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Marcus MA, Gogarten W, Aken HV. Opioids in obstetrics: which route of administration with which opioid do we choose to establish effective analgesia? Ugeskr Laeger 1998; 15:140-6. [PMID: 9587718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Buerkle H, Yang LC, Marcus MA, Brodner G, Dunbar S, Van Aken H. Opioidergic and cholinergic peripheral pain mechanisms. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1998; 111:184-6. [PMID: 9421005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Marcus MA, Wang J, Pi-Sunyer FX, Thornton JC, Kofopoulou I, Pierson RN. Effects of ethnicity, gender, obesity, and age on central fat distribution: Comparison of dual x-ray absorptiometry measurements in white, black, and Puerto Rican adults. Am J Hum Biol 1998; 10:361-369. [DOI: 10.1002/(sici)1520-6300(1998)10:3<361::aid-ajhb11>3.0.co;2-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/1997] [Accepted: 05/16/1997] [Indexed: 11/11/2022] Open
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Abstract
Until today, the use of epidural analgesia in obstetrics still remains controversial. In the opinion of many obstetricians the use of an epidural for a healthy laboring parturient is not necessary and can lead to potentially harmful side effects. However, painful labor leads to a maternal stress reaction with the release of epinephrine and norepinephrine. The resulting vasoconstriction of uterine arteries can induce fetal asphyxia in an otherwise healthy fetus or can aggravate asphyxia in already compromised fetuses. Several studies show that epidural analgesia can attenuate the maternal stress reaction and thereby improve maternal and fetal well-being, as long as precautions are taken. The avoidance of maternal hypotension with sufficient volume preload with lactated Ringer's solution or colloids, and decreasing the concentration of local anaesthetics by adding opioids will prevent an increase in instrumental deliveries. With the use of patient-controlled epidural analgesia (PCEA) the amount of local anaesthetics can even further be reduced.
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Marcus MA, Vertommen JD, Van Aken H, Wouters PF, Van Assche A, Spitz B. Hemodynamic effects of intravenous isoproterenol versus saline in the parturient. Anesth Analg 1997; 84:1113-6. [PMID: 9141941 DOI: 10.1097/00000539-199705000-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of epinephrine as a test dose for epidural analgesia in obstetrics remains controversial. Isoproterenol as a test dose may be efficacious in the parturient. However, the effects of isoproterenol on the uterine blood flow (UBF) and umbilical blood flow (UMB) in the parturient are unknown. In a randomized, double-blind study, the hemodynamic variables in 60 nonlaboring women at term were studied 5 min before and for 10 min after an intravenous injection of either 5 micrograms isoproterenol or 5 micrograms saline. The UBF was assessed in 35 women and the UMB in 25 women using a color Doppler technique. The results of 50 women were used for further analysis. Maternal heart rate (MHR) was measured continuously, and maternal mean arterial pressure was measured every minute. MHR did not change after saline but increased significantly after injection of isoproterenol. UBF also increased significantly after isoproterenol during the same time interval. UMB did not change. Other hemodynamic variables did not change. We conclude that isoproterenol, 5 micrograms, may be a suitable test dose for epidural analgesia in obstetrics.
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Marcus MA, Vertommen JD, Van Aken H, Swinnen G. Prostaglandin-induced ventricular fibrillation during cesarean section. Int J Obstet Anesth 1997; 6:130-1. [PMID: 15321296 DOI: 10.1016/s0959-289x(97)80012-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case report is presented of ventricular fibrillation after intramyometrial injection of 1 mg dinoprostone (PGE(2)) during cesarean section performed under general anesthesia. Anesthesiologists should be aware of the potential cardiovascular side-effects of prostaglandins used by the obstetrician.
