcomes in 163 patients, including a history of cardiac failure, myocardial ischemia, or chronic obstructive pulmonary disease; obesity; smoking; male gender; ASA physical status; abdominal surgery; and the study anesthetics. Colinearity between related prognostic variables (such as disease and ASA physical status) was assessed using progressively segregated groups of variables in eight stepwise logistic regressions. We conclude that the comprehensive stepwise logistic regression of 29 prognostic variables reported here provides a valid estimate of the risks of severe perioperative outcomes associated with general anesthesia.
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PMID:Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. 172 12

Venous thromboembolism is complex with a multifactorial etiology. The Virchow triad (changes in blood flow, changes in vessel wall, and changes in the properties of blood) gives the main factors involved in venous thromboembolism. Venous stasis during immobilization in general anesthesia, stroke with hemiparesis, and heart failure plays a central role. The thromboembolic process can be initiated by a disturbance in the normal "hemostatic balance," with an increased thrombogenic potential, due to release of thromboplastin and collagen exposure during vessel wall injury by stasis and hypoxia, decreased fibrinolysis during surgery, malignancy, among others. Many substances modify these processes, including heparan sulfate, AT III, protein C, t-PA inhibitor, and alpha 2-antiplasmin.
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PMID:Pathophysiology of venous thromboembolism. 175 82

An opiate-based anaesthetic technique has been developed for use in dogs with end-stage heart failure due to dilated cardiomyopathy. It has been used in dogs undergoing translocation of the left latissimus dorsi around the descending thoracic aorta to create an autologous counterpulsation system. Anaesthesia was induced with barbiturate (10 mg/kg thiopentone) and fentanyl (500 micrograms) and maintained by an infusion of fentanyl (0.5 micrograms/kg/minute) [corrected] in addition to halothane (0.1 to 0.5 per cent) and nitrous oxide (20 to 60 per cent). This technique provided safe anaesthesia for major intrathoracic surgery.
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PMID:Development of an opiate-based anaesthetic technique for use in dogs with cardiomyopathy. 154 87

A study was designed to assess the possible effects of intravenous clonidine on postoperative shivering. Fifty patients undergoing spinal fusion under isoflurane anaesthesia were randomly assigned to two groups (n = 25). Patients in one group were given intravenous clonidine (5 micrograms.kg-1 during the first hour, and 0.3 microgram.kg-1.h-1 thereafter) or placebo. Shivering intensity (rated from 0 to 2) and pulmonary artery blood temperature (theta) was recorded every ten minutes for two hours. Haemodynamic and metabolic data were obtained by way of a Swan-Ganz catheter prior to administering the test drug, and then after 1 and 2 hours. On arrival at the recovery room, theta was 36.2 +/- 0.3 degrees C in the clonidine group, and 36.5 +/- 0.2 degrees C in the placebo group. There were no significant differences in shivering between the two groups. Clonidine significantly decreased blood pressure, heart rate, cardiac output and whole body oxygen consumption. The patients in these series were free from any cardiac disease. Further studies are required to assess the possible beneficial effects of clonidine on postoperative oxygen consumption in patients suffering from heart failure.
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PMID:[Effects of intravenous clonidine on postoperative shivering]. 178 7

Catheter-balloon mitral valvuloplasty was performed in 7 females with rheumatic mitral stenosis on the 19th-32nd week of pregnancy. Four patients were operated on with signs of cardiac insufficiency, two--in a state of pulmonary pre-edema. Edema of the lungs in one patient continued developing on the operating table. The results of the treatment were good in all cases. The area of the mitral orifice increased from 0.9-1.75 to 2.4-3.5 cm2. The pressure gradient between the left atrium and the left ventricle dropped from 25-40 to 2-8 mm Hg. This was attended by the disappearance of the diastolic murmur and the clinical manifestations of stasis in pulmonary circulation in all patients. The development of mitral regurgitation after the operation was not encountered in any of the patients. The period of roentgenoscopy lasted 17.5 min. on the average. Screens were used to protect the fetus from the direct effect of the X-rays. Pregnancy ended in delivery in 6 patients; spontaneous labor at term occurred in 4, cesarean section had to be performed in one patient with placenta previa; one woman gave birth to twins on the 36th week of pregnancy. All the babies were healthy. Catheter-balloon valvulotomy does not yield to closed mitral commissurotomy in efficacy. The fact that it is only mildly injurious and does not need general anesthesia make this intervention preferable for pregnant women suffering from mitral stenosis.
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PMID:[Treatment of mitral valve stenosis in pregnant women by the method of balloon valvuloplasty]. 179 21

