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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a double-blind multicenter study, 124 patients with transient ischemic attacks were randomly allocated to one of two groups treated with aspirin (ASA) or sulfinpyrazone respectively. Patients were followed up to assess the relative efficacy of the two treatments in the prevention of the outcomes of stroke, myocardial infarction, vascular death, and worsening or no improvement of TIAs. No significant difference was observed between the two treatments at the end of the follow-up period. Statistical analysis revealed a significant interaction of sex, treatment, and occurrence of events. Analysis of the results according to sex showed that male patients treated with ASA had a highly significant benefit (p less than 0.001) with a 53% risk reduction for further events. In female patients, sulfinpyrazone showed a favorable trend which was not statistically significant.
Stroke
PMID:A randomized trial of aspirin and sulfinpyrazone in patients with TIA. 703 4

The frequency of irreversible induced PA (IPA) by ADP or EN has been studied in 246 stroke patients. Compared to an age and sex matched control group IPA was more frequent in patients with CVD. Eighty six patients were referred to treatment of IPA with ASA or pentoxifylline or both compounds as combined treatment. ASA as well as PO were found to satisfactorily influence IPA however, the best therapeutic results have been achieved by combined treatment.
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PMID:Special therapeutical aspects of cerebrovascular disease. 718 12

Transient cerebral ischemic attacks (TIA) are an important warning symptom of threatening stroke from cerebral infarction (CI). A local treatment program aimed at identifying as many individuals with TIA as possible and treating them in a uniform manner is desirable. Platelet aggregation inhibitors with a combination of acetylsalicylic acid and dipyridamole (ASA + DP) has been compared with anticoagulants (AC). The average length of treatment was 24 months and all patients received the treatment for at least 6 months. Sixty patients received AC and 65 ASA + DP. Four patients in the ASA + DP group (6 percent) and 2 in the AC group (3.3 percent) sustained cerebral infarction. These figures are essentially lower than the expected incidence of 15--20 percent.
Stroke
PMID:Treatment program and comparison between anticoagulants and platelet aggregation inhibitors after transient ischemic attack. 730 42

The clinically acceptable limit of acute normovolemic, normothermic hemodilution, a standard procedure in scoliosis surgery, is not yet well defined. Eight ASA class I patients undergoing idiopathic scoliosis correction were administered a standard anesthetic with 100% oxygen and controlled ventilation. Hemodilution was accomplished by exchanging whole blood for 5% albumin in 0.9% saline. Blood gases, acid-base status, and circulatory variables were recorded prior to and after hemodilution, and every 30 min throughout surgery. The impact of hemodilution was judged by mixed venous oxygen saturation which was maintained at > or = 60%, while intravascular volume was maintained with the 5% albumin solution. Reinfusion of the autologous blood was completed by the end of surgery. In the eight controlled cases in which normovolemic hemodilution was studied, hemoglobin levels decreased from 10.0 +/- 1.6 g/dL to 3.0 +/- 0.8 g/dL. Mixed venous oxygen saturation decreased from 90.8% +/- 5.4% to 72.3% +/- 7.8%. Oxygen extraction ratio increased from 17.3% +/- 6.2% to 44.4% +/- 5.9%. Oxygen delivery decreased from 532.1 +/- 138.1 mL.min-1.m-2 to 260.2 +/- 57.1 mL.min-1.m-2, while global oxygen consumption did not decrease and plasma lactate did not appreciably increase. Central venous pressure increased and peripheral resistance decreased during hemodilution. Cardiac index increased, heart rate remained essentially constant, and left ventricular stroke work index did not decrease significantly. No patients suffered clinically adverse outcomes. Global oxygen transport and myocardial work can be maintained at extreme normovolemic anemia. Our evidence suggests that stages of normovolemic hemodilution more severe than previously reported may be clinically acceptable for young, healthy patients during normocarbic anesthesia.
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PMID:Oxygen consumption and cardiovascular function in children during profound intraoperative normovolemic hemodilution. 781 2