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Marcus MA, Wang J, Thornton JC, Ma R, Burastero S, Pierson RN. Anthropometrics do not influence dual X-ray absorptiometry (DXA) measurement of fat in normal to obese adults: a comparison with in vivo neutron activation analysis (IVNA). OBESITY RESEARCH 1997; 5:122-30. [PMID: 9112247 DOI: 10.1002/j.1550-8528.1997.tb00652.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Dual-energy X-ray absorptiometry (DXA) is now a commonly used method for the determination of bone mineral status and body composition in humans. The purposes of this study were to compare fat mass by in vitro neutron activation analysis (FMIVNA) with that by DXA (FMDXA) in an anthropometrically heterogeneous sample of healthy adult men (n = 33) and women (n = 36) (19 < or = BMI < or = 39), and to determine whether differences in fat mass estimates between the two methods (delta FM) were attributable to subject anthropometry as defined by several circumference (waist, iliac crest, thigh) and skinfold thickness (umbilical, suprailiac, abdominal) measurements. No significant differences between FMDXA and FMIVNA were observed in men (p = 0.46) or women (p = 0.09). The two methods were very highly correlated in both sexes (women r2 = 0.97, p < 0.001, men r2 = 0.91, p < 0.001), although the regression line for men was significantly different from the line of identity (p = 0.043). These results suggest modest trends toward underestimation of FMDXA in men when FMIVNA < 18 kg, and overestimation in men when FMIVNA > 18 kg. delta FM (IVNA-DXA) was not significantly related to any combination of skinfold thickness and circumferences in either gender. Age explained 27% of the variance in delta FM for the men (p = 0.008). Furthermore, delta FM was not significantly related to inter-method disparity in total-body bone mineral measurements in men or women (p < 0.05). The present study demonstrates strong correlation in fat measurements between IVNA and DXA in men and women ranging from normal to markedly obese. Correction for subject anthropometry does not significantly improve this relationship.
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Marcus MA, Bruyninckx FL, Vertommen JD, Wouters PF, Van Aken H. Spinal somatosensory evoked potentials after epidural isoproterenol in awake sheep. Can J Anaesth 1997; 44:85-9. [PMID: 8988830 DOI: 10.1007/bf03014330] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The use of 10-15 micrograms epinephrine as an epidural test-dose is controversial. Isoproterenol would be a better alternative. However, before 5 micrograms isoproterenol can be incorporated in an epidural test-dose, neurotoxicological studies have to be performed. The present study was designed to assess spinal somatosensory evoked potentials (spinal SSEP) before and after epidural isoproteronol. METHODS Spinal SSEPs were recorded before, 30 min after, and 72 hr after 50 micrograms isoproterenol were given epidurally (L3-4) to six chronically instrumented awake sheep. The spinal SSEPs after epidural (L3-4) administration of 15 ml lidocaine 2% were used to evaluate the model. The SSEPs were generated by transcutaneous stimulation of the sciatic nerve in the thigh. Spinal SSEPs were recorded directly from the spinal cord at vertebra T12 using a monopolar epidural electrode referenced to a subcutaneous needle electrode in the adjacent paraspinal area. RESULTS Thirty minutes and 72 hr after epidural injection of 50 micrograms isoproterenol the latency and the amplitude of the SSEP waves were similar to baseline values. After lidocaine, no SSEPs could be generated in three sheep while in three sheep the latency of wave 2 (W2) was prolonged and the amplitude diminished. CONCLUSION Administration of epidural isoproterenol did not affect spinal SSEPs in this study indicating an absence of neurotoxic side effects.
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Marcus MA, Vertommen JD, Van Aken H, Wouters PF. Hemodynamic effects of intravenous isoproterenol versus epinephrine in the chronic maternal-fetal sheep preparation. Anesth Analg 1996; 82:1023-6. [PMID: 8610860 DOI: 10.1097/00000539-199605000-00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Isoproterenol 5 micrograms may be an effective marker of accidental intravascular injection in women in labor; however, before isoproterenol can be incorporated in routinely used epidural test doses, the safety and usefulness should be determined in an animal model. This study was designed to examine the hemodynamic effects of isoproterenol in comparison with epinephrine in the pregnant ewe. Five doses of isoproterenol were tested and compared with two doses of epinephrine in a randomized cross-over fashion. After administration of isoproterenol there was a small decrease of uterine blood flow (UBF) and maternal mean artery pressure (MMAP), which both almost immediately returned to baseline. When epinephrine was used a more pronounced and more prolonged decrease of UBF occurred. Increasing doses of isoproterenol resulted in dose-dependent increases in maternal heart rate (MHR), while with epinephrine this was not the case. A significant increase in the cardiac output was seen after isoproterenol. Neither isoproterenol nor epinephrine affected fetal heart rate (FHR), fetal mean arterial pressure (FMAP), amniotic fluid pressure (Amn-pr), blood gases, or acid base status in the mother and the fetus. Provided that neurotoxic effects are absent, isoproterenol might be a better alternative than epinephrine as a test dose for possible intravenous placement of an epidural catheter in pregnant women.
