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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients scheduled for vascular surgery are considered at risk for perioperative cardiac complications. Choice of anesthetic in such patients is guided by a desire not to adversely affect myocardial function. On the basis of data from laboratory studies, thoracic epidural anesthesia (TEA) has been advocated to prevent myocardial ischemia. The aim of this study was to assess whether TEA combined with general anesthesia has any effect on segmental wall motion (SWM) monitored by transesophageal echocardiography in these patients. Patients received alfentanil, midazolam, vecuronium, and 50% N2O in oxygen, and ventilation was controlled after orotracheal intubation; 12.5 mL of 2% lidocaine HCl was injected through an epidural catheter placed at T6-7 or T7-8. Hemodynamic measurements and transesophageal echocardiographic recordings were obtained before and 10, 20, 30, 40, and 60 min after lidocaine injection. Segmental wall motion was graded a posteriori by two independent experts on a predetermined scale (from 1 = normal to 5 = dyskinesia). A decrease greater than or equal to 2 grades was considered an SWM abnormality indicative of ischemia. Thoracic epidural anesthesia induced a decrease in systemic arterial blood pressure, heart rate, and cardiac index. The SWM score decreased slightly from 1.34 +/- 0.68 to 1.27 +/- 0.64 (mean +/- SD) (at 10 and 20 min, respectively) (P less than 0.05). Patients were a posteriori analyzed according to whether they had documented coronary artery disease or not. The SWM score before TEA was significantly higher in patients with documented coronary artery disease (1.51 +/- 0.88 vs 1.17 +/- 0.51, respectively; P less than 0.05) and did not change significantly after TEA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. 151 Feb 52

In an attempt to locate any atherosclerotic lesion in the ascending aorta and to prevent embolization, intraoperative B-mode ultrasonography was performed in 100 patients with ischemic heart disease (31 women and 69 men). Ultrasonography was carried out with a 10-MHz probe placed directly on the ascending aorta. Ultrasonic imaging demonstrated an atherosclerotic lesion in the lower half of the aorta in 76 patients (76%), a lesion in the upper half of the aorta in 89 patients (89%), and a lesion at the orifice of the innominate artery in 99 patients (99%). Prospective palpation identified an atherosclerotic lesion in 12 (25%) of 48 patients. Thoracic computed tomography in 79 patients showed calcification in the lower half of the aorta in 6 patients (7.6%) and in the upper half of the aorta in 11 (13.9%). Palpation and thoracic computed tomography underestimated the frequency of atherosclerotic lesions. Intraoperative ultrasonography accurately identified atherosclerotic disease. This technique allows the surgeon to modify cannulation, aortic clamping, and operative technique to reduce the risk of perioperative stroke due to embolization of atherosclerotic debris from the ascending aorta.
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PMID:Intraoperative ultrasonic imaging of the ascending aorta in ischemic heart disease. 222 40

A 44-year-old man with aortic valve disease presented with myocardial ischaemia and ultimately infarction in the presence of suspected endocarditis. Thoracic computerised tomographic scan and coronary arteriography suggested the ischaemia was caused by external compression of the left coronary artery due to an aortic root abscess, later confirmed at surgery. Myocardial ischaemia is an infrequent accompaniment of infective endocarditis and is most commonly due to coexisting coronary disease. More rarely, emboli from vegetations may give rise to infarction. Although aortic root abscess is a well recognised complication of aortic valve endocarditis, coronary artery compression is an unusual mode of presentation and we believe this to be the first reported case of myocardial infarction resulting from external compression in this setting.
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PMID:Myocardial infarction due to coronary artery compression by aortic root abscess. 828 41

A case of advanced cryptogenic fibrosing alveolitis (CFA) with multiple bullae and extensive pulmonary fibrosis, scheduled for modified radical mastectomy for carcinoma of breast, is presented. This patient had ischemic heart disease, corticosteroid-induced hypertension, diabetes mellitus, and a difficult airway. Thoracic epidural segmental anesthesia was successfully given to this patient. Preoperative problems, perioperative management, and alternative anesthetic techniques are discussed.
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PMID:Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report. 1077 15

