Left ventricular diastolic filling during coronary artery bypass surgery in patients with diabetes mellitus and/or hypertension.

To evaluate left ventricular diastolic filling (DF) using transesophageal Doppler echocardiography in 40 patients with or without diabetes mellitus and/or hypertension, we measured DF after induction of anesthesia, before and after cardiopulmonary bypass (CPB), and at the end of coronary artery bypass surgery (CABS). In 13 patients with complete measurements, there was no significant change in DF but diastolic filling time became shorter and peak velocity during atrial contraction increased significantly following CPB. In the other patients, the assessment of DF could be performed accurately in CABS patients without diabetes and/or hypertension, but not in CABS patients with these disorders because of a high incidence of fusion of the E-A waves, which is an indicator of impaired DF.

Does transesophageal echocardiography improve postoperative outcome in patients undergoing coronary artery bypass surgery?

The incidence and characteristics of ischemic episodes as detected by transesophageal echocardiography (TEE) and their relationship to postoperative myocardial infarction (MI) and adverse clinical outcome were studied in patients undergoing coronary artery bypass grafting (CABG). Seventeen of 50 patients had 21 TEE-defined ischemic episodes: 4 patients (8%) had 4 ischemic episodes in the pre-cardiopulmonary bypass (CPB) period, and 15 patients (30%) had 17 ischemic episodes in the post-CPB period, whereas 19 patients had 20 ECG ischemic episodes: 3 patients (6%) had 3 ischemic episodes in the pre-CPB period and 17 (34%) had 17 ischemic episodes in the post-CPB period. In 14 patients, ischemic episodes were detected by both TEE and ECG.

Presynaptic interaction between vagal and sympathetic innervation in the heart: modulation of acetylcholine and noradrenaline release.

It is generally accepted that there is a functional antagonism between the sympathetic and parasympathetic (vagal) effects on the heart. In this study guinea-pig right atria loaded either with [3H]noradrenaline or [3H]choline were used and the release of [3H]noradrenaline or [3H]acetylcholine in response to field stimulation was measured under conditions when the negative feedback modulation was excluded. Strong evidence was obtained for a one-sided interaction between the sympathetic and vagal nerves at the level of the prejunctional axon terminals that send the final chemical message to the heart muscle affecting heart rate and force.

New applications of two-dimensional transesophageal echocardiography in cardiac surgery.

This article describes new applications of two-dimensional transesophageal echocardiography (2D-TEE), including (1) detection of pleural fluid (PF) and atelectasis (AT), and (2) evaluation of various cannulation techniques. The left and right pleural spaces were visualized by rotating the probe counterclockwise and clockwise, respectively, from the four-chamber view. PF was depicted as a crescent-shaped echo-free space, enclosed by the lung and posterior chest wall on both sides.

The pre- and postjunctional components of the neuromuscular effect of antibiotics.

The relative contributions of the pre- and postsynaptic components of the myoneural blocking effect of different antibiotics were studied using: (a) a radio-active method that measures selectively the Ca(2+)-dependent, stimulation evoked, quantally released, (3)H-acetylcholine ((3)H-ACh) from the mouse in vitro phrenic nerve-hemidiaphragm preparation without cholinesterase inhibition; (b) measurement of the force of contraction of the indirectly or directly stimulated muscle. The antibiotics studied (neomycin, polymyxin B and lincomycin), reduced the release of (3)H-ACh evoked by stimulation (18 trains of 40 shocks at 50 Hz) in a concentration dependent manner. While the inhibitory effect of neomycin was inversely related to [Ca(2+)](o), that of lincomycin was moderately and that of polymyxin B was not affected by increasing [Ca(2+)](o) from 0.

The anatomical location of the transesophageal echocardiographic transducer during a short-axis view of the left ventricle.

This study was performed to clarify the location of a transesophageal echocardiographic (TEE) transducer when obtaining the short-axis view of the left ventricle (S-LV). The depth of the probe tip from the incisors when obtaining a S-LV, the relationship to the diaphragm, and the location of the cardia of the stomach using a gastroscope attached to the TEE probe were measured in 24 patients undergoing coronary artery bypass grafting. The location of the transducer relative to the cardia and diaphragm was determined.

Hemodynamic effects of high-frequency jet ventilation in dogs with acute right coronary arterial ligation and pulmonary arterial banding.

The hemodynamic effects of high-frequency jet ventilation (HFJV), synchronized with diastole, and intermittent positive-pressure ventilation (IPPV) were studied in 10 dogs with acute right-sided myocardial ischemia and elevated right ventricular pressure. Myocardial ischemia was produced by ligation of the proximal right coronary artery (RCA), then the right ventricular pressure was elevated to facilitate the ischemia by banding the main pulmonary artery. Before and 1, 2, 3, and 5 hr after the RCA ligation, cardiorespiratory variables for each ventilatory mode and creatine phosphokinase MB isoenzyme (CPK-MB) were measured.

Neuromuscular and cardiovascular effects of pipecuronium.

Pipecuronium bromide (Arduan) is a bisquaternary, steroid-type neuromuscular blocking agent in clinical use in Eastern Europe. Before its introduction into clinical practice in the USA, in the first phase of this study the neuromuscular potency of pipecuronium was determined under "balanced" and enflurance anaesthesia by the cumulative log dose-response method in 30 patients each. In the second phase the intubation and onset times, clinical duration of the first and repeated doses, spontaneous recovery index, reversibility of its residual neuromuscular effect by an anticholinesterase and its effect on heart rate and blood pressure was compared with the same variables observed in patients, anaesthetized with identical techniques but who had received vecuronium or pancuronium.

