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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present study was designed to compare the hemodynamic changes of epidural bupivacaine (EB) with epidural sufentanil (ES), supplemented by general anesthesia, in patients scheduled for abdominal aorto-iliac surgery. Twenty-eight ASA Grade 2 patients randomly received bupivacaine 0.5%, 1-1.5 mg kg-1 (n = 14) or sufentanil 150 micrograms (n = 14) epidurally at T12-L1, combined with light general anesthesia. Hemodynamics were measured before (T1) and after (T2) injection of EB or ES, after induction of general anesthesia (T3), and during the aortic dissection period (T4). EB or ES injection both produced a significant decrease in systolic, mean and diastolic blood pressure, left ventricular stroke work index (LVSWI) and coronary perfusion pressure (CPP). The induction of general anesthesia caused a significant fall in heart rate (HR) and cardiac index (CI) in the ES group. Abdominal dissection restored systemic pressure and cardiac index in the ES group. It was concluded that both ES and EB provided adequate analgesia and hemodynamics during tracheal intubation and abdominal dissection for aorto-iliac surgery.
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PMID:Epidural bupivacaine versus epidural sufentanil anesthesia: hemodynamic differences during induction of anesthesia and abdominal dissection in aortic surgery. 130 Aug 56

The purpose of this study was to determine whether external pressure on legs and abdomen could prevent venous blood pooling in persons with paraplegia and thus positively affect their cardiovascular responses to arm exercise. To investigate this, five male subjects with paraplegia (P), with complete lesions between T6 and T12, and five male control subjects who were wheelchair bound (C) (due to a chronic lower extremity disability), performed submaximal arm-cranking exercise at 20%, 40%, and 60% of their maximal power output (Wmax), with and without an antigravity (anti-G) suit inflated to 52 mm Hg (1 psi). For P, higher preexercise systolic pressure (127 vs 117 mm Hg) was seen with the anti-G suit. At 40 and 60% Wmax, significantly lower heart rates (at 40% = 5.7%; at 60% = 10.6%) at similar cardiac outputs were seen for P with an anti-G suit. Although not significant, P also demonstrated higher stroke volumes at 40% (4.8%) and 60% (5.0%) Wmax with external pressure. For C, no differences in preexercise blood pressure or cardiovascular responses at all three exercise levels were seen with or without the anti-G suit. These data suggest that an inflated anti-G suit is able to prevent venous blood pooling and offers hemodynamic benefits in persons with paraplegia during submaximal arm-cranking exercise. In addition, this study reports a possible alternative to hosiery or functional neuromuscular stimulation that could be applied to all subjects with spinal cord injuries regardless of type or duration of the lesion or of muscle-atrophy.
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PMID:The effect of an anti-G suit on cardiovascular responses to exercise in persons with paraplegia. 140 99

The purpose of this study was to examine cardiovascular responses during arm exercise in paraplegics compared to a well-matched control group. A group of 11 male paraplegics (P) with complete spinal cord-lesions between T6 and T12 and 11 male control subjects (C), matched for physical activity, sport participation and age performed maximal arm-cranking exercise and submaximal exercise at 20%, 40% and 60% of the maximal load for each individual. Cardiac output (Qc) was determined by the CO2 rebreathing method. Maximal oxygen uptake was significantly lower and maximal heart rate (fc) was significantly higher in P compared to C. At the same oxygen uptakes no significant differences were observed in Qc between P and C; however, stroke volume (SV) was significantly lower and fc significantly higher in P than in C. The lower SV in P could be explained by an impaired redistribution of blood and, therefore, a reduced ventricular filling pressure, due to pooling of venous blood caused by inactivity of the skeletal muscle pump in the legs and lack of sympathetic vasoconstriction below the lesion. In conclusion, in P maximal performance appears to have been limited by a smaller active muscle mass and a lower SV despite the higher fc,max. During submaximal exercise, however, this lower SV was compensated for by a higher fc and, thus at the same submaximal oxygen uptake, Qc was similar to that in the control group.
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PMID:Cardiovascular responses in paraplegic subjects during arm exercise. 150 43

We describe two patients who developed neurological side effects as part of the spectrum of nitritoid reactions. Both reactions occurred late in the course of treatment. The first patient developed mild nitritoid symptoms and pain in a band-like distribution, corresponding to T10-T12 dermatomes, shortly after gold sodium thiomalate (GSTM) injection. Further injections were followed by similar symptoms in addition to paraesthesiae and altered pin-prick sensation of anterior thigh and legs with no residual deficit. She has had no further episodes since substitution of aurothioglucose. The second patient experienced mild nitritoid symptoms following several GSTM injections prior experiencing a cerebrovascular accident within several hours of her next injection. She subsequently haemorrhaged into the infarcted area with residual neurological deficits. These cases highlight that nitritoid reactions can be severe and may be heralded by milder symptoms. Patients who develop these reactions whilst receiving GSTM can be successfully changed to aurothioglucose.
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PMID:Neurological side effects in two patients receiving gold injections for rheumatoid arthritis. 758 10