30 cases receiving epidural anesthesia for lower extremities and abdominal surgery were selected in this study. Their physical status and average age were ASA I or II and 41 +/- 10.0 years old. Premedication included intramuscular injection of pethidine, atropine and promethazine. Epidural anesthesia was accomplished with 15 ml 2% lidocaine with epinephrine (1:80,000). After the stabilization of vital signs, the patients were put asleep by 0.1 mg/kg of midazolam intravenously. They were then evaluated by the sedative, cardiovascular, respiratory and recovery effects of intravenous midazolam in epidural anesthesia. The results were as follows: The patients receiving IV midazolam averagely fell asleep in 61.6 +/- 20.5 seconds and maintained asleep for 55.4 +/- 12.7 minutes. Pain on injection was not noted in these cases. Cardiovascular parameters revealed midazolam with general depression on systolic pressure (17.4 +/- 7.3%), diastolic pressure (13.4 +/- 8.4%), mean arterial pressure (12.7 +/- 7.0%), heart rate (10.9 +/- 7.2%), stroke volume (13.7 +/- 8.9%) and cardiac output (18.4 +/- 7.0%) respectively. The peak depression reached around 10 minutes after drug administration. Respiratory parameters dropped with SaO2 (1.1 +/- 1.6%) and respiratory rate (9.7 +/- 5.7%) and fell into trough after 5 minutes of drug administration. Although all the above parameters measured were statistically significant, they were of no clinical importance that required further management. No case had delirium, anxiety and vomiting in the recovery period. Conclusively, patients receiving epidural anesthesia with supplement of intravenous midazolam provides a good sedative effect. Clinically, there was less severe untowards reaction either in cardiovascular or respiratory systems. Smooth and stable recovery was also noted.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intravenous midazolam for sedation in epidural anesthesia]. 796 37

Hemodynamic responses to pipecuronium bromide or doxacurium chloride were compared in patients undergoing valvular heart surgery. Thirty ASA class III-IV patients of either sex, mean age 62 +/- 3 years (+/- SD), weight 70 +/- 3 kg, were randomly selected to receive either doxacurium (0.08 mg/kg) or pipecuronium (0.15 mg/kg). Hemodynamic parameters were determined at preinduction, induction, 2 minutes and 6 minutes following administration of the muscle relaxant. Anesthetic induction consisted of midazolam, 0.10 mg/kg, followed by fentanyl, 5 micrograms/kg. Measured or calculated parameters were as follows: mean arterial pressure, heart rate, cardiac index, mean pulmonary artery pressure, systemic vascular resistance index, central venous pressure, pulmonary capillary wedge pressure, stroke volume index, left and right stroke work indices, and pulmonary vascular resistance index. Awake patients who had been randomly assigned to the pipecuronium group had significantly higher pulmonary capillary wedge pressures (22 +/- 2 v 15 +/- 2 mmHg; P < 0.05) and heart rates (86 +/- 3 v 64 +/- 5 beats/min; P < 0.05) than awake patients in the doxacurium group. Following induction, both wedge pressure and heart rate were not significantly different between the two groups. Compared to hemodynamics at induction, there were no clinically significant changes following administration of pipecuronium or doxacurium.
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PMID:Comparison of hemodynamic responses to pipecuronium and doxacurium in patients undergoing valvular surgery while anesthetized with fentanyl. 806 Dec 63

We have compared cardiovascular responses to induction of anaesthesia and to tracheal intubation after propofol 2.5 mg kg-1 and pancuronium 0.1 mg kg-1 in 10 diabetic and 10 matched, non-diabetic (control) ASA I patients. Anaesthesia was maintained with 0.8% enflurane and 50% nitrous oxide in oxygen, with assisted ventilation. The trachea was intubated 3 min after induction of anaesthesia. All 10 diabetic patients (but no controls) had abnormal autonomic function when tested on the day before surgery. There was no difference between the two groups in the pre-induction cardiovascular state. Mean arterial pressure and vascular resistance decreased after induction in each group (P < 0.05). Heart rate increased (P < 0.01) and cardiac index was sustained in the control group, but in the diabetic group heart rate did not change and cardiac index decreased (P < 0.01). There was an earlier decrease in stroke index in the diabetic group (2 min) compared with the controls (5 min). After tracheal intubation, heart rate and cardiac index in the control group and cardiac index in the diabetic group remained unchanged. However, there was a greater increase in heart rate, mean arterial pressure and vascular resistance in the diabetic group compared with the controls after tracheal intubation (P < 0.05). The exaggerated pressor response to tracheal intubation, in the diabetic patients, may reflect autonomic dysfunction.
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PMID:Effect of diabetes mellitus on the cardiovascular responses to induction of anaesthesia and tracheal intubation. 812 3