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Schuppler S, Friedman SL, Marcus MA, Adler DL, Xie Y, Ross FM, Chabal YJ, Harris TD, Brus LE, Brown WL, Chaban EE, Szajowski PF, Christman SB, Citrin PH. Size, shape, and composition of luminescent species in oxidized Si nanocrystals and H-passivated porous Si. PHYSICAL REVIEW. B, CONDENSED MATTER 1995; 52:4910-4925. [PMID: 9981675 DOI: 10.1103/physrevb.52.4910] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Wouters PF, Van de Velde MA, Marcus MA, Deruyter HA, Van Aken H. Hemodynamic changes during induction of anesthesia with eltanolone and propofol in dogs. Anesth Analg 1995; 81:125-31. [PMID: 7598239 DOI: 10.1097/00000539-199507000-00025] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to examine global and regional hemodynamic changes during induction of anesthesia with eltanolone, a new short-acting steroid hypnotic, as compared to propofol, in chronically instrumented dogs. The effects on cardiac performance were assessed in six animals. Renal and hepatic blood flows were examined in a separate study including five animals. Two doses of each drug were investigated: eltanolone 2.5 and 5 mg/kg and propofol 7.5 and 15 mg/kg. Left atrial filling pressures and cardiac output were not affected by either drug. Maximum rate of increase of left ventricular pressures decreased both with eltanolone (-28% and -40% from awake control for the 2.5 and 5 mg/kg doses, respectively) and with propofol (-19% and -30% from awake controls with 7.5 and 15 mg/kg respectively). In contrast to propofol, eltanolone preserved arterial blood pressure. Propofol lowered systemic vascular resistance (-21% and -39% with the low and high dose, respectively), and only slightly decreased left ventricular wall thickening fraction (-16% and -21%). Eltanolone did not affect systemic vascular resistance but reduced the wall-thickening fraction dose-dependently (-28% and -61%). Propofol, but not eltanolone, induced moderate coronary vasodilation. Hepatic arterial blood flow velocity decreased dose-dependently (-21% and -64%) during eltanolone anesthesia whereas, in contrast, it increased after propofol (+59% and +64%). Renal and portal venous blood flows remained essentially unaltered from awake conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Xie YH, Gilmer GH, Silverman PJ, Buratto SK, Cheng JY, Fitzgerald EA, Kortan AR, Schuppler S, Marcus MA, Citrin PH, Roland C. Xie et al. reply. PHYSICAL REVIEW LETTERS 1995; 74:4963. [PMID: 10058646 DOI: 10.1103/physrevlett.74.4963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Marcus MA, Vertommen JD, Van Aken H. Hydroxyethyl starch versus lactated Ringer's solution in the chronic maternal-fetal sheep preparation: a pharmacodynamic and pharmacokinetic study. Anesth Analg 1995; 80:949-54. [PMID: 7537028 DOI: 10.1097/00000539-199505000-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Administration of fluids intravenously prior to spinal and epidural analgesia in obstetrics is required to prevent maternal hypotension and fetal hypoxia. A colloid solution, such as hydroxyethyl starch (HES), might be preferable considering the capacity to stay intravascularly for a longer period. In this study the placental transfer of HES and the hemodynamic effects after infusion were investigated using a chronic maternal-fetal sheep preparation. Either 500 mL HES 10% or 750 mL lactated Ringer's solution (RL) was infused intravenously into the ewe over 30 min. Fetal and maternal blood were assayed for HES, blood gases, and acid-base status before and at regular intervals after infusion. Maternal and fetal cardiovascular variables were recorded continuously for 90 min. After HES infusion, maternal HES levels peaked at 30 min ranging from 6.9 mg/mL to 12.1 mg/mL and declined at 24 h to levels between 0.3 mg/mL and 2.8 mg/mL. Mean fetal HES concentrations remained below 0.3 mg/mL. Infusion of HES decreased hemoglobin (Hb) and plasma viscosity (PV) in the mother. Infusion of RL decreased Hb, but did not change PV. Infusion of HES significantly increased uterine blood flow (UBF), cardiac output (CO), total oxygen-delivery capacity, and uterine artery oxygen delivery. In contrast, infusion of RL did not significantly change these variables. Infusion of HES increases UBF, CO, and uterine and total oxygen-carrying capacity in the pregnant ewe. No significant transplacental transfer of HES was shown.