Thoracic epidural analgesia combined with chronic beta-adrenergic blocker medication may cause cardiac depression. We investigated the cardiovascular and myocardial metabolic effects of a T1-T12 epidural block in 18 patients (age < 65 yr, ejection fraction > 0.5), receiving chronic beta-adrenergic blocker medication and scheduled for aortocoronary bypass surgery. After randomization into a light or deeper general anesthetic group, the cardiovascular and myocardial metabolic effects of a subsequent general anesthesia induction were investigated. Thoracic epidural analgesia induced a moderate decrease in mean arterial pressure, coronary perfusion pressure, free fatty acids, and myocardial consumption of free fatty acids. General anesthesia with thiopental (2-4 mg/kg) and a low fentanyl dose (5 micrograms/kg) increased heart rate, coronary perfusion pressure, and coronary vascular resistance, whereas mean pulmonary arterial pressure and pulmonary capillary wedge pressure decreased. After thiopental (2-4 mg/kg) and a high fentanyl dose (30 micrograms/kg), mean arterial pressure and left ventricular stroke work index decreased. We conclude that a T1-T12 epidural block in well sedated, beta-adrenergic blocked patients does not induce clinically significant cardiovascular effects. Induction of general anesthesia was well tolerated, but the light general anesthetic could not prevent an increase in heart rate and coronary vascular resistance, whereas the deeper anesthetic induced slight myocardial depression. No effect on the atrioventricular conduction, as measured by the PQ-time, was noted.
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PMID:The influence of thoracic epidural analgesia alone and in combination with general anesthesia on cardiovascular function and myocardial metabolism in patients receiving beta-adrenergic blockers. 810 48

The dependence of power on aerobic and anaerobic energy metabolism and on force production was studied in maximal leg exercise. National and international level male rowers (n = 9) performed four modified (legs-only) rowing ergometer exercises: a progressive test, 2-min (T2), 12-min (T12) and 6-min (T6) all-out tests. In T2, significant correlations were observed between power in T2 (PT2) and oxygen debt (r = 0.83, P < 0.05) and between PT2 and average force production (Fav) during the last 30 s (r = 0.85, P < 0.05). These parameters explained 93% of the variation in PT2. The highest correlations between power in T6 (PT6) and physiological parameters were as follows: maximal oxygen uptake (VO2 max: r = 0.87, P < 0.01), blood bicarbonate concentration before the test ([HCO3-before]: r = 0.85, P < 0.05) and blood lactate concentration on anaerobic threshold (BLaAnT: r = -0.82, P < 0.05). Together, these parameters explained 92% of the variation in PT6. In T12, the total power (PT12) correlated with power of anaerobic threshold (PAnT: r = 0.95, P < 0.001) and with the highest VO2 value in this test (VO2 peak: r = 0.92, P < 0.001). These two parameters explained 96% of the variation in PT12. The decrease of at least one of the force parameters during each test was taken as a sign of fatigue. The decline in force was compensated for by an increase in stroke rate at the end of T6 and T12 (P < 0.01, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Interrelations between power, force production and energy metabolism in maximal leg work using a modified rowing ergometer. 833 55

The purpose of this investigation was to compare cardiac output (Qc) in paraplegic subjects (P) with wheelchair-confined control subjects (C) at high intensities of arm exercise. At low and moderate exercise intensity Qc was the same at a given oxygen uptake (VO2) in P and C. A group of 11 athletic male P with complete spinal-cord lesions between T6 and T12 and a group of 5 well-matched athletic male C performed maximal arm-cranking exercise and submaximal exercise at 50%, 70% and 80% of each individual's maximal power output (Wmax). Maximal VO2 (VO2max) was significantly lower, VO2max per kilogram body mass was equal and maximal heart rate (fc) was significantly higher in P compared to C. At VO2 of 1.3, 1.5 and 1.7 l.min-1, and for P 65%-90% of the VO2max, Qc was not significantly different between the groups, although, Qc in P was achieved with a significantly lower stroke volume (SV) and a significantly higher fc. Although the SV was lower in P, it followed the same pattern as SV in C during incremental exercise, i.e. an increase in SV until about 45% Wmax and thereafter a stable SV. The similar Qc at a given VO2 in both groups indicated that, even at high exercise intensities, circulation in P can be considered isokinetic with a complete compensation by fc for a lower SV.
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PMID:Cardiac output in paraplegic subjects at high exercise intensities. 835 54

