ABSTRACT
Rapid-sequence induction and tracheal intubation are used in the management of patients at risk of aspiration. Patients with coronary artery disease (CAD) are at additional risk of adverse hemodynamic responses to intubation. The hemodynamic and hormonal responses to intubation with sufentanil, 7 micrograms/kg, and succinylcholine, 1.5 mg/kg, were studied in patients with CAD and good left ventricular function (ejection fraction greater than or equal to 0.4) who were undergoing elective coronary artery bypass grafting. Tracheal intubation occurred 60 seconds after administration of sufentanil and succinylcholine. Heart rate, systemic and pulmonary arterial pressures, pulmonary artery occlusion and central venous pressures, and cardiac outputs were measured at various time intervals before and after induction of anesthesia. Systemic vascular resistance and cardiac index were calculated. Arterial blood samples were drawn before and after anesthetic induction for the determination of catecholamine concentrations in serum. Rapid-sequence administration of sufentanil and succinylcholine resulted in a moderate decrease (24%) in mean arterial pressure from 95 to 72 mm Hg, and the mean arterial pressure remained less than the control value at 1, 3, and 5 minutes after intubation. Systemic vascular resistance also decreased (23%) after administration of sufentanil and returned to control values 5 minutes after intubation. There were no changes in cardiac index until 5 minutes after intubation, at which time it decreased (18%) from 2.8 to 2.3 L/min/m2.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Anesthesia, Intravenous , Anesthetics , Coronary Artery Bypass , Fentanyl/analogs & derivatives , Intubation, Intratracheal , Narcotics , Succinylcholine , Adult , Aged , Anesthetics/administration & dosage , Anesthetics/pharmacology , Blood Pressure/drug effects , Cardiac Output/drug effects , Catecholamines/blood , Dopamine/blood , Epinephrine/blood , Female , Fentanyl/administration & dosage , Fentanyl/pharmacology , Hemodynamics/drug effects , Humans , Male , Middle Aged , Narcotics/administration & dosage , Narcotics/pharmacology , Norepinephrine/blood , Succinylcholine/administration & dosage , Succinylcholine/pharmacology , Sufentanil , Vascular Resistance/drug effectsABSTRACT
We evaluated the effects of esmolol, a short acting (t1/2 beta = 9 min) beta-blocker on hemodynamics during noxious stimulation associated with aortocoronary bypass surgery. Group E (n = 10) and P (n = 10) patients had their morning dose of beta- or calcium blockers withheld except for nifedipine, and were given infusions of esmolol (E) or placebo (P) beginning prior to anesthetic induction and continuing until mediastinal dissection. Group S (n = 10) patients received their usual medication the morning of surgery and received neither esmolol nor placebo. All patients received fentanyl infusions for anesthesia and pancuronium for relaxation. Esmolol patients had no changes in heart rate throughout the study. In contrast, significant increases in heart rate occurred during induction, intubation, and surgical stimulation in Groups P and S. Esmolol patients had a statistically significant but transient increase in pulmonary capillary wedge pressure (PCWP) after intubation, which did not require treatment. There were no significant changes in PCWP in Group S and a decrease in PCWP in Group P patients. We conclude that esmolol was effective in attenuating potentially deleterious responses to noxious stimulation during fentanyl-pancuronium anesthesia.
Subject(s)
Coronary Artery Bypass , Fentanyl , Hemodynamics/drug effects , Pancuronium , Propanolamines/pharmacology , Adult , Aged , Blood Pressure/drug effects , Cardiac Output , Drug Evaluation , Electrocardiography , Heart Rate/drug effects , Humans , Intubation, Intratracheal , Middle Aged , Pulmonary Wedge Pressure/drug effects , Vascular Resistance/drug effectsABSTRACT
The hemodynamic effects of lumbar epidural anesthesia (LEA) were evaluated in 11 patients with severe preeclampsia. All patients were receiving magnesium sulfate upon entry into the study. Hemodynamic measurements were obtained before and after LEA, at delivery, and 2 hr postpartum. Lumbar epidural anesthesia significantly reduced mean arterial pressure from 121.4 mm Hg to 97.7 mm Hg, without altering cardiac index, pulmonary vascular resistance, central venous pressure (CVP), or pulmonary capillary wedge pressure (PCWP). There was a slight but statistically insignificant decrease in systemic vascular resistance from 1078 to 900.7 dynes X sec X cm-5. Cardiac index and left ventricular stroke work index were elevated in these patients, suggesting hyperdynamic left ventricular function. There was poor correlation between PCWP and CVP in several patients. We conclude that LEA may be used safely in severe preeclamptic patients and that pulmonary arterial catheters may help guide appropriate therapy in preeclamptic patients with cardiac failure or oliguria refractory to modest fluid challenges.
Subject(s)
Anesthesia, Epidural , Pre-Eclampsia , Adult , Blood Pressure , Female , Gestational Age , Hemodynamics , Humans , Pre-Eclampsia/physiopathology , Pregnancy , Pulmonary Edema/physiopathology , Stroke VolumeABSTRACT
Carbonic anhydrase (CA) was found to be equally susceptible to direct inhibition by ethanol, whether the enzyme originated from homogenates of rabbit gastric, duodenal, or ileal mucosa. When gastric mucosa was separated into a soluble (cytoplasmic) and a membrane fraction, the membrane CA was more susceptible to ethanol inhibition, but less susceptible to acetazolamide inhibition, than the soluble enzyme. Male rat liver CA is relatively insensitive to acetazolamide inhibition, while female rat liver CA shows a sensitivity similar to that of other tissues. We found ethanol inhibited male and female rat liver CA equally, indicating a different site, or mode, of inhibition for ethanol and acetazolamide.