scholarly journals Comparison of the Effects of Low-flow and Normal-flow Desflurane Anaesthesia on Inflammatory Parameters in Patients Undergoing Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Tugba Bingol Tanriverdi ◽  
◽  
Mehmet Tercan ◽  
Ayse Gusun Halitoglu ◽  
Ahmet Kaya ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Low Flow ◽  
Normal Flow ◽  
Inflammatory Parameters ◽  
Desflurane Anaesthesia

Abstract 12660: Impact of Aortic Valve Replacement versus Medical Management on Survival of Low Flow Low Gradient Severe Aortic Stenosis With Normal Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Zaher Fanari ◽  
Dimitrios Barmpouletos ◽  
Vivek K Reddy ◽  
Sumaya Hammami ◽  
Zugui Zhang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Rank Test ◽  
Normal Ejection Fraction ◽  
Normal Flow ◽  
Log Rank Test

Background: The impact of aortic valve replacement (AVR) versus medical management (MM) in patients with paradoxical low flow is unclear. The objective of this study was to compare outcomes of AVR versus MM in patients with severe aortic stenosis and normal ejection fraction and different transaortic flow and gradient. Methods: We identified consecutive patients presenting to our echo lab with an aortic valve area (AVA) < 1.0cm 2 and EF≥ 50%. We stratify patients depending on gradient (≥ 40 vs. < 40 mmHg) and stroke volume index (SVI < 35 vs. ≥35 ml/m 2 ). 4 groups were identified (, normal flow, high gradient [NF/HG]; normal flow, low gradient [NF/LG]; low flow, high gradient [LF/HG] and low flow, low gradient [LF/LG]. These 4 groups were also stratified depending on management (AVR vs. MM). All patients were retrospectively followed for the occurrence of death. Results: A total of 954 patients were included in analysis. Mean follow up was 2.45 ± 1.9 years. The mean age was 75.4 ± 5.6 years. Comparing all 4 AS subgroups, the mortality was higher in LF/HG followed by LF/LG, NF/HG and NF/LG (LF/HG 37.1% vs. LF/LG 33.9% vs. NF/HG 30.3%vs. NF/LG 20.2%; Log Rank Test, P=0.003). Patients who underwent medical therapy have a higher mortality than the overall cohort in all subgroups (LF/HG 44.3% vs. NF/HG 36.6% vs. LF/LG 33.7% vs. NF/LG 21.2%; Log Rank Test, P=0.001). Patients with HG had a higher chance of getting aortic valve replacement (AVR) than those with LF/LG and NF/LG (20.7% NF/HG vs. 10.6% LF/HG vs. 4.7% LF/LG and 3.6% NF/LG; P=0.01). Patients who underwent AVR had lower mortality rates when compared with the overall cohort in all subgroups (LF/HG 21.4% vs. 18.9% NF/HG vs. 6.6% LF/LG and 7.1% NF/LG; Log Rank Test, P= 0.253). Conclusion: Patients with LF/LG represent an under-recognized high-risk group with similar prognosis to NF/HG. Although these patients may benefit tremendously from AVR, they are less likely to undergo AVR when compared to HG patients.

P6486Flow state, gradients and anatomopathological valvular calcification: influence in aortic stenosis surgical outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J T Museli ◽  
L Zambruno ◽  
N Coria ◽  
G Giunta ◽  
J F Salmo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Low Flow ◽  
P Value ◽  
Flow State ◽  
Normal Flow ◽  
Perioperative Mortality ◽  
High Gradient ◽  
The Relationship

