Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of CPB on plasma ADH levels, urine flow, and urine osmolality was studied in nine patients. All patients received morphine, 1 mg. per kilogram, and 50 per cent nitrous oxide-50 per cent oxygen for anesthesia. CPB utilized a Travenol disposable bubble oxygenator and the prime consisted of 3 L. of Ringer's lactate. Measurements were made prior to induction of anesthesia , at 30 minutes following surgical incision, and at 15, 30, and 45 minutes during CPB. There were no statistically significant changes in mean arterial BP, cardiac index, serum sodium, or serum osmolality in any period. Urine flow increased from 0.99 +/- 0.3 ml. per minute to a high of 6.13 +/- 2.0 ml. per minute at 30 minute at 30 minutes on CPB (P less than 0.02). Urine osmolality declined from a control value of 691 +/- 142 mOsm. per kilogram to a low of 425 +/- 48 mOsm. per kilogram at 45 minutes on CPB (p less than 0.05). ADH levels rose from a control value of 4.3 +/- 1.5 to 13.0 +/- 3.3 pg. per milliliter with surgical stimulatiion (p less than 0.05). During CPB the ADH levels rose to a peak of 23.7 +/- 3.6 pg. per milliliter at 30 minutes (p less than 0.01) and were declining at 45 minutes. These data suggest that the stress of CPB results in an outpouring of ADH (or vasopressin) to function as a pressor to produce an increase in peripheral resistance. The ADH concentrations far exceed those required for normal physiologic control of water excretion and the urineflow will thus vary more with the hemodynamic changes than with the ADH levels.
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PMID:Antidiuretic hormone levels during cardiopulmonary bypass. 83 Oct 6

We compared endothelin (ET) plasma levels during and after aortocoronary bypass (CPB) grafting in old and young patients. Correlations to cardiopulmonary parameters and catecholamines were tested. The study included 22 patients (11 aged greater than 70 years and 11 aged less than 55 years). Measurements were performed after induction of anesthesia (baseline), before bypass, during bypass, after patients were weaned off bypass, at the end of operation, and after 4-h intensive care (IC) treatment. ET [radioimmunoassay (RIA) technique] and catecholamines [high pressure liquid chromatography (HPLC) technique] plasma levels were determined from arterial blood samples; hemodynamics (pulmonary artery catheter), oxygen data, and laser Doppler flow were also monitored. Baseline ET plasma levels were within normal range (young, 3.1 +/- 0.9 pg/ml, old, 4.5 +/- 1.4 pg/ml). Old patients had higher values during the entire investigation period. During CPB ET plasma levels increased to a maximum immediately after patients were weaned off bypass. A significant increase (twofold to baseline) was noted during IC therapy. ET plasma levels did not correlate to catecholamine plasma levels or to hemodynamic or laser Doppler flow parameters. A significant correlation existed between ET plasma levels and oxygen consumption. Monitoring ET plasma levels appears to be of minor value in predicting circulatory changes and assessing surgical stress. Further investigations must elucidate the increase in oxygen consumption and its correlation to ET plasma level.
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PMID:Endothelin plasma levels in old and young patients during open heart surgery: correlations to cardiopulmonary and endocrinology parameters. 128 Jul 25

The activation of the complement system was investigated in 10 patients with rheumatic valve disease having heart surgery. The C3c, C4, leukocyte count and polymorphonuclear neutrophil count were determined in the blood samples taken before anaesthesia, after anaesthesia, 10 minutes after protamine administration and after the closure of the skin incision. In addition, atrial blood samples were taken after the release of the cross-clamp and pulmonary neutrophil trapping was investigated. In this study C3c and C4 consumption was found to take place after 30 minutes of CPB (cardiopulmonary bypass) and 10 minutes after protamine administration; the affects of anaesthesia and heparin were not significant.
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PMID:The factors effecting complement activation in open heart surgery. 128 17

