Quantification of mitral regurgitation using proximal isovelocity surface area method in dogs. (1/4)

The present study was performed to determine the accuracy and reproducibility of calculating the mitral regurgitant orifice area with the proximal isovelocity surface area (PISA) method in dogs with experimental mitral regurgitation and in canine patients with chronic mitral insufficiency and to evaluate the effect of general anesthesia on mitral regurgitation. Eight adult, Beagle dogs for experimental mitral regurgitation and 11 small breed dogs with spontaneous mitral regurgitation were used. In 8 Beagle dogs, mild mitral regurgitation was created by disrupting mitral chordae or leaflets. Effective regurgitant orifice (ERO) area was measured by the PISA method and compared with the measurements simultaneously obtained by quantitative Doppler echocardiography 4 weeks after creation of mitral regurgitation. The same procedure was performed in 11 patients with isolated mitral regurgitation and in 8 Beagle dogs under two different protocols of general anesthesia. ERO and regurgitant stroke volume (RSV) by the PISA method correlated well with values by the quantitative Doppler technique with a small error in experimental dogs (r = 0.914 and r = 0.839) and 11 patients (r = 0.990 and r = 0.996). The isoflurane anesthetic echocardiography demonstrated a significant decrease of RSV, and there was no significant change in fractional shortening (FS), ERO area, LV end-diastolic and LV end-systolic volume. ERO area showed increasing tendency after ketamine-xylazine administration, but not statistically significant. RSV, LV end-systolic and LV end-diastolic volume increased significantly (p < 0.01), whereas FS significantly decreased (p < 0.01). The PISA method is accurate and reproducible in experimental mitral regurgitation model and in a clinical setting. ERO area is considered and preferred as a hemodynamic-nondependent factor than other traditional measurements.  (+info)

Does rectus sheath infusion of bupivacaine reduce postoperative opioid requirement? (2/4)

INTRODUCTION: The aim of this work was to assess the effect of intermittent bupivacaine infusion into rectus sheath space on postoperative opioid requirement, postoperative pain score and peak expiratory flow rate. PATIENTS AND METHODS: A prospective, randomised study involving patients undergoing midline laparotomy. Patients were randomised to receive either intermittent infusion of bupivacaine 0.25% or normal saline via catheters placed in the rectus sheath for 48 h after operation. All patients received intravenous morphine infusion on demand with a patient-controlled analgesic device (PCAD). RESULTS: Forty ASA I-III patients were studied. Nineteen were randomised to receive bupivacaine and 21 patients received normal saline. Patient characteristics and surgical variables were comparable in the two groups. The mean wound lengths were similar. There was no statistically significant difference in postoperative opioid requirement, postoperative pain score and peak expiratory flow rate between the two groups. CONCLUSIONS: Intermittent bupivacaine infusion into the rectus sheath space after midline laparotomy does not reduce postoperative opioid requirement nor does it affect postoperative pain score or peak expiratory flow rate.  (+info)

Conscious sedation and analgesia with rectal ketamine in the Macaca fuscata monkey. (3/4)

Conscious sedation is commonly utilized in pediatric dentistry. Although opioid analgesics are often employed, patient safety would be enhanced if nonopioid drugs were used. The purpose of this study was to determine if rectal ketamine could produce plasma concentrations that would achieve both conscious sedation and analgesia to gingival needle puncture. Five 2-year-old male Macaca fuscata monkeys were given rectal ketamine at a dosage of 60 mg/kg and 90 mg/kg one week apart. Blood was drawn at selected times after administration, and vital signs, level of sedation, and consciousness were assessed. Plasma ketamine concentrations ranged from 240 to 820 ng/mL and from 390 to 3120 ng/mL after rectal administration at doses of 60 mg/kg and 90 mg/kg, respectively. Two monkeys after the high dose showed analgesia to a gingival needle puncture at plasma ketamine concentrations that ranged from 1390 to 3120 ng/mL. A good level of sedation was consistently observed in four monkeys (80%) following rectal ketamine at a dosage of 90 mg/kg, whereas one monkey showed a consistently good level at a dosage of 60 mg/kg. Sedation and dose were significantly (P less than 0.001) associated with plasma ketamine concentrations; physiologic parameters were not (P greater than 0.05). The results of this study suggest that rectal ketamine can produce plasma concentrations of the drug sufficient to achieve sedation in the monkey. The attainment of concomitant analgesia to a gingival needle puncture was not as predictable.  (+info)

Double-blind comparison of rectally administered diazepam to placebo for pediatric sedation: the cardiovascular response. (4/4)

The sedative and cardiovascular effects of rectally administered diazepam (0.6 mg/kg) were compared to placebo in uncooperative children who required sedation during dental treatment. Twelve healthy preschool children, who required amalgam restorations, were treated during two standardized restorative appointments in a double-blind, crossover study. Blood pressure and pulse were obtained during four specified intervals during the appointment. The behavior of the children during the treatment visits was videotaped and later statistically analyzed using a kinesics/vocalization instrument. Behavioral ratings of cooperation were significantly improved during the treatment visit following diazepam. All interfering bodily movements, patient vocalizations and operator commands for the diazepam group were reduced significantly (p+info)