Atrial fibrillation is the second most common arrhythmia after ventricular premature beats. For years, prophylactic anticoagulation has been recommended in patients with atrial fibrillation in underlying rheumatic heart disease. With the aim of establishing the risk of embolism in non-rheumatic atrial fibrillation, and the justification for prophylactic anticoagulation therapy, five prospective studies were carried out. The results obtained indicate that all patients with chronic atrial fibrillation should receive anticoagulation therapy wherever possible (INR 2.0 to 3.0). The sole exception are patients aged under 55 years with no other organic heart disease. For this group, the risk of a stroke is appreciably reduced, so that treatment with ASA suffices.
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PMID:[Anticoagulation in non-rheumatic atrial fibrillation. Recommendations based on five prospective studies]. 814 16

The ASA Closed Claims Project has generated a standardized collection of case summaries of adverse anesthetic outcomes, with the objectives of identifying major areas of anesthesiologist liability and the contribution of substandard care to anesthetic injury. Seventy-six (3%) of the files in the project's current database of over 2,400 case summaries are for anesthesia-related injuries sustained during cardiac surgery. The most common adverse outcomes in the cardiac surgical group were death (36%), brain damage (16%), stroke (13%), and nerve damage (11%). Equipment malfunction or misuse was responsible for 37% of the adverse outcomes in the cardiac group, compared with only 9% in the noncardiac group (P = < 0.01). Conversely, respiratory-related damaging events were responsible for only 9% of adverse outcomes in the cardiac group, compared with 32% of adverse outcomes in the noncardiac claims (P = < 0.01); incidences of damaging events related to the cardiovascular system and those events related to inadequate or inappropriate fluid therapy were similar in both groups. Although there are several important limitations intrinsic to closed-claims analysis, data from the Closed Claims Project suggest that careful attention to IV catheter management and cardiopulmonary bypass equipment will reduce the risk of injury to patients.
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PMID:Risk management in cardiac anesthesia: the ASA Closed Claims Project perspective. 816

Using transthoracic electrical bioimpedance with the BoMed NCCOM3-R7, we measured cardiovascular changes in 16 ASA I and II Chinese patients undergoing laparoscopic cholecystectomy. The peritoneal cavity was insufflated with carbon dioxide to a pressure up to 15 mm Hg. Tidal volume, minute volume and end-tidal carbon dioxide partial pressure were kept constant. Insufflation resulted in a mean (SD) 13 (14)% decrease in stroke index (SI) (P < 0.01), but the effect on cardiac index (CI) was more variable (mean 7 (17)% decrease, range 36% decrease to 22% increase (P = 0.07)). Mean arterial pressure increased by 55 (29)% (P < 0.001) and systemic vascular resistance index increased by 63 (33)% (P < 0.001), with the maximum effect occurring 10-15 min after the commencement of insufflation. Multiple regression analysis showed a greater decrease in SI in patients with a small body mass index and large intraperitoneal pressure (P = 0.01), while a greater decrease in CI was found in patients with a small body mass index and younger age (P = 0.001). Three patients had a further reduction in CI during surgery, with one patient having a 48% decrease compared with pre-induction values. Deflation of the peritoneum resulted in an increase in both CI (25 (26)%) and (22 (29)%) (P < 0.01) to values which were not different from pre-induction data. Arterial blood-gas analysis showed decreases in pH and base excess after 1 h of insufflation (P < 0.01).
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PMID:Haemodynamic changes in patients undergoing laparoscopic cholecystectomy: measurement by transthoracic electrical bioimpedance. 832 62


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