Perioperative GIK therapy has been advocated to ensure adequate energy substrate levels during cardiac surgery. However, hyperglycemia should be avoided because it may worsen neurologic outcome after cerebral ischemia. A prospective, randomized, clinical comparison was performed between two prebypass infusion regimens in 32 elective nondiabetic CABG patients. Sixteen patients (GIK group) received glucose, 0.6 g/kg/h, insulin, 0.12 U/kg/h, and KCl, 0.12 mmol/kg/h, from the induction of anesthesia to the start of CPB; while the remaining 16 patients (R group) received only Ringer's acetate. The pump prime was glucose free and a blood cardioplegia technique was used in both groups. No differences were found between the groups with regard to myocardial injury; the CK-MB enzyme fractions were elevated to a similar degree and the frequency of postoperative ECG changes were similar in both groups. Likewise, there were no differences in hemodynamic changes, need for inotropic support, arrhythmia frequency, or duration of ICU stay. The GIK patients had higher blood glucose (P < 0.05) and insulin levels (P < 0.01); blood glucose increased to 12.4 +/- 5.4 mmol/L (mean +/- SD) at cannulation, with a drop after starting bypass. Interindividual variation in GIK patients was great, with glucose values ranging between 20.1 mmol/L at cannulation to 2.0 mmol/L after starting CPB. A hyperglycemic response was seen in both groups during rewarming: 15.0 +/- 4.2 and 15.0 +/- 3.1 mmol/L in GIK and R patients, respectively. It is concluded that prebypass GIK infusion had no clinical benefits for elective CABG patients as compared to Ringer's acetate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prebypass glucose-insulin-potassium infusion in elective nondiabetic coronary artery surgery patients. 142 Oct 62

The QRS complex in lead V5 was studied during cardiac surgery. R wave amplitude decreased after induction of anesthesia to approximately 50% to 60% of the preanesthetic level before the institution of CPB (P < 0.001). An rS complex appeared immediately after cardioversion and changed in configuration to an Rs complex 15 to 30 minutes after aortic declamping. The R wave continued to recover toward the preanesthetic level at sternal closure. Patients with coronary artery disease had a poorer recovery of the R wave (P < 0.05) than patients with valvular heart disease; the former recovered to only 50% of the preanesthetic level at sternal closure. Nonsurvivors had much smaller R waves (26.1 +/- 20.5%) than survivors (P < 0.001). The R wave peaked 30 to 40 ms after initiation of the QRS complex, which indicates recovery of conductivity and the activation sequence of the left ventricular (LV) free wall, which is easily disturbed by hypothermia, cardioplegia, and ischemia during aortic cross-clamping. Monitoring QRS complex changes in lead V5 appears to be important on weaning from cardiopulmonary bypass to detect regional ischemia, and also to observe electrophysiologic recovery of the LV free wall.
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PMID:QRS complex changes in the V5 ECG lead during cardiac surgery. 147 59

The changes in the concentrations of nine serum proteins were studied in ten patients who underwent open-heart surgery for mitral or aortic valve replacement. alpha 1-glycoprotein, albumin, transferrin, alpha 2-macroglobulin, IgG, IgA, IgM, C3, and C4 were assessed before anesthesia induction, after sternotomy, ten minutes after the beginning of CPB, and ten minutes following the end of CPB; values were corrected for haemodilution. All the proteins, with the exception of alpha 1-glycoprotein, showed similar trends that were characterized by a significant decrease after CPB. Linear contrasts did not show any significant difference among the proteins expressed as per cent of the initial values. Such generalized decrease was probably due to the aspecific damage caused by oxygenators, pumps and aspirators. On the contrary, specific mechanisms, as IgM aggregation or complement activation, do not affect significantly the concentration of single proteins. Also the hypothesis of a relevant protein migration toward the extravascular space was rejected because of the absence of any significant relation between the molecular weight of the proteins and their decrease after CPB.
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PMID:[Loss of plasma protein in open-heart surgery]. 187 Jul 28