Professor Attilio Maseri is a clinical investigator with a remarkable track record of innovative research who, by changing traditional paradigms, contributed to shape new diagnostic techniques in pathophysiologic thinking. His research has been characterized by challenging the generalizations of accepted "wisdom" which did not offer satisfactory explanations for the observations he made in his clinical practice. The results of his clinical investigations have contributed greatly to the opening of new avenues of research and patient management in the field of ischemic heart disease. His clinical and research experiences are catalogued in 740 pages of his single-authored textbook Ischemic Heart Disease. A Rational Basis for Clinical Practice and Clinical Research. This book chronicles Maseri's novel unifying vision of ischemic heart disease. In 2001, Professor Maseri left Catholic University in Rome to take on bigger challenges in Milan where he is now functioning as Professor of Cardiology at the University Vita-Salute San Raffaele and Director of the Cardio-Thoracic and Vascular Department of the San Raffaele Scientific Institute. His research interests include application of molecular biology, differential gene expression profiling, and clinical cardiovascular research such as molecular mechanisms of coronary instability and molecular mechanisms of negative and positive ventricular remodeling. Professor Attilio Maseri will be remembered as a thoughtful clinician, a mentor for many whose academic careers have blossomed, and a careful clinical investigator whose innovative research in ischemic heart disease will set the highest standards for those who follow in his giant footsteps. On a personal note, I first met Attilio Maseri, his wife Francesca, and their son Filippo at the 1976 Pisa conference. What transpired at that conference influenced my own career and stimulated my continued interest in ischemic heart disease as well as my enthusiasm for the international aspects of cardiovascular medicine. I consider myself fortunate to be a friend of Attilio Maseri and to have benefited from my associations with him, both professionally and personally.
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PMID:Attilio Maseri. 1523 1

This article presents a review of current literature on impact of thoracic epidural anesthesia on functions of organs and systems. Its role in anesthetic management of pulmonary resection is discussed. Thoracotomy is one of the most painful surgical procedures followed by intense, acute, and chronic pain associated with post-thoracotomy. Thoracic epidural anesthesia ensures adequate analgesia in postoperative period and assists in solving problem of chronic pain. Thoracic epidural anesthesia reduces systemic stress response by inducing sensory and sympathetic blockade. Pulmonary resection produces changes in respiratory function which may result in respiratory insufficiency and other pulmonary complications. During one lung ventilation, thoracic epidural anesthesia reduces pulmonary blood shunt and improves oxygenation. Postoperatively due to effective pain relief and improvement of diaphragm function, thoracic epidural anesthesia improves respiratory function, and rate of pulmonary complications is decreased. Sympathetic blockade during thoracic epidural anesthesia reduces the rate of perioperative myocardial ischemia and cardiac mortality. It also reduces the number of thromboembolic and gastrointestinal complications and has a positive effect on immune function. Due to numerous benefits, thoracic epidural anesthesia can be recommended as a standard in pulmonary resection surgery.
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PMID:[A role of thoracic epidural anesthesia in pulmonary resection surgery]. 1686 35

Thoracic epidural anesthesia has been widely used to complement general anesthesia in coronary artery bypass grafting. The main advantages of the combination are excellent pain control and a less pronounced stress response to surgery. The invasiveness of surgery to treat ischemic heart disease has been attenuated thanks to the use of the mini-sternotomy and coronary anastomosis without extracorporeal circulation. In 4 patients, coronary artery revascularization was carried out via a mini-sternotomy, grafting the anterior descending artery to the left internal thoracic artery under high thoracic epidural anesthesia (block of segments T1-T8) with a perfusion of 0.75% ropivacaine and fentanyl in a conscious patient. There were no hemodynamic or respiratory complications during surgery. The mean duration of stay in the intensive care unit was less than 18 hours and the mean hospital stay was less than 5 days. Postoperative coronary arteriograms demonstrated the patency of all grafts and all patients were asymptomatic at 1 month. Our initial experience suggests that the use of only high thoracic epidural anesthesia is feasible in coronary revascularization in selected, cooperative patients who require a single coronary bypass graft.
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PMID:[Epidural anesthesia for coronary revascularization in the conscious patient]. 1799 99

