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

The aims of this study were: 1) to describe the frequency and type of cardiopulmonary complications, 2) to identify factors significantly associated with cardiovascular and pulmonary complications associated with anaesthesia and surgery, and 3) to estimate the total risk of cardiopulmonary complications for an anaesthetic when a combination of risk factors is present. Seven thousand three hundred and six anaesthetized patients undergoing gastrointestinal, urological, gynaecological, and orthopaedic surgery were included in the study; 6.3% (1:16) had one or more cardiovascular complications requiring intervention associated with anaesthesia and surgery, and 4.8% (1:21) had pulmonary complications. The total incidence of patients with one or more complications associated with anaesthesia and surgery was 9.4% (1:11). Based on logistic regression analyses, our data indicate that the following patient categories constitute high risk patients with regard to cardiovascular complications: patients aged greater than or equal to 70 years, patients with a history of ischaemic heart disease (IHD) with previous myocardial infarction less than 1 year, a history of chronic heart failure (CHF), and in patients admitted to major surgery. The extent of pulmonary complications following anaesthesia and surgery was significantly correlated to patients aged greater than or equal to 70 years, preoperative chronic obstructive lung disease (COLD), major surgery, and to general anaesthesia involving muscle relaxants. Attempts to estimate the cardiopulmonary complications which may accompany anaesthesia and surgery provided important information about the anaesthetic course and outcome. With our model it seems possible to distinguish between very different levels of cardiopulmonary risk in the anaesthetic patient.
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PMID:A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. 230 15

In a prospective study we examined the strength of association between preoperative left ventricular performance measured by radionuclide cardiography in patients with cardiac or pulmonary insufficiency (high-risk patients) and cardiopulmonary complications associated with anaesthesia and surgery. Detailed pre-, intra- and postoperative data collected for 7306 anaesthetized patients were included in the study. One hundred and thirty-one patients (1.8%) were classified as high-risk patients, and 95 patients were examined with radionuclide cardiography. The results demonstrated a 58% incidence of cardiovascular complications for high-risk patients when the left ventricular ejection fraction (LVEF) was abnormal (less than 50% or greater than 70%) compared with 12% when LVEF was normal (50-70%). In addition, high-risk patients with left ventricular end-diastolic volume (LVEDV) greater than 140 ml developed cardiovascular complications in 37% of the cases. Patients admitted to major surgery with LVEF less than 50 or greater than 70% were at greater risk than patients with LVEF = 50-70% as demonstrated by a significant increase in the total incidence of cardiopulmonary complications, 70% vs. 17%. It is appropriate to measure LVEF in patients admitted for major surgery who have an increased risk of cardiopulmonary complications as clinically evidenced by heart failure or severe ischaemic heart disease. As the predictive information given by LVEDV was less than that given by LVEF, there are no clinical reasons for measurement of LVEDV.
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PMID:Cardiopulmonary complications in high-risk surgical patients: the value of preoperative radionuclide cardiography. 234 18

A model of acute rat heart damage by a large single dose of isoprenaline (ISO) (100 mg.kg-1 s.c.) was assessed for its suitability to evaluate changes in drug kinetics in acute heart failure. Within 24h after the administration of the above dose the colorimetric dilution method revealed a decrease in cardiac output by more than 20% and mild increase in total peripheral resistance in anaesthetized female Wistar rats. At the same time, marked hypotension developed with a decrease in mean arterial blood pressure by nearly 20%. An acceleration of both depolarization and repolarization of the atrial and ventricular musculatures and a surprising bradycardia were demonstrated electrocardiographically. ECG failed to demonstrate any signs of myocardial ischaemia. Determination of bromsulphalein and inulin clearance values revealed decreased liver and kidney function. Mild anaesthesia-induced respiratory and metabolic acidosis was improved by ISO administration. The described model at least partially corresponds to the manifestations of acute heart failure with hypotension in man.
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PMID:Changes in cardiac output, hepatic and renal functions in rats with isoprenaline-induced heart damage. 235 Sep 69