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Vertommen JD, Marcus MA, Van Aken H. The effects of intravenous and epidural sufentanil in the chronic maternal-fetal sheep preparation. Anesth Analg 1995; 80:71-5. [PMID: 7802304 DOI: 10.1097/00000539-199501000-00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study examines the placental transfer and hemodynamic and acid-base changes after intravenous (i.v.) and epidural administration of sufentanil in the chronically instrumented maternal-fetal sheep preparation. A dose of 50 micrograms sufentanil was injected either i.v. or epidurally into seven ewes. Neither i.v. nor epidural injection of sufentanil affected maternal mean arterial pressure (MMAP), uterine blood flow (UBF), maternal heart rate (MHR), fetal mean arterial pressure (FMAP), fetal heart rate (FHR), or blood gases and acid-base status in mother and fetus, After i.v. administration, a peak sufentanil level of 1.28 ng/mL +/- 0.285 (SD) was detected in maternal plasma. A peak plasma level of 0.037 ng/mL +/- 0.041 (SD) was attained in the fetus. A constant maternal-fetal concentration ratio of 5.5 from 15-60 min after the i.v. injection was found. After epidural injection a mean peak plasma level of 0.059 ng/mL +/- 0.042 (SD) was reached in the mother 25 min after injection. Sufentanil levels were undetectable in fetal plasma after epidural injection into the mother. Because placental transfer of sufentanil is small, the maternal and fetal cardiovascular and acid-base effects are minimal in the pregnant ewe.
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Marcus MA, Thijs N, Meulemans AI. A prolonged but successful resuscitation of a patient struck by lightning. Eur J Emerg Med 1994; 1:199-202. [PMID: 9422167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case of a person struck by lightning is presented in which treatment consisted of 60 min of resuscitation, followed by a 3 day period of artificial ventilation. Persons who are struck by lightning might benefit from prolonged resuscitation efforts, since patients such as this one, as well as similar cases described in the literature, have survived without major sequelae. In our opinion, on-the-spot advanced life support, hypothermia and a moderate rehydration policy contributed to this patient's successful resuscitation.
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Xie YH, Gilmer GH, Roland C, Silverman PJ, Buratto SK, Cheng JY, Fitzgerald EA, Kortan AR, Schuppler S, Marcus MA, Citrin PH. Semiconductor surface roughness: Dependence on sign and magnitude of bulk strain. PHYSICAL REVIEW LETTERS 1994; 73:3006-3009. [PMID: 10057258 DOI: 10.1103/physrevlett.73.3006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Wouters PF, Marcus MA, Van Aken HK, van de Velde M, Miserez M, Deruyter HA, Mignolet K, Flameng W. Global and regional haemodynamic effects of urapidil in conscious dogs with chronic coronary artery occlusion. Eur J Anaesthesiol 1994; 11:381-90. [PMID: 7988582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The haemodynamic effects of urapidil, an alpha 1-antagonist with central serotoninergic properties, were studied in an experimental canine model of chronic ischaemic heart disease. Global and regional haemodynamic recordings were made in conscious dogs with ameroid-induced single vessel coronary artery occlusion. Three intravenous bolus-infusion doses of urapidil (0.1 mg kg-1 + 0.3 mg min-1; 0.5 mg kg-1 + 1.5 mg min-1; 2.5 mg kg-1 + 7.5 mg min-1) were given on separate occasions in 12 animals. Regional blood flows were measured with radioactively labelled tracer microspheres. The effects of urapidil and dipyridamole, a powerful arteriolar vasodilator, on regional myocardial blood flow distribution to normal and collateral-dependent myocardium were compared. Urapidil caused a dose-dependent reduction of arterial blood pressure. There was moderate tachycardia and decreased left atrial filling pressures at the higher doses. Urapidil was a much weaker coronary vasodilator than dipyridamole. Dipyridamole caused maldistribution of intercoronary and transmural flows (endo-to-epicardial flow ratio in collateral-dependent regions from 1.35 +/- 0.07 to 0.7 +/- 0.13 and flow ratio between collateral-dependent and normal regions from 1.09 +/- 0.03 to 0.57 +/- 0.14). Urapidil preserved blood flow to both regions. Urapidil did not affect systolic wall thickening fraction in normal or ischaemic regions of the heart. Renal (+16%) and splanchnic perfusion (+45%) increased during urapidil infusion. Urapidil preserves myocardial function and perfusion and increases renal and intestinal blood flow in dogs with chronically ischaemic hearts.
