1
|
Anesthesia for Congenital Heart Diseases in Adults. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
2
|
Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
Collapse
|
3
|
Svorc P, Bacova I, Gresova S, Svorc P. Chronobiological perspectives on myocardial electrophysiological parameters under three types of general anaesthesia in a rat model. BIOL RHYTHM RES 2016. [DOI: 10.1080/09291016.2016.1263003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pavol Svorc
- Medical Faculty, Department of Physiology, Safarik’s University, Kosice, Slovak Republic
| | - Ivana Bacova
- Medical Faculty, Department of Physiology, Safarik’s University, Kosice, Slovak Republic
| | - Sona Gresova
- Medical Faculty, Department of Physiology, Safarik’s University, Kosice, Slovak Republic
| | - Pavol Svorc
- Medical Faculty, Department of Physiology and Patophysiology, Ostrava University, Ostrava, Czech Republic
| |
Collapse
|
4
|
Bennett JM, Ehrenfeld JM, Markham L, Eagle SS. Anesthetic management and outcomes for patients with pulmonary hypertension and intracardiac shunts and Eisenmenger syndrome: a review of institutional experience. J Clin Anesth 2014; 26:286-93. [DOI: 10.1016/j.jclinane.2013.11.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 11/25/2022]
|
5
|
Svorc P, Svorc P, Novakova M, Bacova I, Jurasova Z, Marossy A. Ketamine/xylazine anaesthesia in the chronobiological studies. BIOL RHYTHM RES 2014. [DOI: 10.1080/09291016.2014.884305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Gupta N, Kaur S, Goila A, Pawar M. Anaesthetic management of a patient with Eisenmenger syndrome and β-thalassemia major for splenectomy. Indian J Anaesth 2011; 55:187-9. [PMID: 21712881 PMCID: PMC3106397 DOI: 10.4103/0019-5049.79892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
Collapse
Affiliation(s)
- Nishkarsh Gupta
- Department of Anesthesiology and Intensive Care, PGIMER and Associated Dr. RML Hospital, New Delhi, India
| | | | | | | |
Collapse
|
7
|
Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, Connolly HM, Graham TP, Gurvitz MZ, Kovacs A, Meadows AK, Reid GJ, Reiss JG, Rosenbaum KN, Sagerman PJ, Saidi A, Schonberg R, Shah S, Tong E, Williams RG. Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues. Circulation 2011; 123:1454-85. [DOI: 10.1161/cir.0b013e3182107c56] [Citation(s) in RCA: 317] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
López A, Mayo Moldes M, Vilanova V, Prieto MP, Corujeira M, Barreiro Canosa JL. [Repair of congenital heart disease in an adult with septal defects and pulmonary stenosis: anesthetic management]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:51-53. [PMID: 21348218 DOI: 10.1016/s0034-9356(11)70697-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 66-year-old man with complex congenital heart defects (atrial septal defects, with incomplete cor triatriatum, an aneurysmal sac in the membranous septum, ventricular communication and pulmonary valve stenosis) was scheduled for surgery for progressive dyspnea even at rest. During anesthetic induction, effort was made to avoid increased shunting. Surgery consisted of resection of the cor triatriatum membrane, closure of communications with pericardial patches, pulmonary valve replacement, replacement of the root with a porcine root, and pulmonary artery aneurysmorrhaphy. Severely decreased contractility developed while the patient was still in the operating room; inotropic support with adrenaline and dobutamine was required. Extubation was completed in the postoperative recovery unit with no further complications. Echocardiography showed a left-ventricular ejection fraction of 45%. We found few published reports of cases of complex congenital heart disease treated surgically in adulthood. In such cases, cardiac pathophysiology must be carefully considered, and maneuvers that increase systemic resistance or right-ventricular ejection fraction should be avoided. Postoperative pulmonary vascular resistance should be kept as low as possible.