A survivor of a clinically severe presentation of amniotic fluid embolism during cesarean section performed under epidural anesthesia is presented. Some general pathophysiologic features of amniotic fluid embolism are discussed in the context of presented case: seizures as a first sign of amniotic fluid embolism, heart failure and coagulopathy. In addition we discuss the management of the epidural catheter in coagulopathy in the presented case.
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PMID:Amniotic fluid embolism during epidural anesthesia for cesarean section. 179 32

Interventional cardiology has become an alternative to surgery in the treatment of coronary artery and stenotic valvular diseases. Percutaneous transluminal coronary angioplasty is a method of treating severe coronary stenoses under simple local anaesthesia with a primary success rate of 90% and a mortality of about 1%--nearly zero in single vessel disease. These results have to be tempered by the relatively common occurrence of restenosis (30 to 40%) which are treatable by repeat angioplasty. Amongst the new techniques under evaluation at present, coronary endoprostheses (stents) seem to be the most effective in reducing the rate of restenosis. Percutaneous mitral valvuloplasty with an inflatable balloon catheter is associated with excellent results in cases of mitral stenosis when the valvular and subvalvular apparatus is not stiff and not calcified. On the other hand, the results of aortic valve dilatation are often inadequate and temporary, and this technique is now reserved for very elderly patients with severe aortic stenosis and irreducible cardiac failure, inoperable, and for patients with symptomatic calcific aortic stenosis who have to undergo urgent extracardiac surgery and who could benefit from valvular replacement at a later date. Interventional cardiology may replace or postpone surgery and allows effective treatment of patients too old or too ill to undergo cardiac surgery.
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PMID:[Interventional cardiology in adults]. 180 82

A 6-month-old child presented with a history, physical signs and radiographic findings suggestive of the presence of a foreign body in the tracheobronchial tree. However, further investigation revealed extrinsic compression of the left main bronchus by a grossly enlarged left atrium. Treatment of the patient's heart failure resulted in resolution of the signs. Anomalous origin of the left coronary artery was found to be the cause.
Anaesthesia 1991 Apr
PMID:An unusual cause of obstructive emphysema. 182 38

Sixteen patients presenting for abdominal aortic surgery were divided into two groups according to whether or not there was a history and clinical evidence of chronic heart failure (CHF). Atrial natriuretic peptide (ANP) and catecholamines were measured during a preoperative exercise test and then with induction of anaesthesia and surgery. Patients in the CHF group (n = 8) had a much-reduced cardiac output (CO) rise in response to exercise compared to the control group (13% vs. 75%, P less than 0.05). This difference was due to the absence of a stroke volume increase in the CHF group. Induction of anaesthesia resulted in a greater fall in mean arterial pressure in the CHF group prior to the start of surgery, due to a greater fall in CO. Plasma ANP levels were higher in the CHF group at rest and at each exercise stage (P less than 0.05). ANP levels were not altered by induction of anaesthesia or intubation, but increased with the start of surgery in the CHF group (P less than 0.05). Increases in plasma catecholamine levels in response to exercise and to surgery were similar in the two groups. Changes in endogenous ANP may be important in counteracting the undesirable effects of vasoconstrictor hormones during physical exercise or surgical stress.
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PMID:Influence of cardiac failure on atrial natriuretic peptide responses in patients undergoing vascular surgery. 183 63


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