The author in an attempt to evaluate hemodynamic changes in the clinical stages of Korean hemorrhagic fever measured plasma volume, cardiac output and effective renal plasma flow utilizing radioisoto es during various phases of the disease. Cardiac output was measured by radiocardiography with external monitoring method using RIHSA. Effective renal plasma flow was obtained from blood clearance curve drawn by external monitoring after radiohippuran injection according to the method described by Razzak et al. The study was carried out in thirty-eight cases of Korean hemorrhagic fever and the following conclusions were obtained. 1. Plasma volume was increased in the patients during the oliguric-and hypertensive diuretic phases, while it was normal in the patients during the normotensive-diuretic phase. 2. Cardiac index was increased in the patients during the oliguric phase and was slightly increased in the patients at the hypertensive diuretic phase. It was normal in the other phases. 3. Total peripheral resistance was increased in the hypertensive patients during diuretic phase, while it was normal in the rest of phases. 4. Effective renal plasma flow was significantly reduced in the patients during the oliguric and diuretic phases as well as at one month after the oliguric onset. There was no significant difference between the oliguric and the early diuretic phases. Renal plasma flow in the group of patients at one month after the oliguric onset was about 45% of the normal, however, it returned to normal level at six months after the onset. 5. Clinical syndrome of relative hypervolemia was observed in some patients during the oliguric phase or hypertensive diuretic phase. Characteristic hemodynamic findings were high cardiac output and normal to relatively increased peripheral resistance in these cases. Relatively increased circulating blood volume due to decreased effective vascular space was suggested for the mechanism of relative hypervolemia. 6. Cardiac hemodynamic alteration returned to normal during late stage of the diuretic phase, while renal hemodynamic changes were normalized at six months after the onset.
Purpose : It is well known that suspension microlaryngeal surgery produces marked increases in arterial blood pressure and heart rate. In this study, we evaluated the effects of 10% lidocaine preoperatively sprayed for attenuation of the perioperative hemodynamic response during suspension microlaryngeal surgery. Materials and Methods : Fifty American Society of Anesthesiologists (ASA) class 1 patients scheduled for excision of a vocal polyp by suspension laryngoscopy were randomly divided into two groups (n=25 for each group). They were intubated without 10% lidocaine spray (control group) or given 1.5 mg/kg of 10% lidocaine sprayed onto the pharyngolaryngeal and intratracheal sites 90 sec prior to intubation (10% lidocaine group). Anesthesia was maintained using desflurane in $O_2/N_2O$ 50%. The arterial blood pressure and heart rate were measured at preinduction (T0), 1 min (T1), 3 min (T2), 5 min (T3) after tracheal intubation, and 1 min (T4), 3 min (T5), 5 min (T6) and 10 min (T7) after the suspension laryngoscopy. Results : In the 10% lidocaine group, the arterial blood pressure and heart rate at 1 (T1), 3 (T2) min after tracheal intubation and 1 (T4), and 3 (T5) min after suspension laryngoscopy were lower than the same measurements in the control group. Conclusion : 10% lidocaine sprayed onto the pharyngolaryngeal and intratracheal sites before intubation was an effective method for attenuation of the perioperative hemodynamic response during suspension microlaryngeal surgery.