Collapse
Affiliation(s)
- A López
- Servicio de Anestesiología y Reanimación, Hospital do Meixoeiro, Complexo Hospitalario Universitario de Vigo.
| | | | | | | | | | | |
Collapse
|
9
|
Solanki SL, Vaishnav V, Vijay AK. Non Cardiac Surgery in a Patient with Eisenmenger Syndrome-Anaesthesiologist's Challenge. J Anaesthesiol Clin Pharmacol 2010; 26:539-40. [PMID: 21547187 PMCID: PMC3087280 DOI: pmid/21547187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sohan Lal Solanki
- Residents, Department of Anaesthesiology and Intensive Care, J.L.N. Medical College and Associated Hospitals, Ajmer (Rajasthan), India
- Correspondence: Dr. Sohan Lal Solanki,
| | - Vaibhav Vaishnav
- Residents, Department of Anaesthesiology and Intensive Care, J.L.N. Medical College and Associated Hospitals, Ajmer (Rajasthan), India
| | - A. K. Vijay
- Associate Professor, Department of Anaesthesiology and Intensive Care, J.L.N. Medical College and Associated Hospitals, Ajmer (Rajasthan), India
| |
Collapse
|
10
|
Martucci G, Mullen M, Landzberg MJ. Care for Adults with Congenital Heart Disease. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
11
|
Abstract
Laparoscopic surgery represents a significant advance in surgical technique, but a number of physiologic sequelae result from positioning and insufflation. These physiologic changes may be more significant in patients with complex congenital heart disease. We present the anesthetic management of a patient with Fontan physiology who successfully underwent two separate laparoscopic procedures.
Collapse
Affiliation(s)
- Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | |
Collapse
|
12
|
Fischer MU, Priebe HJ. Anaesthetic management for hip arthroplasty in a 46-yr-old patient with uncorrected truncus arteriosus type IV. Br J Anaesth 2006; 97:329-32. [PMID: 16798771 DOI: 10.1093/bja/ael148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In modern adult anaesthetic practice uncorrected complex congenital heart lesions are rare. Persistent truncus arteriosus accounts for only 1.2-3% of all congenital heart malformations. If not corrected, fewer than 20% of these patients survive the first year of life. Here we report the successful management of an adult patient with uncorrected truncus arteriosus who presented for hip arthroplasty.
Collapse
Affiliation(s)
- M U Fischer
- Department of Anaesthesia, University Hospital Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | | |
Collapse
|
13
|
Russell IA, Rouine-Rapp K, Stratmann G, Miller-Hance WC. Congenital Heart Disease in the Adult: A Review with Internet-Accessible Transesophageal Echocardiographic Images. Anesth Analg 2006; 102:694-723. [PMID: 16492817 DOI: 10.1213/01.ane.0000197871.30775.2a] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Isobel A Russell
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA.
| | | | | | | |
Collapse
|
14
|
Stayer SA, Andropoulos DB, Russell IA. Anesthetic management of the adult patient with congenital heart disease. ACTA ACUST UNITED AC 2003; 21:653-73. [PMID: 14562571 DOI: 10.1016/s0889-8537(03)00040-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As the number of CHD repairs in adults continues to increase, these operations will be performed in a wider variety of institutions and systems. Unfortunately, not all of these centers will have an optimal environment for correcting CHD in adults. This type of surgery is best accomplished in a facility specifically designed for treating adults with CHD. Optimal care of these patients is provided by cardiologists who are trained and experienced in pediatric and adult cardiology, by surgeons who are trained and experienced in treating CHD, and by anesthesiologists who are experienced in caring for adults with CHD. Whatever the setting, cardiac anesthesiologists involved in these cases must be thoroughly aware of the anesthetic implications for the unique pathophysiology of each patient, and they must not rely on their "usual" expectations of either true pediatric CHD or acquired adult heart disease.