Anesthetic management of patients with cardiomyopathy was studied. In the past 8 years, we experienced 24 surgical procedures for 16 patients complicated with cardiomyopathy of whom 6 cases with hypertrophic type (HCM) and 10 cases with dilated type (DCM). In HCM there was no correlation between the incidence of intraoperative complication and preoperative evaluation by New York Heart Association. In HCM cases who revealed atrial fibrillation, conduction disturbance on ECG and hypokinesis on echocardiogram resulted in high incidence of cardiac complication during anesthesia. Induction of anesthesia is extremely risky if the anesthesiologist is not aware of the presence of cardiomyopathies. In DCM, preoperative episode of heart failure, arrhythmias and conduction disturbance on ECG were considered as anesthetic risk factors. Both in HCM and DCM, there were no statistical significance in complication between general anesthesia and epidural anesthesia. The authors recommend epidural technique as a method of choice for HCM patient.
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PMID:[Anesthetic management of patients with cardiomyopathies]. 238 60

A 57-year-old man was given 40 mg of activated carbon aclacinomycin (ACM) emulsion into mesenteric lymph nodes during anesthesia with enflurane, nitrous oxide, oxygen and epidural anesthesia. He had no complications preoperatively. Immediately after the injection, his skin turned to red, and 5 minutes later, sinus tachycardia, R wave amplitude reduction, T wave amplitude elevation, QT prolongation and PVCs were noted, and then, ventricular fibrillation (Vf) occurred 15 minutes after the injection. We succeeded in electrical defibrillation within about 180 seconds. At that time, both arterial blood gas and electrocytes were normal. Serum ACM concentration was remarkably elevated 60 minutes after the administration, and remained high 22 hrs later. Postoperative course was uneventful and he was discharged on the 17th postoperative day. It has been said that ACM has relatively low cardiotoxicity compared with adriamycin because of rapid distribution and metabolism. However, it might cause cardiac complication such as ECG abnormality, heart failure, pericarditis, though the effects are transient and reversible. Therefore we should be ready for its rapid treatment. Coenzyme Q10 could counteract cardiotoxicity of ACM.
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PMID:[Ventricular fibrillation after administration of aclacinomycin emulsion into mesenteric lymph nodes in a patient anesthetized with enflurane, nitrous oxide and oxygen]. 238 61

Two cases of malignant hyperthermia (MH) are presented. The first patient presented initially with tachyarrhythmia intraoperatively and rapid onset of MH crisis. Nasopharyngeal temperature of 43 degrees C was attained after 15-20 minutes of anaesthesia. The patient eventually died of myocardial failure despite external cardiac massage, inotropic support and ventricular pacing. The second patient presented with increasing endogenous hypercarbia following the administration of suxamethonium and isoflurane. The use of the end tidal carbon dioxide monitor led to an early diagnosis of MH. The early use of dantrolene may have contributed to the favourable outcome.
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PMID:Malignant hyperthermia. 239 48

The natriuretic, diuretic, and hypotensive responses to infused atrial natriuretic peptide (ANP) were measured in rats 4 weeks after myocardial infarction induced by coronary artery ligation. Rat [1-28]-ANP was infused intravenously in doses of 0.1, 0.3, and 1.0 microgram/kg/min for 30 min each under pentobarbital anesthesia. There was a marked natriuresis, diuresis, and fall in blood pressure in rats with infarction but each response was significantly attenuated when compared with sham-operated controls (ANOVA: p less than 0.01, p less than 0.05, and p less than 0.01, respectively). Urinary cyclic guanosine monophosphate (cGMP) excretion in rats with infarction was higher than that of controls but rose to the same absolute level in both groups in response to ANP infusion (0.3 microgram/kg/min). Reduced ANP responsiveness may result from impaired postreceptor mechanisms or from physiological antagonism by angiotensin II. Reduced ANP responsiveness may partly explain impaired salt handling in heart failure.
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PMID:Atrial natriuretic peptide infusion in chronic heart failure in the rat. 247 48