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Schuppler S, Friedman SL, Marcus MA, Adler DL, Xie Y, Ross FM, Harris TD, Brown WL, Chabal YJ, Brus LE, Citrin PH. Dimensions of luminescent oxidized and porous silicon structures. PHYSICAL REVIEW LETTERS 1994; 72:2648-2651. [PMID: 10055937 DOI: 10.1103/physrevlett.72.2648] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Wouters PF, Van Aken H, Van de Velde M, Marcus MA, Flameng W. Functional adaptation to myocardial ischemia: interaction with volatile anesthetics in chronically instrumented dogs. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 1994; 31:25-37. [PMID: 7873416 DOI: 10.1016/s1054-3589(08)60606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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145
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Wouters PF, Van Aken H, Marcus MA, Van De Velde M, Van Herck A, Flameng W. Effects of halothane and isoflurane on collateral dependent myocardium in chronically instrumented dogs. Anesth Analg 1993; 77:516-25. [PMID: 8368551 DOI: 10.1213/00000539-199309000-00016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The effects of moderate systemic hypotension with halothane (HALO) and isoflurane (ISO) on regional myocardial function and perfusion were studied in dogs with chronic coronary artery occlusion. Vasodilator reserve in collateral-dependent (CD) myocardium was quantified in conscious animals by using a dipyridamole challenge test. Blood flow was distributed homogeneously to the normal (Nl) and CD myocardium at rest, but subendocardial perfusion increased only in the Nl area after dipyridamole. HALO and ISO were administered at doses that reduced diastolic arterial pressure to 50 mm Hg. End-tidal concentrations were 1.3 +/- 0.2 vol% for HALO (1.5 minimum alveolar anesthetic concentration) and 1.8 +/- 0.2 vol% for ISO (1.4 minimum alveolar anesthetic concentration), respectively. Global and regional hemodynamic depression were more pronounced with HALO. Systolic wall-thickening fraction decreased both in the Nl (-37%) and CD area (-27%). Myocardial blood flow to Nl and CD myocardium decreased to a comparable extent. ISO predominantly decreased systemic vascular resistance and, when compared to HALO, decreased systolic wall-thickening fraction less in both the Nl (-19%) and CD area (-18%). In addition, regional myocardial perfusion to both Nl and CD myocardium remained virtually unaltered from conscious control conditions. Despite reductions of diastolic blood pressure to 50 mm Hg, neither HALO nor ISO induced ischemic dysfunction in myocardium with diminished vasodilator reserve. Both anesthetics preserved intercoronary as well as transmural blood flow distribution. During HALO, myocardial perfusion was less both in Nl and CD myocardium due to a more pronounced metabolic depression. We conclude that moderate hypotensive doses of ISO and HALO preserve regional myocardial function of collateral-dependent myocardium in dogs with single vessel occlusion and enhanced collateral circulation.
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Khalil SN, Nuutinen LS, Rawal N, Marcus MA, van Haaren ER, Stanley TH. Induction of anesthesia in children following administration of methohexital into the sigmoid colon. MIDDLE EAST JOURNAL OF ANAESTHESIOLOGY 1991; 11:289-99. [PMID: 1815115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors evaluated the sigmoidal administration of methohexital, the effect of methohexital concentration (1% versus 2%), the effect of dosage (25 mg/kg versus 15 mg/kg) on sleep-success rate, administration - sleep time, recovery time and the effect of aspirating the residual methohexital on recovery time. The study demonstrated that both 1% solution and 25 mg/kg of sigmoidal methohexital were independently associated with significantly higher sleep success rate and faster onset of sleep compared with 2% and 15 mg/kg of sigmoidal methohexital solution respectively. The recovery time was significantly affected by the dose of methohexital and was not significantly affected by the concentration of methohexital solution. Aspiration of the residual methohexital did not significantly affect the recovery time.