Abstract Introduction Aortic stenosis (AS) patients are heterogeneous. The relationship between stenosis severity, transvalvular flow state and gradients is conflictive and non-linear. Objective To evaluate the relationship between transvalvular flow state and gradients with the anatomopathological aortic valve characteristics and perioperative morbimortality among patients (pt) submitted to aortic valve replacement (AVR). Methods We analyzed 516 pt with symptomatic severe AS (effective valve area <1 cm2) with preserved left ventricular ejection fraction (>50%) submitted to AVR. Perioperative mortality and a combined endpoint (death, low cardiac output syndrome and acute renal injury) were analyzed dividing the population by transvalvular flow (35 ml/m2) and mean gradient (40 mmHg), both measured by echocardiography. A morphologic evaluation of 383 operatively excised native cardiac valves was performed. Valvular thickening and calcification were categorized in mild, moderate and severe. Results Male subjects represented 52.9% (283 pt). Mean age were 69±11.5 years. Pt showed a mean ejection fraction of 61±4.8%, the peak gradient was 86.2±24 mmHg, and mean gradient was 53±18 mmHg. Cardiac low output syndrome (normal flow (NF) – 14%, low flow (LF) – 23%; p<0,02), IABP (NF 1,8%, LF 6%, p<0,02) and perioperative mortality (NF 2,7%, LF 7%, p<0,02) were more frequent in low flow pt (185 – 35%). Bicuspid valves represented 24.5% of the whole population. Bicuspid patients were younger 64±9 vs 73±12 years (p<0.05) and had more moderate–severe calcification (MSC) 93.4% vs 75.6% (p<0.05). No difference was found in moderate -severe thickening (MSTh) and MSC when analyzing the population by flow (35 ml/m2). On the contrary, low gradient pt (<40mmHg) had lower MSC and MSTh. (Table) Finally, 4 groups were considered: normal flow–high gradient NFHG (52.2%), normal flow–low gradient NFLG (12%), low flow–high gradient LFHG (25.5%) and low flow–low gradient LFLG (10.1%). A trend toward more perioperative events was seen in the LF-LG group despite less calcified and thickened valves. (Figure) Table 1 Normal Flow Low Flow P value Normal gradient Low gradient P value M-S thickening 143 (58.1%) 80 (58.3%) NS 186 (62.4%) 37 (43.5%) 0.0018 M-S calcification 195 (79.2%) 119 (86.8%) NS 263 (88.2%) 51 (60%) <0.05 Bicuspid valve 62 (25%) 32 (23%) NS 62 (25.2%) 32 (23.3%) NS M-S: Moderate-Severe. Figure 1 Conclusions In our population of severe symptomatic AS with preserved ejection fraction submitted to AVR, low gradient pts had less calcified and thickened valves. LFLG pts presented a trend towards more perioperative events despite having less valvular calcification.

scholarly journals Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mohammed Heyba ◽  
Ahmed Khalil ◽  
Yasser Elkenany
Keyword(s):  
Cardiac Arrest ◽  
Laparoscopic Cholecystectomy ◽  
Flow Rate ◽  
Low Flow ◽  
Postanesthesia Care Unit ◽  
Surgical Team ◽  
Severe Bradycardia ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgical Operations

Laparoscopy is becoming increasingly popular in gynecological and general surgical operations. There are complications that are inherent to the laparoscopy techniques; amongst them is intraoperative vagal-mediated bradycardia that results from peritoneal stretching. This can occur due to high flow rate of gas during peritoneal insufflation, a practice still happening nowadays. We report a case of a middle-aged hypertensive patient who was undergoing elective laparoscopic cholecystectomy. The patient was assessed more than once preoperatively by the anesthesia team for blood pressure optimization. The patient underwent general anesthesia and developed severe bradycardia immediately after peritoneal insufflation. The management started immediately by stopping the insufflation and deflating the abdomen. Afterwards, atropine was administered intravenously, and CPR was started preemptively according to the ACLS protocol to prevent the patient from progressing into cardiac arrest. She responded to the management and became vitally stable within one minute. After confirming that there was no cardiac or metabolic insult through rapid blood investigations and agreeing that the cause of bradycardia was the rapid insufflation, the surgical team proceeded with the surgery in the same setting using low flow rate of CO2 to achieve pneumoperitoneum. There were no complications in the second time and the operation was completed smoothly. The patient was extubated and shifted to the postanesthesia care unit to monitor her condition. The patient was stable and conscious and later shifted to the wards and discharged on routine follow-up after confirming that there were no complications in the postoperative follow-up. Therefore, it is important to monitor the flow rate of CO2 during peritoneal insufflation in laparoscopic surgery as rapid peritoneal stretch can cause severe bradycardia that might progress into cardiac arrest, especially in hypertensive patients. It is also important for the anesthetist to be vigilant and ready to manage such cases.

