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Carfentanil citrate was given orally to five adult brown bears (Ursus arctos) on 14 separate occasions during the winter and summer to determine effective anesthetic dosages and how season may alter these dosages. Lower blood urea nitrogen:creatinine ratios, depressed appetite, and decreased activity levels in the winter versus summer were reflective of different metabolic states, even though bears were not hibernating in the winter. Doses of carfentanil citrate between 6.0 and 15.2 microg/kg were mixed with 5-10 ml of honey, which the bears licked voluntarily from a spoon. During each anesthetization, respiratory and heart rates, hemoglobin saturation, temperature, electrocardiogram, blood gas values, and level of consciousness were monitored and utilized to determine effective dosages. Mean (+/- SE) dose requirements in the winter were 7.6 +/- 0.4 microg/kg, whereas a greater mean dose of 12.7 +/- 0.5 microg/kg was required in the summer (P < 0.05). After ingestion began, sternal recumbency occurred in an average of 7.5 min (range: 4-11 min), and full restraint and safe handling was achieved in 21 min (range: 8-40 min). At the end of each procedure, naltrexone was given as the reversal agent at a ratio of 100 mg naltrexone per 1 mg carfentanil, with 25% of the dose given i.v. or i.m. and 75% given s.c. Mean reversal time was 6 min after injection of naltrexone (range: 4-9 min). Rapid induction and recovery times and ease of oral administration make carfentanil citrate an effective anesthetic agent for use in brown bears. However, hypoventilation and respiratory acidosis were noted in all bears, and oxygen insufflation is recommended.

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UNLABELLED: Although continuous auscultation has been used during surgery as a monitor of cardiac function for many years, the effect of anesthetics on heart sounds has never been quantified. We determined the root mean squared amplitude and frequency characteristics (peak frequency, spectral edge, and power ratios) of the first (S1) and second (S2) heart sounds in 19 healthy children during induction of anesthesia with halothane. In all patients, halothane decreased the amplitude of S1 (R2 = 0.87 +/- 0.12) and S2 (R2 = 0.66 +/- 0.33) and the high-frequency components (>80 Hz) of these sounds. These changes were clearly audible and preceded decreases in heart rate and blood pressure. The spectral edge decreased for S1 in 18 patients (R2 = 0.73 +/- 0.24) and for S2 in 13 patients (R2 = 0.58 +/- 0.25). Peak frequency did not change. The rapidity with which myocardial depression and its associated changes in heart sound characteristics occurred confirms that continuous auscultation of heart sounds is a useful clinical tool for hemodynamic monitoring of anesthetized infants and children. IMPLICATIONS: Heart sound characteristics can be used to monitor cardiac function during halothane anesthesia in children. The changes occur rapidly and precede noticeable changes in heart rate and blood pressure.

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A 57-year-old woman was admitted for examination because of chest discomfort. Transthoracic echocardiography was performed and she was diagnosed as having hypertrophic cardiomyopathy. An echocardiogram also revealed that she had midventricular obstruction with a pressure gradient of 125 mmHg determined by Doppler echocardiography. A phonocardiogram showed an early systolic sound and the beginning of the sound coincided with the time of septal-posterior wall contact. In addition, the timing also corresponded to the sudden obstruction of blood flow in the region of the midventricular narrowing. Furthermore, this sound markedly decreased with the reduction in pressure gradient caused by cibenzoline treatment. Thus, it was concluded that the early systolic sound was associated with midventricular obstruction and produced by a rapid deceleration of the interventricular flow caused by midventricular obstruction.

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In early 1973, Waagstein administered bolus intravenous injections of practolol and, subsequently, alprenolol, 50 mg twice daily, to reduce the heart rate of a 59-year-old woman with refractory, idiopathic dilated congestive cardiomyopathy (DCCM) and resting tachycardia. The patient's condition improved dramatically and continued to improve during subsequent oral therapy. This experience, combined with increasing interest in the role of beta blockade in myocardial protection, led to investigation of oral practolol, 50-400 mg twice daily, for 2-12 months in 6 additional patients with advanced DCCM. These findings, published in 1975, indicated improved ventricular function for all participants. In a 1980 open-label follow-up study, 28 patients with DCCM received alprenolol, metoprolol, practolol, or propranolol. Treatment was associated with improvements in myocardial function as well as in related symptomatology. These effects were reversed following drug withdrawal. The findings suggested that beta blockers possessed potential value in treatment of idiopathic DCCM.

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