The purpose of this study was to investigate cardiovascular responses in subjects with paraplegia (P) during prolonged upper body exercise in a hot environment. In addition, the effect of the level of the lesion on cardiovascular regulation of persons with paraplegia was studied. Four P with lesions between T2-T6 (P1), five P with T7-T8 lesions (P2), four P with lesions between T9-T12 (P3), and 10 control subjects (C) performed 45-min arm-cranking exercise at 40% of the individual peak power output, in a climatic room at 35 degrees C with a 70% relative humidity. From the 15th to the 45th min, cardiac output (Q) and oxygen uptake (VO2) remained unaltered in all subjects, except a significant decrease of Q in P1. Stroke volume (SV) decreased significantly in both P (-20%) and C (-18%) during the test. Heart rate (HR) increased in compensation for P2 (56%), P3 (65%), and C (55%), whereas HR in P1 did not increase significantly. Hemoglobin concentration changes, representing total plasma volume changes, increased significantly in P2, P3, and C but not in P1. Weight loss and sweat rate increased relative to the sensate skin area and, thus, to the level of the spinal cord lesion (P < 0.01). In conclusion, P with lesions below T6 are able to maintain a stable Q by increasing HR to compensate for the declining SV during exercise in a hot environment. P with lesions above T6 cannot fully compensate for the reduction in SV by an increase in HR, therefore, Q declines.
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PMID:Cardiovascular responses in persons with paraplegia to prolonged arm exercise and thermal stress. 849 85

Exercise intolerance in persons with paraplegia (PARAS) is thought to be secondary to insufficient venous return and a subnormal cardiac output at a given oxygen uptake. However, these issues have not been resolved fully. This study utilized lower-body positive pressure (LBPP) as an intervention during arm crank exercise in PARAS in order to examine this issue. Endurance-trained (TP, n = 7) and untrained PARAS (UP, n = 10) with complete lesions between T6 and T12, and a control group consisting of sedentary able-bodied subjects (SAB, n = 10) were tested. UP and TP subjects demonstrated a diminished cardiac output (via CO2 rebreathing) during exercise compared to SAB subjects. Peak oxygen uptake (O2peak) remained unchanged for all groups following LBPP. LBPP resulted in a significant decrease in heart rate (HR) in UP and TP (P < 0.05), but not SAB subjects. LBPP produced an insignificant increase in cardiac output (Q) and stroke volume (SV). The significant decrease in HR in both PARA groups may indicate a modest hemodynamic benefit of LBPP at higher work rates where circulatory sufficiency may be most compromised. We conclude that PARAS possess a diminished cardiac output during exercise compared to the able-bodied, and LBPP fails to ameliorate significantly their exercise response irrespective of the conditioning level. These results support previous observations of a lower cardiac output during exercise in PARAS, but indicate that lower-limb blood pooling may not be a primary limitation to arm exercise in paraplegia.
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PMID:The effect of lower body positive pressure on the cardiovascular response to exercise in sedentary and endurance-trained persons with paraplegia. 969 13

This study investigated whether a 60-minute arm-cranking exercise at 50% of the individual maximal power output would increase lower limb skin blood flow (laser Doppler flowmetry) in individuals with high-level (T5-T9; n = 6) and low-level paraplegia (T10-T12; n = 6), compared to 6 able-bodied controls. Significant (P < 0.05) group by time interactions (two-way repeated measures ANOVA) were found for leg cutaneous vascular conductance, leg skin temperature and esophageal temperature. Cutaneous vascular conductance increased to a peak of approximately 180% of pre-exercise rest in both paraplegic groups and to -436% in the control group, with differences after 15, 30, 45 and 60 minutes of exercise. Leg skin temperature increased by approximately 0.3 C in individuals with paraplegia and decreased by approximately 2.0 C in able-bodied. Esophageal temperature increases at the end of exercise were higher in individuals with paraplegia (approximately 0.9 C) than in able-bodied subjects (approximately 0.5 C). Heart rate was higher in the paraplegic groups than in able-bodied, whilst stroke volume and cardiac output were not different (impedance cardiography). The data suggest that lesion level had no influence on the results. These findings indicate that there is no excessive shunting of blood to the skin of the lower limbs of individuals with paraplegia during sustained exercise.
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PMID:Cutaneous vascular response and thermoregulation in individuals with paraplegia during sustained arm-cranking exercise. 1128 24


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