scholarly journals Echocardiographic Evaluation of Aortic Stenosis – Normal Flow and Low Flow Scenarios

2014 ◽  
Vol 9 (2) ◽  
pp. 92
Author(s):  
Ian G Burwash ◽  
Keyword(s):  
Clinical Outcome ◽  
Aortic Stenosis ◽  
Patient Management ◽  
Low Flow ◽  
Normal Flow ◽  
Prognostic Information ◽  
Echocardiographic Evaluation ◽  
Mean Pressure ◽  
Echocardiographic Assessment ◽  
Valve Area

The echocardiographic evaluation of the patient with aortic stenosis (AS) has evolved in recent years, beyond confirming the diagnosis and measuring the resting mean pressure gradient or valve area. New echocardiographic approaches have developed to address the clinical dilemmas related to discordant haemodynamic data, asymptomatic haemodynamically severe AS and low-flow, low-gradient AS in order to better evaluate the disease severity, enhance the risk stratification of patients and provide important prognostic information. This article reviews the echocardiographic evaluation of the AS patient and focuses on the echocardiographic assessment of the haemodynamic severity, the prediction of clinical outcome and the use of echocardiography to guide patient management in the presence of normal flow and low flow scenarios.

Mechanisms of changes in K+ balance on reduction and reestablishment of flow in isolated rat liver

1990 ◽  
Vol 258 (1) ◽  
pp. G45-G51
Author(s):  
L. Sestoft ◽  
M. Folke
Keyword(s):  
Carboxylic Acid ◽  
Time Course ◽  
Low Flow ◽  
Second Phase ◽  
Acid Uptake ◽  
Normal Flow ◽  
K Uptake ◽  
Cellular Volume ◽  
K Permeability ◽  
K Release

The effects of low flow and reestablished normal flow on K+ balance and carboxylic acid balance was studied in perfused liver of 48-h starved rats at perfusate pH 7.4 and 6.8. The rate of net K+ release induced by ouabain was 1.8 mumol.min-1.g-1 at pH 7.4 and 1.4 mumol.min-1.g-1 at pH 6.8. Lowering of flow to 30% normal was accompanied by a transient, diphasic loss of K+ (max 0.15 mumol.min-1.g-1). Reestablished normal flow was immediately accompanied by a monophasic K+ uptake (max 0.35 mumol.min-1.g-1). These changes in potassium balance were independent of perfusate pH. Reduction of flow caused an almost immediate depolarization of 4 mV followed by a steady tendency to repolarization. Reestablished normal flow induced a transient hyperpolarization. Production of carboxylic acids during the low flow period did not correlate with the diphasic time course of K+ loss, and carboxylic acid uptake after reestablishment of flow did not correlate with the transient uptake of K+. The data show that the initial phase of K+ loss during low flow is due to inhibition of the Na(+)-K(+)-pump; the second phase may be reasonably explained by increased K+ permeability concomitant to cellular volume regulation.

scholarly journals Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation

2020 ◽  
Vol 11 (2) ◽  
pp. 28-34
Author(s):  
Vladlen V. Bazylev ◽  
Dmitrii S. Tungusov ◽  
Ruslan M. Babukov ◽  
Fedor L. Bartosh ◽  
Artur I. Mikulyаk ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Odds Ratio ◽  
Low Flow ◽  
Normal Flow ◽  
Long Term Follow Up ◽  
Group 2 ◽  
Long Term Mortality