Objectives: Sanjointang has been clinically used much for treating sleeplessness. However, the effects of Sanjointang in artificial sleep deprivation situations are not known. The purpose of this study is to evaluate the heart rate, left ventricular systolic pressure, left ventricular diastolic pressure, +dp/dt maximum, -dp/dt maximum, and -dp/dt / +dp/dt ratio which are related to the hemodynamic functions of the heart by using sleep-deprived Sparague-Dawley rats, in order to clarify the impact of Sanjointang on hemodynamic functions of the heart of sleep deprived rats. Methods: Eighteen hearts were removed from the male Sparague-Dawley rats weighting about 180g were perfused by the Langendorff technique with modified 37 Krebs-Henseleit's buffer solution at a constant perfusion pressure (60mmHg). They were randomly assigned to one of the following three groups, 1) Normal group (those which did not have sleep deprivation and received normal saline administration), 2) Control group (sleep deprived and normal saline administered), 3) Sample group (sleep deprived and Sanjointang was administered). Control and sample groups rats were deprived 96 hours of sleep by using the modified multiple platform technique. Heart rate, left ventricular systolic pressure, left ventricular diastolic pressure, +dp/dt maximum, -dp/dt maximum, -dp/dt / +dp/dt ratio were evaluated at baseline after the administration of either normal saline or Sanjointang. Results: The heart rate and -dp/dt / +dp/dt ratio was significantly decreased in rats with 96 hours of sleep deprived significantly decreased. The change in the heart rate after administering Sanjointang did not show any significant difference. The left ventricular systolic pressure of the removed heart significantly decreased due to Sanjointang administration, while the left ventricular diastolic pressure significantly increased (p<0.05). The +dp/dt maximum and -dp/dt maximum both significantly decreased in the removed heart after administering Sanjointang. (p<0.05). There was no significant difference observed in the -dp/dt / +dp/dt ratio after administering Sanjointang. Conclusions: According to the results above, sleep deprivation significantly decreases heart rate and -dp/dt / +dp/dt ratio. This is considered as a result of exhaustion due to accumulation of fatigue. Meanwhile, Sanjointang reduced left ventricular systolic pressure and raised left ventricular diastolic pressure, and relieved the contractility and relaxation of the myocardium. Consequently, this reduces the burden of the heart and creates a relatively stabilized heart condition similar to a sleeping condition.
For the study of the hemodynamic changes of the cranial pancreaticoduodenal arterial flow(cPDAF) in the dog with acute pancreatitis, acute pancreatitis was experimentally induced in 10 dogs by the injection of oleic acid into the accessory pancreatic duct. The parameters of cPDAF were measured by transcutaneous pulsed-wave Doppler ultrasonography. The hemodynamic changes included resistive indexe(RI), pulsatility index(PI) and maximum velocity (Vmax). Ultrasonographic scans were performed before the induction of pancreatitis and once daily for five days after the induction. The RI, PI and Vmax were increased with day as follows; the RI prior to induction was 0.625$\pm$0.096 (mean$\pm$SD), the PI was 1.117$\pm$0.289 and the Vmax was 0.349$\pm$0.094 m/s. After five days, the RI was 0.727$\pm$0.051 (p<0.0l), the PI was 1.480$\pm$0.284 (p<0.0l) and the Vmax was 0.585:$\pm$0.114 m/s (p<0.00l). These results show that there is some relation between the increase of the RI, PI and Vmax of cPDAF and the progress of acute pancreatitis in dogs. Therefore, the measurements of the hemodynamic changes of cPDAF may be a valuable technique for the evaluation of acute pancreatitis in dogs.
Park, Seung Min;Lee, Kang Hyun;Choi, Han Ju;Park, Kyung Hye;Kim, Sang Chul;Kim, Hyun;Hwang, Sung Oh
Journal of Trauma and Injury
/
v.21
no.1
/
pp.22-27
/
2008
Purpose: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. Methods: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. Results: The mean age of the patients was $48.8{\pm}18.7$, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was $7.5{\pm}8.7days$ in intensive care and $55.1{\pm}47.9days$ in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). Conclusion: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.
Om, K.S.;Ahn, J.M.;Park, S.K.;Jo, Y.H.;Choi, W.W.;Choi, J.S.;Kim, H.C.;Min, B.G.
Proceedings of the KOSOMBE Conference
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v.1997
no.05
/
pp.59-63
/
1997
It is needless to say that the hemodynamic variables estimation is a very important study for the artificial heart. Even though its importance there have not been satisfactory results which can be applied to the real-world situations. This paper surveys and recommends how to cope with the problem of hemodynamic variable estimation for the moving-actuator type total artificial heart (MA-TAH).