This study on dogs determined whether the requirement for enflurane anesthesia was different pre- versus postcardiopulmonary bypass (CPB). Male mongrel dogs (n = 16) were anesthetized with enflurane in oxygen. Tracheal intubation was performed, monitors placed, and end-tidal enflurane concentration measured via a Puritan-Bennett Anesthesia Agent Monitor. MAC was determined by the tail-clamp method. CPB was then initiated using aortoatrial (n = 6, group 1) or femoral artery-vein (n = 4, group 2) cannulation or none (n = 6, group 3, control). CPB was maintained for 1 h using a bubble oxygenator, a crystalloid prime, and flows of approximately 70-80 ml/kg with a mean systemic pressure maintained between 50-70 mmHg. Following separation from CPB, MAC was again determined. The reduction in enflurane MAC following CPB was 30.1 +/- 21.5% (mean +/- SD; P less than 0.05 vs. pre-CPB) in group 1 but there was a wide range of reduction produced (3.8-58.8%). The degree of MAC reduction (19.8 +/- 8.6%; P less than 0.05 vs. pre-CPB) produced by CPB in group 2 was much less variable in degree (range 13.0-32.4%) but did not differ from group 1. Although pre- versus post-CPB mean systemic pressure fell from 83 +/- 13 to 69 +/- 15 mmHg (P less than 0.05), this is above the level likely to produce a reduction in MAC. No other significant hemodynamic changes were observed. Temperature pre- versus post-CPB was not different. The degree of hemodilution and acid-base disturbances are unlikely to be the explanation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Does cardiopulmonary bypass alter enflurane requirements for anesthesia? 211 43

Electrocardiographic (ECG) changes demonstrated on lead V5 were investigated regarding the effect of hemodynamic change as well as site and degree of the LAD stenosis. Results were summarized as follows. 1. Myocardial ischemic changes on lead V5 occurred in the patients with two or more stenosis on LAD when heart rate increased. 2. Total occlusion of LAD with collaterals from stenosed RCA showed ischemic change on hypotension due to partial perfusion of cardiopulmonary bypass. 3. Ischemic changes occurred in patients with spontaneous angina and non-transmural myocardial infarction when the pericardium was opened. 4. Induction of anesthesia with fentanyl and droperidol kept blood pressure lower, but with this method no ischemic change on lead V5 occurred before CPB.
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PMID:[Intraoperative ischemic change demonstrated on lead V5 related to hemodynamic episodes as well as sites and degree of coronary vascular lesion]. 224 2

This report has reviewed some of the cardiovascular aspects of ANP. The emergence of the heart as an endocrine organ requires that numerous questions be asked with regard to the importance of ANP to anesthesia and surgery. It is clear that the interaction of the hormone with other vasoactive compounds, including anesthetic agents, requires further elucidation. The accumulation of more information regarding the regulation of ANP and its cardiovascular setting will define its role in hemodynamic homeostasis in the acute clinical setting. Questions of specific interest to the anesthesiologist that require elucidation are: (1) Does the presence of abnormal ANP levels, associated with specific disease states, affect perioperative cardiovascular function? (2) Do cardiac surgery and CPB affect ANP-adrenergic interaction? (3) What is the relationship among blood volume, blood pressure, cation metabolism, and the ANP-renin-angiotensin system in perioperative patients? (4) What is the role of ANP as a therapeutic modality in surgical patients?
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PMID:Atrial natriuretic peptide. 253 91

The authors studied the effects of withdrawing oral diltiazem therapy on the subsequent course of coronary artery bypass graft surgery. Patients with severe coronary artery disease were divided into three groups using a prospective, controlled, randomized protocol. In group D (diltiazem-continuation) patients, diltiazem was administered 2.1 +/- 0.1 hours (mean +/- SEM) before anesthetic induction (n = 10). Group DW (diltiazem-withdrawal) patients received their final diltiazem dose 17.3 +/- 2.9 hours before anesthesia (n = 10). Group R was a reference group of patients not receiving diltiazem (n = 11; not randomized). Anesthesia was induced and maintained with fentanyl and pancuronium without use of halogenated anesthetics. No clinically important differences were detected in measured hemodynamics or drug requirements. Group D patients did not have a lower systemic vascular resistance (SVR) index (P greater than 0.31) or mean arterial pressure (P greater than 0.08) compared with group DW. Also, no evidence for a diltiazem withdrawal response was found, because group DW did not have either a higher SVR index (P = 0.99) or a higher pulmonary vascular resistance index (P = 0.99) compared with group R, and no severe myocardial ischemia, coronary artery spasm, or postoperative heart block were seen. Plasma diltiazem concentrations decreased significantly during CPB (P less than 0.0001), but showed overlap between groups D and DW. Plasma diltiazem concentration did not correlate significantly with simultaneous SVR. These data show the benign effects of both diltiazem administration and its acute withdrawal before coronary artery bypass surgery with high-dose fentanyl anesthesia.
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PMID:Diltiazem withdrawal before coronary artery bypass surgery. 257 11


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