Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

Because acute segmental wall motion abnormalities (SWMAs) of the left ventricle are highly sensitive and specific indicators of myocardial ischemia, this study compared the incidence and significance of ischemia, as detected by two-dimensional transesophageal echocardiography and surface electrocardiography, during anesthesia and surgery in patients at high risk of myocardial ischemia. During surgery, 24 of the 50 patients studied had new SWMAs, whereas only six had ST segment changes. All patients with ST segment changes also had new SWMAs: in three instances, SWMAs occurred before the ST segment change, and in three instances, they occurred simultaneously.

Voltage-dependent ion channels in T-lymphocytes.

The gigaohm seal 'patch-clamp' technique has recently enabled exploration of the electrical properties of cells of the immune system. In this paper we review progress made to date in cataloguing the ion channels present in the cell membranes of T-lymphocytes and present new data on the types of ion channels present in a number of human and murine T-cell-derived cell lines. The ion channels thus far described in these cells are strikingly similar to those found in nerve and muscle cells.

Electroimmunology: the physiologic role of ion channels in the immune system.

The recent development of the gigaohm seal voltage clamp technique has provided an approach to study individual cells of the immune system. Six distinct types of ion channels, most resembling channels found in nerve and muscle, have been identified in immune cells. Some of these channels appear to play important roles in various aspects of immune function.

Nitrous oxide does not hinder the repair of halothane-induced hepatic injury in the rat.

Nitrous oxide administration may limit DNA synthesis by inactivating methionine synthetase, and may thus hamper the repair of an injured organ such as the liver. To test this possibility, we pretreated rats with phenobarbital and exposed them to 0.3 MAC halothane in 9% oxygen for 46 min, followed immediately and again 24 hr later by 70% nitrous oxide (0.

[Intraoperative monitoring using transesophageal 2-dimensional echocardiography].

Currently used monitoring techniques, such as measurements of blood pressure and heart rate, provide incomplete information about cardiac function during surgery. Invasive monitoring like intraoperative pulmonary artery pressure measurement with flow-directed balloon catheters may be more sensitive to detect cardiac instability, but they are associated with potentially fatal complications such as dysrhythmias and pulmonary artery rupture. In search of a more informative and yet safe intraoperative hemodynamic monitoring system, we have investigated the use of 2-D transoesophageal echocardiography (TEE).

Demyelination as a test for a mobile Na channel modulator in frog node of Ranvier.

We found previously that the external surface of frog skeletal muscle fibers can be irreversibly modified by treatment with the amino group-specific reagent, trinitrobenzene sulfonic acid (TNBS). Reaction of the muscle membrane with TNBS permanently shifts the potential dependence of the sodium channel inactivation gating process, h infinity, to more hyperpolarized potentials. The experiments presented here show nearly identical effects on the sodium currents of voltage-clamped frog node of Ranvier in the presence of TNBS.

A voltage-gated potassium channel in human T lymphocytes.

Human peripheral T lymphocytes were studied at 20-24 degrees C using the gigaohm seal recording technique in whole-cell or outside-out patch conformations. The predominant ion channel present under the conditions employed was a voltage-gated K+ channel closely resembling delayed rectifier K+ channels of nerve and muscle. The maximum K+ conductance in ninety T lymphocytes ranged from 0.

Ion channels in lymphocytes.

The advent of the gigaohm-seal recording technique has enabled the study of the electrical properties of small cells, such as individual lymphocytes. Recent studies using this technique in combination with standard immunological and biochemical techniques indicate that cells of the immune system may utilize ion channels, similar in properties to those described in nerve and muscle, in the process of activation. For example, potassium channels may be required for T-lymphocyte mitogenesis and calcium channels for antibody production.

Nitrous oxide, too, is hepatotoxic in rats.

Anesthetic hepatotoxicity was tested under various conditions of hypoxia in rats pretreated with phenobarbital. Administration of 0.3 MAC halothane or fentanyl in 9% oxygen (fractional concentration of inspired oxygen = 0.

Isoflurane does not prevent hepatic injury produced by halothane in rats.

We speculated that the inhibitory effect of isoflurane on the metabolism of halothane might reduce hepatic injury produced by halothane. To test this hypothesis we pretreated male rats with phenobarbital and 24 hr later exposed them to one of three types of anesthesia. One group of rats was anesthetized with 0.

Brief periods of hypoxia can produce hepatic injury in rats.

To determine whether brief periods of hypoxia could produce hepatic injury, we pretreated Sprague-Dawley rats with phenobarbital, deprived them of food for 24 hr, and then exposed them to various hypoxic mixtures of nitrogen and oxygen for various lengths of time. Rats exposed to 6% oxygen for 15 or more minutes had centrilobular injury, the severity of which was directly related to the length of exposure (r = 0.71).

Voltage-gated potassium channels are required for human T lymphocyte activation.