Collapse
Affiliation(s)
- Stephen A Stayer
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin, Houston, TX 77030, USA.
| | | | | |
Collapse
|
15
|
Andropoulos DB, Stayer SA, Skjonsby BS, East DL, McKenzie ED, Fraser CD. Anesthetic and perioperative outcome of teenagers and adults with congenital heart disease. J Cardiothorac Vasc Anesth 2002; 16:731-6. [PMID: 12486655 DOI: 10.1053/jcan.2002.128410] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the perioperative outcome of patients >or=13 years old undergoing surgery for congenital heart disease in a children's hospital by a dedicated congenital heart surgery and anesthesia team with procedure-matched younger control patients. DESIGN Retrospective medical record review study. From October 1997 to July 2000, medical records of all patients >12 years old requiring cardiopulmonary bypass were reviewed. A control group of patients <or=5 years old was reviewed, and 2 patients were matched to each older patient by diagnosis and surgical procedure. Data are reported as mean +/- SD. Older (study) patients were compared with younger (control) patients using t-test or chi square, with p <or= 0.05 significant. SETTING Medical school-affiliated tertiary-care children's hospital. PARTICIPANTS Patients undergoing congenital heart surgery. MEASUREMENTS AND MAIN RESULTS The study group (older patients) comprised 85 patients, and the control group (younger patients) comprised 170 patients. There were no intraoperative deaths. All major complications-cardiopulmonary resuscitation, neurologic injury, massive hemorrhage with sternotomy, femoral cannulation for emergent bypass, and severe episodes of hypotension on induction of anesthesia-occurred in older patients undergoing repeat sternotomy. CONCLUSION Mortality and major morbidity were low in both groups; however, all major intraoperative incidents occurred in older repeat sternotomy patients, suggesting increased perioperative risk for adverse outcomes in these patients.
Collapse
Affiliation(s)
- D B Andropoulos
- Division of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston TX 77030-2399, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Foster E, Graham TP, Driscoll DJ, Reid GJ, Reiss JG, Russell IA, Sermer M, Siu SC, Uzark K, Williams RG, Webb GD. Task force 2: special health care needs of adults with congenital heart disease. J Am Coll Cardiol 2001; 37:1176-83. [PMID: 11300419 DOI: 10.1016/s0735-1097(01)01277-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
17
|
Abstract
The incidence of congenital cardiovascular malformation is unknown but is estimated to be approximately 0.8% of live births. This figure does not include preterm infants (all of whom have a patent ductus arteriosus [PDA]) or stillborn infants (who have a high incidence of cardiovascular abnor malities). Approximately 9% of patients with congenital car diac disease and 11% of those with uncorrected left-to-right intracardiac shunts will develop the Eisenmenger syndrome (ES). ES develops at different rates, depending on the size and location of the cardiac lesion and the amount of in creased pulmonary blood flow and pressure. Onset in in fancy is common in patients with PDA or a large ventricular septal defect (VSD). ES is seen in up to 50% of patients with VSD larger than 1.5 cm in diameter, whereas there is only a 3% incidence in those with defects that are less than 1.5 cm in diameter. Children with Down syndrome and a VSD or atrioventricular canal defect are prone to early development of ES. They have abnormal upper airways that predispose them to chronic upper airway obstruction and sleep apnea, both of which promote hypoxemia, hypercarbia, and early development of pulmonary hypertension. ES develops early in nearly all patients with uncorrected transposition of the great arteries and truncus arteriosus, whereas most patients with uncorrected ASD who develop the syndrome do so in the second decade of life. The prognosis for survival through childhood with ES is relatively good. Patients usually lead remarkably active lives until shortly before they die. The goal of this article is to provide a detailed overview of the pathophysiology, clinical presentation, and medical and sur gical management of these patients. Particular focus on the anesthetic management of patients undergoing cardiac and noncardiac surgery is provided.
