Articles: human.
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Journal of anesthesia · Aug 2014
Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model.
Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n = 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). ⋯ Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P = 0.002, P < 0.001) and intermediate (P = 0.04, P = 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P = 0.93), intermediate perfusion (P = 1.00), and hypoperfusion (P = 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.
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Scand. Cardiovasc. J. · Aug 2014
Prognosis and response to first-line single and combination therapy in pulmonary arterial hypertension.
To investigate survival, treatment escalation, effects of first-line single- and first-line combination therapy and prognostic markers in idiopathic- (IPAH), hereditary- (HPAH) and connective tissue disease-associated (CTD-PAH) pulmonary arterial hypertension (PAH). ⋯ We confirm improved survival with PAH-targeted therapies. Survival is still poor and early treatment escalation frequently needed. First-line combination therapy may more potently improve haemodynamics. MRAP/CI may represent a new prognostic marker in PAH.
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Sheng Wu Yi Xue Gong Cheng Xue Za Zhi · Aug 2014
[Closed-loop control for chest compression based on coronary perfusion pressure: a computer simulation study].
In this study, a closed-loop controller for chest compression which adjusts chest compression depth according to the coronary perfusion pressure (CPP) was proposed. An effective and personalized chest compression method for automatic mechanical compression devices was provided, and the traditional and uniform chest compression standard neglecting individual difference was improved. ⋯ The performance of the fuzzy controller was evaluated and compared to that of a traditional PID controller in computer simulation studies. The simulation results demonstrated that the fuzzy closed-loop controller produced shorter regulation time, fewer oscillations and smaller overshoot than those of the traditional PID controller and outperforms the traditional PID controller in CPP regulation and maintenance.