The calcium channel blockers, verapamil and diltiazem, inhibit phytohemagglutinin (PHA)-induced mitogenesis at concentrations that block the T lymphocyte K channel currents. K channel blockers also inhibit the allogeneic mixed lymphocyte response in a dose-dependent manner with the same potency sequence as for block of K currents. K channel blockers inhibit PHA-stimulated mitogenesis only if added during the first 20-30 h after PHA addition, but not later, indicating a requirement for functional K channels during this period.

Transesophageal two-dimensional echocardiography: comparison of ultrasonic and anatomic sections.

Conventional 2-dimensional echocardiography has become a well-established tool for evaluating cardiovascular diseases. Recent introduction of 2-dimensional transesophageal echocardiography has widened the ultrasonic examination possibilities of the heart and great arteries. The 6 standard transesophageal transducer positions that have proved representative and of diagnostic value are described.

Monitoring with two-dimensional transesophageal echocardiography. Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac, or infrarenal aortic occlusion.

When the aorta must be temporarily occluded at the suprarenal or supraceliac levels during surgery, the resulting large increase in afterload may make the myocardium ischemic, even though systemic and pulmonary artery pressures and cardiac output are maintained at normal levels. These traditional indices of myocardial well-being do not appear to be sufficiently sensitive, since cardiac complications are still the most frequent cause of perioperative death and morbidity after aortic reconstruction. To evaluate two-dimensional transesophageal echocardiography as a monitor of myocardial well-being, we studied 24 American Society of Anesthesiologists physical status class III or IV adult patients who were undergoing aortic reconstruction and occlusion at the supraceliac (n = 12), suprarenal-infraceliac (n = 6), or infrarenal (n = 6) level.

Voltage-gated K+ channels in human T lymphocytes: a role in mitogenesis?

Membrane receptors and ion transport mechanisms probably have an important role in lymphocyte activation leading to T-lymphocyte proliferation in the immune response. Here we have applied a gigaohm-seal patch clamp technique to reveal the identity and properties of ion channels in human T lymphocytes. A voltage-dependent potassium channel bearing a resemblance to the delayed rectifier of nerve and muscle cells was found to be the predominant ion channel in these cells.

The effect of alpha-adrenergic blockade on cardiac performance and tissue oxygen delivery during excision of pheochromocytoma.

To establish criteria for administration of the optimal dose of alpha-adrenergic receptor blocking drugs, we studied cardiac performance and tissue oxygen tension in three patients who underwent excision of pheochromocytoma. Subcutaneous oxygen tension was measured by the method of Niinikoski and Hunt. Cardiac function was assessed by thermodilution cardiac output, systemic and pulmonary arterial blood pressures, and continuous two-dimensional transesophageal echocardiography of a cross section of the left ventricle at the level of the papillary muscles.

Chemical modification of potassium channel gating in frog myelinated nerve by trinitrobenzene sulphonic acid.

We investigated the actions of externally applied trinitrobenzene sulphonic acid (TNBS) on the K currents of voltage-clamped frog myelinated nerve fibres. TNBS treatment irreversibly slowed the tail currents for K channel closing up to 10-fold. Time constants for the tail currents appear shifted 60-80 mV in the hyperpolarizing direction following TNBS treatment.

The cardiovascular effects of vecuronium (ORG NC45) and pancuronium in patients undergoing coronary artery bypass grafting.

Vecuronium is a new nondepolarizing muscle relaxant which has been shown to cause no significant cardiovascular effects. Utilizing invasive monitoring in patients undergoing coronary artery bypass grafting, the authors compared the cardiovascular effects of vecuronium (0.28 mg/kg) in seven anesthetized patients with those of pancuronium (0.

A noninvasive in vivo method of assessing the kinetics of halothane metabolism in humans.

The authors describe a noninvasive method of estimating the kinetic constants that characterize metabolism of inhaled anesthetics in humans. Ten healthy male volunteers breathed subanesthetic concentrations of halothane and isoflurane in a fixed inspired ratio of 20:1. Isoflurane served as a marker that identified changes in uptake in nonmetabolizing depots.

Calcium-induced inactivation of alamethicin in asymmetric lipid bilayers.

This paper discusses a calcium-dependent inactivation of alamethicin-induced conductance in asymmetric lipid bilayers. The bilayers used were formed with one leaflet of phosphatidyl ethanolamine (PE) and one of phosphatidyl serine (PS). Calcium, initially confined to the neutral lipid (PE) side, can pass through the open alamethicin channel to the negative lipid (PS) side, where it can bind to the negative lipid and reduce the surface potential.

Alamethicin channels incorporated into frog node of ranvier: calcium-induced inactivation and membrane surface charges.

Alamethicin, a peptide antibiotic, partitions into artificial lipid bilayer membranes and into frog myelinated nerve membranes, inducing a voltage-dependent conductance. Discrete changes in conductance representing single-channel events with multiple open states can be detected in either frog node or lipid bilayer membranes. In 120 mM salt solution, the average conductance of a single channel is approximately 600 pS.