Awake aortic aneurysm repair in patients with severe pulmonary disease.
*Consciousness; Abdominal/*surgery; Administration; Aged; Albuterol/administration & dosage/therapeutic use; Anesthesia; Aortic Aneurysm; Blood Loss; Bronchodilator Agents/administration & dosage/therapeutic use; Critical Care; Epidural; Forced Expiratory Volume/physiology; General; Home Care Services; Hospitalization; Humans; Hypnotics and Sedatives/administration & dosage; Iliac Aneurysm/*surgery; Inhalation; Intravenous; Length of Stay; Lung Diseases/*complications/drug therapy/therapy; Oxygen Inhalation Therapy; Retroperitoneal Space; Retrospective Studies; Risk Factors; Safety; Steroids/administration & dosage/therapeutic use; Surgical; Theophylline/administration & dosage/therapeutic use; Time Factors; Vital Capacity/physiology
BACKGROUND: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. METHODS: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. RESULTS: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. CONCLUSIONS: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.
McGregor W E; Koler A J; Labat G C; Perni V; Hirko M K; Rubin J R
American journal of surgery
1999
1999-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0002-9610(99)00153-1" target="_blank" rel="noreferrer noopener">10.1016/s0002-9610(99)00153-1</a>
Myocardial work load is a major determinant of norepinephrine-induced left ventricular dysfunction.
Anesthesia; Animals; Blood Pressure/*drug effects; Cardiovascular; Consciousness; Diastole/drug effects; Dose-Response Relationship; Drug; General; Heart Rate/*drug effects; Heart/drug effects/*physiology; Left/drug effects/*physiology; Models; Norepinephrine/*pharmacology; Pentobarbital; Rabbits; Systole/drug effects; Time Factors; Ventricular Function
This study was conducted to determine whether increased myocardial energy demand plays a role in norepinephrine (NE)-induced left ventricular (LV) dysfunction. A range of arterial pressure-heart rate (P-R) products (myocardial energy demand) was produced in both conscious and pentobarbital sodium-anesthetized rabbits with the same dose of NE (10 micrograms priming bolus plus 2.5 micrograms.kg-1 x min-1 for 2.5 h). After NE treatment, LV function was evaluated in vitro and found to be markedly diminished in the rabbits that had an elevated P-R product. In contrast, LV function was not significantly affected when the P-R product was maintained near control levels during NE treatment. In separate experiments, rabbit hearts were isolated and exposed to NE (10,000 or 50,000 pg/ml) for 2.5 h under low P-R product conditions. These hearts exhibited a dose-dependent decrease in LV function that was modest compared with that observed in rabbits that had elevated P-R products during in vivo NE treatment. Our results suggest that high concentrations of NE may cause modest degrees of LV dysfunction independently of increases in myocardial energy demand, but the LV dysfunction is exacerbated when myocardial energy demand is elevated.
Bosso F J; Allman F D; Pilati C F
The American journal of physiology
1994
1994-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1152/ajpheart.1994.266.2.H531" target="_blank" rel="noreferrer noopener">10.1152/ajpheart.1994.266.2.H531</a>
Persistent left ventricular dysfunction after cocaine treatment in rabbits.
Female; Male; Animals; Rabbits; Blood Pressure/drug effects; In Vitro Techniques; Stroke Volume/drug effects; Epinephrine/blood; Anesthesia; Norepinephrine/blood; Cocaine/*pharmacology; Consciousness; Heart/drug effects/physiology/*physiopathology; Ventricular Function; Dose-Response Relationship; Drug; General; Left/*drug effects
The present study was undertaken to determine whether the diminished cardiac performance associated with cocaine administration persists after the drug has been eliminated from the body. Cocaine (5 or 10 mg/kg iv) was administered to conscious (n = 7) or pentobarbital-anesthetized (n = 7) rabbits, respectively. Seven conscious and seven anesthetized control rabbits received the saline vehicle. Two and one-half hours later, the hearts were removed from the animals and perfused under cocaine-free conditions. Left ventricular (LV) contractility was evaluated by plotting steady-state LV systolic and diastolic pressures as a function of LV end-diastolic volume (preload). LV systolic performance was diminished in a dose-related manner in hearts isolated from cocaine-treated rabbits, but was statistically different from control only at the higher cocaine dose (P \textless 0.05). In a second set of experiments, hearts (n = 6) were isolated, and their LV function was evaluated before, during, and after cocaine exposure. In these experiments, cocaine was added to the perfusate in increments to produce concentrations of 5, 10, and 15 mg/liter. After LV function was evaluated at the highest cocaine dose, cocaine-free perfusion conditions were restored, and LV function was reevaluated. In these experiments, cocaine produced a dose-dependent decrease in LV function that readily reversed when cocaine-free perfusion was reinstated. We conclude that cocaine diminishes LV contractility, and that the diminished cardiac performance may not readily reverse after in vivo exposure. Moreover, the rapid restoration of cardiac performance after exposure to cocaine in vitro suggests that the mechanism operating in vivo involves more than a simple direct action on the myocyte. Catecholamine cardiotoxicity does not appear to be a primary factor.
Pilati C F; Espinal A R; Pukys T F
Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine (New York, N.Y.)
1993
1993-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3181/00379727-203-43579" target="_blank" rel="noreferrer noopener">10.3181/00379727-203-43579</a>
Cleveland Clinic's summer research program in reproductive medicine: an inside look at the class of 2014.
Female; Humans; Male; Ohio; medical education; Surveys and Questionnaires; Curriculum; *Internship and Residency; Hospitals; Access to Information; biomedical research; Biomedical Research/*education; medical students; program development; program evaluation; Program Evaluation; Reproductive Medicine/*education; research training; summer internship; translational medical research; General
BACKGROUND: The American Center for Reproductive Medicine's summer internship course in reproductive medicine and research at Cleveland Clinic is a rigorous, results-oriented annual program that began in 2008 to train both local and international students in the fundamentals of scientific research and writing. The foremost goal of the program is to encourage premedical and medical students to aspire toward a career as a physician-scientist. The internship provides participants with an opportunity to engage in original bench research and scientific writing while developing theoretical knowledge and soft skills. This study describes selected survey responses from interns who participated in the 2014 internship program. The objective of these surveys was to elicit the interns' perspective on the internship program, its strengths and weaknesses, and to obtain insight into potential areas for improvement. METHODS: Questionnaires were structured around the five fundamental aspects of the program: 1) theoretical knowledge, 2) bench research, 3) scientific writing, 4) mentorship, and 5) soft skills. In addition, an exit survey gathered information on factors that attracted the interns to the program, communication with mentors, and overall impression of the research program. RESULTS: The opportunity to experience hands-on bench research and scientific writing, personalized mentorship, and the reputation of the institution were appreciated and ranked highly among the interns. Nearly 90% of the interns responded that the program was beneficial and well worth the time and effort invested by both interns and faculty. CONCLUSION: The outcomes portrayed in this study will be useful in the implementation of new programs or refinement of existing medical research training programs.
Durairajanayagam Damayanthi; Kashou Anthony H; Tatagari Sindhuja; Vitale Joseph; Cirenza Caroline; Agarwal Ashok
Medical education online
2015
2015
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3402/meo.v20.29517" target="_blank" rel="noreferrer noopener">10.3402/meo.v20.29517</a>