Collapse
Affiliation(s)
- Joseph Previte
- Arkansas Children's Hospital, Division of Pediatric Anesthesia, Little Rock, AR
| | - Panchapakesan Haran
- Arkansas Children's Hospital, Division of Pediatric Anesthesia, Little Rock, AR
| |
Collapse
|
18
|
Affiliation(s)
- M E Brickner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047, USA
| | | | | |
Collapse
|
19
|
Abstract
OBJECTIVES The purpose of this study was to evaluate the morbidity and mortality associated with noncardiac surgery (NCS) in patients (pts) with Eisenmenger syndrome. BACKGROUND Noncardiac surgery in pts with Eisenmenger syndrome is associated with increased cardiovascular complications. METHODS Fifty-eight pts with Eisenmenger syndrome (17M, 41F aged 18 to 69 years (mean 41 years) who had been followed for up to 41.5 years (mean 9.3 years) were retrospectively evaluated for any NCS done at > or = 17 years of age. RESULTS Twenty-four pts had a total of 28 NCSs at an age of 17 to 55 years (mean 29 years) including 9 tubal ligations, 3 neurosurgeries, 3 cholecystectomies, 3 hysterectomies, 3 vasectomies, and 1 each spinal fusion, appendectomy, eye enucleation, hernia repair, hand surgery, tonsillectomy and therapeutic abortion. There were two deaths (7%), one following spinal fusion and the other following appendectomy at another institution. Fourteen of these NCSs were performed at our institution, including 11 under general anesthesia. The duration of anesthesia varied from 75 to 525 min (mean 165 min). All pts remained in sinus rhythm. The lowest systolic blood pressure (BP) ranged from 78 to 125 mm Hg. Of those 11 pts, 9 were extubated immediately after surgery and 2 needed dopamine. Ten patients were discharged without any complications, including 3 within 1 day of surgery. One death occurred 10 days following spinal fusion. This pt had the longest anesthesia (525 min) and an intraoperative systolic BP as low as 78 mm Hg. She also needed the largest fluid administration (6,475 cc) in addition to postoperative mechanical ventilation and dopamine. CONCLUSIONS Adult pts with Eisenmenger syndrome are at increased risk with NCS, but with current/modern techniques, the risk of death is less than previously thought. In the vast majority of cases, NCS can be undertaken without substantial morbidity, and early extubation is achievable. However, even with relatively minor surgery, significant complications, including death, can occur. Referral to major centers with expertise in the care of pts with Eisenmenger syndrome is advisable.
Collapse
Affiliation(s)
- N M Ammash
- Department of Anesthesiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
| | | | | | | |
Collapse
|
20
|
Warner MA, Lunn RJ, O'Leary PW, Schroeder DR. Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease. Mayo Perioperative Outcomes Group. Mayo Clin Proc 1998; 73:728-34. [PMID: 9703297 DOI: 10.4065/73.8.728] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the outcomes and risk factors for morbidity associated with anesthesia and noncardiac surgical procedures in children and adults with congenital heart disease. DESIGN We conducted a retrospective cohort study of the 6-year period from January 1987 through November 1992 at one of the Mayo-affiliated hospitals in Rochester, Minnesota. MATERIAL AND METHODS In all children and adults 50 years of age or younger with congenital heart disease who underwent one or more noncardiac surgical or diagnostic procedures and anesthesia, we analyzed the risk factors for 30-day perioperative morbidity and mortality. RESULTS The overall frequency of complications among the 276 patients who underwent 480 noncardiac surgical procedures and anesthesia was 5.8% (28 of 480), and only 1 patient died intraoperatively. Major risk factors univariately associated with complications for the first procedures (15 of 276 patients or 5.4%) included the presence of cyanosis (P = 0.002), current treatment for congestive heart failure (P<0.001), poor general health (P<0.001), and younger age at the time of the procedure (P = 0.027). Procedures performed on the respiratory and nervous systems also were associated with high frequencies of complications. Complications in patients undergoing ambulatory surgical procedures were infrequent (1.7%). CONCLUSION The frequency of perioperative complications in children and adults who have congenital heart disease and undergo noncardiac surgical procedures and anesthesia is low. Patients who have pulmonary hypertension, congestive heart failure, or cyanosis and children with congenital heart disease who are younger than 2 years of age have an increased frequency of perioperative morbidity.