Postoperative cardiac outputs and other hernoaynamic values were serially measured in fifteen patients of cyanotic congenital heart disease, after use of blood cardioplegic solution. Cardiac indices showed no change untill eight postoparative hours, then it began to decline to reach as low as 3.22$\pm$0.7L/min/m2 at 12 hours. After then gradual increse occ-ured to recover upto immediate postoperative value at 20 hours. Sharp decrese of heart rate and increse of systemic vascular resistance during 8~16 hours and steady increase of stroke indices during the whole study periods were observed. These observations suggested that the myocardium recovered gradually after open heart surgery, and that the decrease of cardiac indices during 8~16 hours could be a result of decrease of heart rates and increase of afterload. The changes of cardiac indices correlated with the changes of heart rate, postoperative time and mixed venous oxygen saturation [p<0.05]. No other hemodynamic values found to be in statistically significant correlation with the changes of cardiac indices. Left ventricular dysfunction seemed to occur more frequently during 8~12 hours, but it was not statistically significant. [p=0.73] In conclusion, great care must be taken during 2~3 days after the operation of cyanotic congenital heart disease, not to fall into a low cardiac output state, by maintaing adequate heart rates and reducing afterload especially when the systemic vascular resistance increases.
The Hydrodynamic performance of the trileaflet polymer prosthetic valves depends on the design of the leaflet and the physical properties of the leaflet membrane. In order to study the effect of leaflet membrane elasticity on the hemodynamic performance of trileaflet prosthetic valve, leaflet membranes are manufactured using two different polymers - Biospan and Tecoflex SG-93A. The hemodynamic performance parameters are measured under steady and physiological pulsatile flow, and compared with monoleaflet polymer valve(floating valve) and bileaflet mechanical valve(St. Jude Medical valve). Well designed trileaflet valve shows the lowest mean pressure drop among the tested valves. The trileaflet valves with Biospan membrane show lower pressure drop and back low comparing to those with Tecoflex membrane. More elastic membrane may provide wide opening area during systole and close membrane ree edge contact during diastole. Durability of trileaflet valves are also tested in vitro. Trileaflet valves with non-uniform membrane thickness ail within 17 days because of stress concentration. Trileaflet polymer valves with uniform membrane thickness perform well over 55 days without failure.
Twenty-four patients with left main coronary artery stenosis exceeding 50% underwent coronary artery bypass grafting from January 1991 through June 1993. Four patients [17%] had stenosis only in left main coronary artery and 20 patients [83%] had associate lesion[s] in left anterior descending , circumflex, or right coronary artery. Sixteen patients [67%] had higher degrees of stenosis [>70%] in left main coronary artery. Preoperatively 18 patients [75%] had unstable angina pectoris even during aggressive medical treatment. Preoperatively aggressive medical treatment was performed to relieve the symptom in patients with unstable angina. All patients were perioperatively treated with continuous infusion of isosorbide dinitrate to stabilize symptomatic and hemodynamic states. Twenty patients underwent elective coronary bypass surgery and 4 patients urgent operations due to severe unstable angina. There was no thirty-day mortality or late death. Angina recurred in 1 patient, but coronary angiographic study showed good patency of grafts and the symptom was relieved with medical treatment. We concluded that coronary artery bypass grafting can be safely performed by perioperative efforts, including continuous infusion of isosorbide dinitrate, for hemodynamic stabilization in patients with left main coronary artery stenosis.
Journal of The Korean Dental Society of Anesthesiology
/
v.10
no.2
/
pp.166-171
/
2010
Background: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Nicardipine and remifentanil have been used to induce controlled hypotension in healthy patients. This study compared controllability of nicardipine and remifentanil on hemodynamic stability during controlled hypotension. Methods: Forty healthy patients scheduled for orthognathic two jaw surgery were randomly allocated to nicardipine (group N) and remifentanil (group R) group. After induction of anesthesia, group N (n = 20) was infused with nicardipine to induce hypotension and group R (n = 20) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured over 5 minute interval. Surgical field rating and blood loss were measured after surgery. Results: HR was lower in group R than group N. MAP was maintained at 50-60 mmHg during controlled hypotension but the fluctuation of blood pressure and HR were more frequent in group N than group R. There were no significant differences in the surgical field rating and blood loss between the groups. Conclusions: Nicardipine and remifentanil enabled controlled hypotension and provided good surgical conditions, but the fluctuation of hemodynamic parameters was more frequent in nicardipine group.
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