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Lind GH, Marcus MA, Mears SL, Ashburn MA, Peterson BJ, Bernhisel KT, Stanley TH. Oral transmucosal fentanyl citrate for analgesia and sedation in the emergency department. Ann Emerg Med 1991; 20:1117-20. [PMID: 1928885 DOI: 10.1016/s0196-0644(05)81387-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE To evaluate the safety and efficacy of oral transmucosal fentanyl citrate (OTFC) as a noninvasive method of providing analgesia and sedation for patients in the emergency department. DESIGN Prospective, nonblinded. SETTING ED of a tertiary care university hospital. TYPE OF PARTICIPANTS Ten patients, 6 to 34 years old, with acute painful conditions requiring treatment in the ED. INTERVENTIONS Premedication with OTFC and local anesthetic prior to incision or wound closure. MEASUREMENTS AND MAIN RESULTS Pain and activity (sedation) scores, vital signs (including systolic and diastolic arterial blood pressures, heart and respiratory rates, and pulse oximetry-determined oxygen saturation) were measured before and at two- to ten-minute intervals during and after OTFC consumption. All patients accepted OTFC. Patients received an average of 13.7 +/- 2.5 micrograms/kg of fentanyl citrate in 11.8 +/- 6.8 minutes. Decreases in pain were reported in two patients in two minutes and by all patients 14 minutes after beginning OTFC consumption. Sixty percent of patients became drowsy or sedated 12 to 30 minutes after beginning OTFC. Vital signs and oxygen saturation changes were small and not clinically significant. The most important side effects were pruritus (30%), nausea (20%), and dizziness and dry mouth (40%). All were considered mild and not disturbing, although one patient required post-procedure antiemetic therapy for recurrent vomiting. The mean time to discharge from the ED was 139 +/- 54 minutes after receiving OTFC. CONCLUSION OTFC may be useful in providing rapid, noninvasive analgesia and sedation in the ED and deserves further evaluation.
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Marcus MA, Andrews MP, Zegenhagen J, Bommannavar AS, Montano P. Structure and vibrations of chemically produced Au55 clusters. PHYSICAL REVIEW. B, CONDENSED MATTER 1990; 42:3312-3316. [PMID: 9995846 DOI: 10.1103/physrevb.42.3312] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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149
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Lind GH, Marcus MA, Ashburn MA, Mears SL, Petersen B, Stanley TH. ORAL TRANSMUCOSAL FENTANYL CITRATE FOR ANALGESIA AND ANXIOLYSIS IN THE EMERGENCY ROOM. Anesth Analg 1990. [DOI: 10.1213/00000539-199002001-00241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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150
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Stanley TH, Leiman BC, Rawal N, Marcus MA, van den Nieuwenhuyzen M, Walford A, Cronau LH, Pace NL. The effects of oral transmucosal fentanyl citrate premedication on preoperative behavioral responses and gastric volume and acidity in children. Anesth Analg 1989; 69:328-35. [PMID: 2774228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors compared the safety, efficacy, and effects on gastric volume and pH of oral transmucosal fentanyl citrate (OTFC) premedication and of placebo lollipop and no premedication in 55 children undergoing elective operations. The patients were randomly assigned to receive no premedication (group A, N = 18); OTFC containing 15-20 micrograms/kg of fentanyl citrate (group B, N = 18); or a placebo lollipop (group C, N = 19). Activity (sedation) and anxiety scores, vital signs (including systolic and diastolic arterial blood pressures, heart and respiratory rates), and pulse oximetry determined oxygen saturation were measured before and at 10-min intervals after premedication until the patients were taken to the operating room. Gastric contents were aspirated via an orogastric tube and analyzed for volume and pH after induction of anesthesia. Quality of induction and recovery were evaluated using scoring schedules; recovery times were measured and side effects recorded. OTFC was readily accepted and provided levels of sedation and anxiolysis significantly greater after 10 min than after no premedication or the placebo lollipop. Arterial blood pressures, heart rate, and oxygen saturations were not different among the three groups. In patients given OTFC, respiratory rates were significantly lower after 10 min than they were in patients having no premedication.(ABSTRACT TRUNCATED AT 250 WORDS)
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