Intraoperative assessment of pulmonary vein flow.

This study was undertaken to assess the suitability for intraoperative pulmonary vein flow measurements in 15 patients undergoing coronary artery bypass grafting. Using two-dimensional color Doppler transesophageal echocardiography, all four pulmonary veins--right upper and lower and left upper and lower pulmonary veins were easily visualized. Pulmonary vein flow was pulsatile.

Diagnosis of myocardial ischemia by the pressure-rate quotient and diastolic time interval during coronary artery bypass surgery.

Diagnosis of intraoperative myocardial ischemia by the rate-pressure product (RPP), pressure-rate quotient (PRQ), and diastolic time interval (DTI) was studied in 13 patients undergoing coronary artery bypass grafting (CABG) with fentanyl, vecuronium/pancuronium, and enflurane anesthesia. Criteria for ischemia were 1 mm of ST segment elevation or depression or T wave inversion on the ECG. RPP was calculated by multiplying the systolic arterial pressure (SAP) times the heart rate (HR); PRQ was determined by dividing the mean arterial pressure (MAP) by the HR; and DTI was defined as the interval from the closure of the aortic valve on M-mode transesophageal echocardiography to the onset of the QRS complex on the ECG.

Hemodynamic effects of high-frequency jet ventilation in dogs with a chronically banded pulmonary artery.

Two to seven weeks after banding the main pulmonary artery, the hemodynamic effects of high-frequency jet ventilation (HFJV) and conventional mechanical ventilation (CMV) were studied in dogs with and without PEEP. In comparison with CMV, HFJV significantly increased cardiac index, stroke index (SI), left ventricular stroke work index, and oxygen delivery index, and decreased pulmonary vascular resistance index both with and without PEEP; however, there were significant decreases in PaO2 and increases in intrapulmonary physiologic shunt ratio in HFJV without PEEP. SI without PEEP was significantly greater with HFJV when the peak airway pressure was synchronized with the diastole in pulmonary arterial pressure (PAP) than with CMV and with HFJV synchronized with the systole in PAP.

In vitro comparison of the neuromuscular antinicotinic and intestinal antimuscarinic effects of different nondepolarizing muscle relaxants.

The postsynaptic antimuscarinic properties of different nondepolarizing muscle relaxants were compared with their postsynaptic antinicotinic effect. d-Tubocurarine, pipecuronium and vecuronium were the most selective antagonists on postsynaptic nicotinic receptors. Gallamine, diadonium and Duador (RGH-4201) had relatively greater effect on postsynaptic muscarinic receptors.

Epidural analgesia for labor and delivery in a patient with von Willebrand's disease.

Patients with histories of bleeding disorders may still benefit from regional anesthetic techniques. The decision to perform the block should be individualized, based on coagulation tests. The authors describe a patient with von Willebrand's disease in whom pregnancy itself improved factor VIII activity, enabling performance of an epidural block for labor and delivery.

Effects of LF-14, THA and physostigmine in rat hippocampus and cerebral cortex.

The effects of physostigmine, tetrahydroaminoacridine (THA) and LF-14 [3,3-dimethyl-1(4- amino-3-pyridyl)urea], a 3,4-diaminopyridine derivative, were compared on inhibition of acetyl- cholinesterase (AChE) activity, and release of [(3)H]acetylcholine (ACh) from rat brain cortical and hippocampal slices. All three compounds caused a concentration dependent inhibition of AChE, with an order of potency physostigmine > THA >LF-14. The electrically stimulated release of ACh from hippocampal and cortical slices was decreased by 10(?5)M physostigmine, although the effect was significant only in cortex.

Heterogeneity of presynaptic muscarinic receptors involved in modulation of transmitter release.

In order to extend the characterization of muscarinic receptors at presynaptic sites their inhibitory effect on the stimulation-evoked release of [3H]noradrenaline and [3H]acetylcholine from different axon terminals was studied and the dissociation constants and potencies of different antagonists were estimated, in guinea-pig and rat. While oxotremorine reduced the release of [3H]acetylcholine and [3H]-noradrenaline in a concentration-dependent manner from different release sites (Auerbach plexus, noradrenergic neurons in the right atrium, cerebral cortex), McN-A 343, an M1 receptor agonist, enhanced their release evoked by field stimulation. When the inhibitory effect of oxotremorine on transmitter release was studied, pancuronium, pirenzepine and atropine were competitive antagonists of presynaptic muscarinic receptors located on the noradrenergic axon terminals of the atrium.

Presynaptic effect of muscle relaxants on the release of 3H-norepinephrine controlled by endogenous acetylcholine in guinea pig atrium.

The influence of nondepolarizing muscle relaxants (MR) on the resting and electrically evoked release of tritiated norepinephrine (3H-NE) was investigated, in the absence and presence of 10(-4) mol/l cocaine, in the in vitro right atrium preparation of guinea pigs (g.p.) preloaded with 3H-NE.

A simple method for monitoring muscular relaxation during continuous infusion of vecuronium.

There is considerable individual variation in the dose of vecuronium required for the maintenance of surgical relaxation. Therefore to provide uninterrupted relaxation without overdosage it is advisable to regulate the IV infusion of vecuronium on the basis of appropriate monitoring. Monitoring with mechanomyography (MMG) or electromyography requires costly equipment and is too complex for routine clinical use.