Collapse
Affiliation(s)
- M A Warner
- Department of Anesthesiology, Mayo Clinic Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
21
|
Mulhern KM, Mahoney LT, Bjornsen KD, Skorton DJ. Management of adults with congenital heart disease undergoing noncardiac surgery. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1062-1458(97)00021-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Albertson TE, Walby WF, Stark LG, Joy RM. The effect of propofol on CA1 pyramidal cell excitability and GABAA-mediated inhibition in the rat hippocampal slice. Life Sci 1996; 58:2397-407. [PMID: 8691984 DOI: 10.1016/0024-3205(96)00243-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An in vitro paired-pulse orthodromic stimulation technique was used to examine the effects of propofol on excitatory afferent terminals, CA1 pyramidal cells and recurrent collateral evoked inhibition in the rat hippocampal slice. Hippocampal slices 400 microns thick were perfused with oxygenated artificial cerebrospinal fluid, and electrodes were placed in the CA1 region to record extracellular field population spike (PS) or excitatory postsynaptic potential (EPSP) responses to stimulation of Schaffer collateral/commissural fibers. Gamma-aminobutyric acid (GABA)-mediated recurrent inhibition was measured using a paired-pulse technique. The major effect of propofol (7-28 microM) was a dose and time dependent increase in the intensity and duration of GABA-mediated inhibition. This propofol effect could be rapidly and completely reversed by exposure to known GABAA antagonists, including picrotoxin, bicuculline and pentylenetetrazol. It was also reversed by the chloride channel antagonist, 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS). It was not antagonized by central (flumazenil) or peripheral (PK11195) benzodiazepine antagonists. Reversal of endogenous inhibition was also noted with the antagonists picrotoxin and pentylenetetrazol. Input/output curves constructed using stimulus propofol caused only a small enhancement of EPSPs at higher stimulus intensities but had no effect on PS amplitudes. These studies are consistent with propofol having a GABAA-chloride channel mechanism causing its effect on recurrent collateral evoked inhibition in the rat hippocampal slice.
Collapse
Affiliation(s)
- T E Albertson
- Department of Molecular Biosciences School of Veterinary Medicine, University of California, Davis 93010, USA.
| | | | | | | |
Collapse
|
23
|
Chen Y, Berglin E, Belboul A, Roberts D. A mathematical analysis of haemorheologic factors during cardiopulmonary bypass for congenital heart disease. Perfusion 1995; 10:431-38. [PMID: 8747900 DOI: 10.1177/026765919501000607] [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: 02/02/2023]
Abstract
Rheologic properties of blood are impaired by cardiac surgery using cardiopulmonary bypass. This study was set out to establish a mathematical model in order to assess seven known haemorheologic factors and evaluate their degrees of influence on blood rheology in cardiopulmonary bypass. Sixteen patients undergoing elective congenital cardiac surgery were studied. High shear blood viscosity, low shear blood viscosity, haematocrit, red blood cell filtration rate, red blood cell electrophoresis time, plasma viscosity and fibrinogen were monitored. The method for mathematical calculation was the stepwise regression analysis. The results showed that both high shear and low shear blood viscosity were mainly influenced by haematocrit and plasma viscosity. Red blood cell filterability contributed more than red blood cell electrophoresis time for low shear blood viscosity. The mathematical model was re-tested statistically and demonstrated that the selected factors in the model represented approximately 75% of rheologic changes during the surgery. Therefore, this mathematical analysis can be used to estimate the role of various possible haemorheologic factors and evaluate cardiopulmonary bypass techniques and therapeutic interventions.
Collapse
Affiliation(s)
- Y Chen
- Department of Thoracic and Cardiovascular Surgery, Sahlgrenska University Hospital, Gottenburg, Sweden
| | | | | | | |
Collapse
|
24
|
Miner PD, Canobbio MM. CARE OF THE ADULT WITH CYANOTIC CONGENITAL HEART DISEASE. Nurs Clin North Am 1994. [DOI: 10.1016/s0029-6465(22)02731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|