Journal of anesthesia
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Journal of anesthesia · Mar 1995
Prophylactic hemostatic drugs do not reduce hemorrhage: Thromboelastographic study during upper abdominal surgery.
Although a number of hemostatic drugs are currently used during surgery to reduce hemorrhage, their effects on bleeding are still controversial. Furthermore, few studies have been made on their prophylactic effects. The purpose of this study was to clarify the effects of hemostatic drugs on bleeding. ⋯ No significant difference in blood loss was observed between the groups. Our findings, therefore, suggest that these two hemostatic drugs do not have prophylactic effects on intraoperative bleeding. Further studies are, however, necessary before applying these results to all surgical patients.
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Journal of anesthesia · Mar 1995
Differential effects of halothane, enflurane, isoflurane, and sevoflurane on the hemodynamics and metabolism in the perfused rat liver in fasted rats.
The effects of volatile anesthetics on hepatic hemodynamics and metabolism were studied using isolated liver perfusion. The liver was isolated from overnight-fasted male Sprague-Dawley rats and placed in a recirculating perfusion-aeration system. The liver was perfused through the portal vein at a constant pressure of 12 cmH2O. ⋯ The increase in lactate concentration in the recirculating perfusate was significantly enhanced by the volatile anesthetics, and the enhancement was less remarkable in the isofluranetreated group than in the enflurane-or sevoflurane-treated groups. These results indicate that volatile anesthetics alter hepatic carbohydrate metabolism but maintain hepatic blood flow when the perfusion pressure is kept constant. Isoflurane exerts exceptional influence on hepatic oxygen consumption and lactate production, and may be preferable for operations that limit the oxygen supply to the liver.
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Journal of anesthesia · Mar 1995
Fibrinolytic shutdown after cardiopulmonary bypass surgery is caused by circulating cytokines during operation, accompanied by endothelial injury.
It has been hypothesized that increased cytokines during cardiopulmonary bypass surgery cause postoperative fibrinolytic shutdown. To investigate the role of cytokines and to elucidate its mechanism, tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), plasminogen activator inhibitor-1 antigen (PAI-1 Ag), PAI-1 activity, and thrombomodulin in 16 patients undergoing elective cardiopulmonary bypass surgery were analyzed after induction of anesthesia, before and after cardiopulmonary bypass, and at the end of the operation. during surgery, TNF-α and LI-1β were detected in 44% and 63% of the cases, respectively. PAI-1 Ag (P<0.01), PAI-1 activity (P<0.001) and thrombomodulin (P<0.01) were significantly increased at the end of the operation. ⋯ In group 1, there was a significant positive correlation between thrombomodulin and PAI-1 Ag (r (2)=0.117,P<0.05) and PAI-1 activity (r (2)=0.124,P<0.05). In conclusion, TFN-α and IL-1β were released into the systemic circulation during cardiopulmonary bypass surgery, and this release may have been caused by vascular endothelial injury. These cytokines increased PAI-1 activity.
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Journal of anesthesia · Mar 1995
Ischemia may be less detrimental than anemia for O2 transport because of CO 2 transport: A model analysis.
We analyzed the relationship between oxygen delivery (Do2) and Pto2 (tissue Po2). We found an important factor which has not been specified before. In the previous O2 transport model, Do2 was a dependent variable, calculated from hemoglobin, blood flow, Pao2, and the oxygen dissociation curve (ODC). ⋯ In ischemia the CO2 transport is disturbed, leading a higher draining venous Pco2, which in turn maintains a higher Po2 the capillary, resulting in a higher gradient for Po2 between capillary and the tissue. Between ischemia and anemia, ischemia is less detrimental than anemia. In ischemia, the CO2 transport is disturbed, which in turn maintains a higher Po2 at the capillary.