Because of increasing dyspnea, adenoidectomy and tonsillectomy were indicated in a 6-year-old girl with Pfaundler-Hurler disease. The main symptoms were cardiac insufficiency and chronic bronchitis. Because of the large skull with hypoplastic cervical spine, anomalies of facial bones, larynx and jawbone normal intubation was impossible. We therefore performed intubation during spontaneous breathing under inhalation anesthesia and topical anesthesia of the larynx. After exploratory laryngoscopy a preformed Woodbridge tube was inserted into the trachea blind and by ear during of inspiration. The patient's cardiac insufficiency and chronic bronchitis made a balanced anesthesia with reduced dosage of rapifen and halothane necessary. In spite of the poor general prognosis, after the operation a considerable relief of the patient's suffering was noted, because she was able to breathe freely.
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PMID:[Difficult intubation and anesthesia in Pfaundler-Hurler disease]. 249 13

The new phosphodiesterase-III inhibitor (PDI) enoximone is a non-catecholamine, non-glycoside cardiotonic agent with concomitant vasodilating properties. It has proved beneficial in patients with severe chronic heart failure. The influence of enoximone i.v. on hemodynamics was investigated during cardiac surgery under various conditions. METHODS. A randomized series of 60 patients undergoing elective aorto-coronary bypass grafting were studied. The hemodynamic effects of 0.5 mg/kg enoximone given i.v. as a bolus (30 s) were investigated before anesthesia (n = 10), during anesthesia (n = 10), and during extracorporeal circulation (ECC, n = 10) and compared with those observed in corresponding control groups (n = 10 in each control) of patients who had received saline solution as placebo. Anesthesia was maintained with weight-dependent dosages of fentanyl, midazolam and pancuronium bromide. All patients were invasively monitored by means of a pulmonary artery catheter. Additionally, left ventricular pressure (LVP), left ventricular end-diastolic pressure (LVEDP) and dp/dtmax were measured before the initiation of ECC. During ECC direct vascular effects were investigated with measurement of perfusion pressure and the volume of the oxygenator. RESULTS. Before the induction of anesthesia no significant change in MAP and HR could be observed, whereas CI increased (+20%) and TSR decreased (-24%) significantly. During anesthesia, the injection of enoximone was followed by a significant decrease in MAP only in the 1st min (-17%); baseline level was reached again after 6 min; and HR was slightly increased (+8%). TSR (-31%) and LVEDP (-38%) decreased, whereas CI (+17%) and dp/dtmax (+45%) were increased significantly. During ECC perfusion pressure (-37%) and the volume of the oxygenator (-17%) were significantly decreased, demonstrating direct vasodilating effects on both the arteries and the vein. CONCLUSION. Arterial and venous vasodilation with an increase in myocardial performance (dp/dtmax) resulting in an increase in CI were the predominant hemodynamic effects of enoximone i.v. No arrhythmogenic effects or interactions with the anesthetics used were observed in this study.
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PMID:[Hemodynamic effects of the new phosphodiesterase inhibitor enoximone in heart surgery patients]. 252 51

Myotonia is defined as a persistent contraction of skeletal muscles after their stimulation. This contracture is not prevented or relieved by regional anaesthesia or muscle relaxants. The sensitivity to non-depolarizing muscle relaxants is usually normal. Suxamethonium, neostigmine, hypothermia, a rise in kalaemia should be avoided. There have been case reports of malignant hyperthermia in patients with myotonia congenita. Dystrophia myotonica is the second most frequent of the inherited muscle diseases, after Duchenne's dystrophy. The severity of the disease is due more to the muscular atrophy and the multiple organ involvement than to the abnormal contraction. Atrioventricular heart block and dysrhythmias are more common than heart failure. Prolonged apnoea and pneumonia are the main risks of anaesthesia. In severe cases, exists a restrictive respiratory insufficiency which is preceded by a fall in the maximum expiratory pressure. Dysphagias and inefficient coughing may occur early. An increased susceptibility to hypnotic drugs and opiates is a common feature. Spontaneous sleep apnoeas should be sought before anaesthesia, especially by using pulse oximetry. The anaesthetic implications are reemphasized.
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PMID:[Anesthesia in myotonia]. 253 24


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