Thoracic epidural anesthesia (TEA) combined with general anesthesia in cardiac surgery has the potential to initiate earlier spontaneous ventilation and extubation, improved hemodynamics, less arrhythmia or myocardial ischemia, and an attenuated neurohormonal response. The aim of the current study was to characterize the correlation between TEA and postoperative resource use or outcome in a consecutive-patient cohort. The study was performed in a tertiary care, 3-surgeon, university-affiliated hospital that performs 350 to 400 cardiac surgeries per year. All 1293 adult patients who underwent cardiac surgery between July 1, 2002, and February 1, 2006, were included. Patients were assigned to anesthesiologists practicing TEA (TEA group, n = 506) or not (control group, n = 787) for cardiac surgery. The preoperative parameter values and Parsonnet scores for the 2 groups were similar. The 2 groups had the same distribution of surgery types. The TEA group presented with fewer intensive care unit (ICU) complications, such as delirium, pneumonia, and acute renal failure, and presented with better myocardial protection. The TEA group presented with a higher proportion of immediately postoperative extubations and with shorter ventilation times and ICU stays. Total ICU costs decreased from US $18,700 to $9900 per patient. Combining TEA and general anesthesia for cardiac surgery allows a significant change in anesthesia strategy. This change improves immediate postoperative outcomes and reduces the use and costs of ICU resources.
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PMID:Epidural anesthesia improves outcome and resource use in cardiac surgery: a single-center study of a 1293-patient cohort. 1818 77

This article reviews the challenges in caring for individuals with congenital heart disease in developing countries and is drawn in part from the author's Presidential Address to the American Association for Thoracic Surgery in Philadelphia, May 2006. Economic globalization is resulting in demographic and lifestyle changes which are increasing the incidence of ischemic heart disease worldwide. A massive expansion of cardiothoracic surgery in developing countries is beginning. Although the rate of coronary surgery is contracting in Western countries, the population bulge that is approaching 65 years of age will also stretch surgical manpower and resources in developed countries within 10 to 20 years. The incidence of congenital heart disease is stable, but earlier and more accurate diagnosis is rapidly increasing the numbers of children needing the services of a congenital cardiac surgery team. Many opportunities for philanthropy are available, but care should be taken to assist in the most meaningful way by working with a long-term educational program and avoiding surgical tourism.
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PMID:Congenital heart surgery in developing countries. 1839 18

Epidemiological studies have reported an inverse association between dietary flavonoid intake and mortality for ischemic heart disease. Quercetin reduces blood pressure and restores endothelial dysfunction in hypertensive animals. However, quercetin (aglycone) is usually not present in plasma, but it is rapidly metabolized during absorption by methylation, glucuronidation and sulfation. We have analyzed the vasorelaxant effects and the role on NO bioavailability and endothelial function of quercetin and its conjugated metabolites (quercetin-3-glucuronide, isorhamnetin-3-glucuronide and quercetin-3'-sulfate) in rat aorta. Thoracic aortic rings isolated from Wistar rats were mounted for isometric force recording and endothelial function was tested by measuring the vasorelaxant response to acetylcholine. NADPH-enhanced O(2)(-) release was quantified in homogenates from cultured aortic smooth muscle cells using lucigenin chemiluminescence. Unlike quercetin, the conjugated metabolites had no direct vasorelaxant effect, and did not modify endothelial function or the biological activity of NO. However, all metabolites (at 10 micromol/L) prevented, at least partially, the impairment of endothelial-derived NO response under conditions of high oxidative stress induced by the SOD inhibitor DETCA. Furthermore, they protected the biological activity of exogenous NO when impaired by DETCA. Quercetin and quercetin-3'-sulfate (>or=10 micromol/L) or quercetin-3-glucuronide (100 micromol/L) inhibited NADPH oxidase-derived O(2)(-) release. Quercetin and quercetin-3-glucuronide (1 micromol/L) prevented the endothelial dysfunction induced by incubation with ET-1. These data indicate, for the first time, that the conjugated metabolites could be responsible for the in vivo protective activity of quercetin on endothelial dysfunction.
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PMID:Glucuronidated and sulfated metabolites of the flavonoid quercetin prevent endothelial dysfunction but lack direct vasorelaxant effects in rat aorta. 1880 86


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