Relevance.It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currently no comparative studies of patients with NFHG and LFLG after the Ozaki procedure. The better hemodynamic properties of autopericardial cusps compared with biological prostheses can more favorably influence the results in patients with LFLG in the short and long-term follow-up periods. Aim.1. Compare the hospit and long-term results of patients of the LFLG group with the results of patients of the NFHG group after the Ozaki procedure. 2. Identify predictors of hospital and long-term mortality in patients with LFLG. Materials and methods.All patients have been divided into two groups. Group 1: 137 patients with NFHG and signs of classic aortic stenosis: AVA1 cm2, Gmean40, SV index 35 ml/m2and normal left ventricle (LV) ejection fraction. Group 2. 71 patients with LFLG and underestimation of the average gradient indices (Gmean40) despite a decrease in the aortic valve aperture AVA1 cm2amid a decrease in the index of stroke volume 35 ml/m2and LV systolic function. Results.Hospital mortality after surgical correction of AV stenosis was significantly higher in patients of group 2: 3 (4.2%) patients and 1 (0.7%) patients, respectively (p=0.002). Survival at the maximum follow-up period for patients with LFLG was significantly lower than in the group of patients with NFHG 88.6 (95% confidence interval CI 4449.6) and 97.8 (95% CI 48.951), respectively (p=0.009). According to the results of the Cox regression analysis, the independent predictors of mortality in the long-term follow-up of patients with LFLG are the SV odds ratio 0.8 (95% CI 0.91.1);p=0.008 and the global longitudinal LV deformation (GLS) odds ratio 0.56 (95% CI 0.471.1);p=0.01. Conclusions.1. After the Ozaki procedure, patients with the LFLG group have higher risks of adverse events, both at the hospital stage and in the long-term follow-up, compared to patients with NFHG. 2. The duration of ischemia and LV mass are predictors of hospital mortality in the LFLG group of patients. 3. Predictors of long-term mortality in patients with LFLG are LV stroke volume index and global longitudinal LV deformation.

scholarly journals Remodeling of Resistance Arteries in Renal Failure: Effect of Endothelin Receptor Blockade

2001 ◽  
Vol 12 (10) ◽  
pp. 2040-2050 ◽  
Author(s):  
KERSTIN AMANN ◽  
GABRIEL MIL TENBERGER-MIL TENYI ◽  
AURELIA SIMONOVICIENE ◽  
ANDREAS KOCH ◽  
STEPHAN ORTH ◽  
...  
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
High Flow ◽  
Mesenteric Arteries ◽  
Low Flow ◽  
Normal Flow ◽  
Flow Conditions ◽  
First Order ◽  
The Media ◽  
Intimal Thickness

Abstract. Remodeling of vessels is a known feature of renal failure, but it is unclear whether this represents an appropriate or inappropriate response to the known changes in blood flow, shear stress, and wall tension. To investigate remodeling in response to variations in blood flow, first-order mesenteric arteries were exposed to high- and low-flow conditions via the ligation of second-order branches, according to the technique described by Pour-ageaud and De Mey. The resulting changes in vessel geometric features, relative proportions of intima and media, submicroscopic structure, and immunostaining for proliferating cell nuclear antigen (PCNA), endothelin-1 (ET-1), and ETAreceptors were assessed in first-order mesenteric arteries under low-flow and high-flow conditions. Subtotally nephrectomized (SNX) animals were compared with sham-operated rats. Animals either were left untreated or were treated with the ETAreceptor antagonist (ET-RA) LU-135252, because of suggestions in the literature that ET is involved in vascular remodeling in uremia. A highly significant increase in intimal thickness was noted in low-flow arteries (4.21 ± 1.39 μm) of SNX animals, compared with normal-flow arteries (2.06 ± 0.61 μm), but this increase was not observed in sham-operated rats (1.38 ± 0.77 in low-flow arteriesversus2.40 ± 0.35 μm in normal-flow arteries). The increase in intimal thickness in low-flow arteries was abrogated by ET-RA. The medial thickness was increased in untreated SNX animals (19.5 ± 3.61 μm), compared with sham-operated rats, and this increase was also prevented by ET-RA. The medial thickness was not affected by low flow in either sham-operated or SNX animals. In parallel, the number of PCNA-positive intimal cells was higher in low-flow, but not high-flow, arteries of SNX rats, compared with sham-operated rats. No significant change was observed in sham-operated animals. In the media, the number of PCNA-positive cells was higher in untreated SNX animals than in sham-operated rats. The number was even more markedly increased in high-flow, but not low-flow, vessels. This increase was abrogated by ET-RA. It is concluded that, in uremic animals, the response of the intima to low flow and the response of the media to high flow are exaggerated. Both responses are apparently mediated by ET.

A comparison of propofol- and desflurane-anaesthesia for laparoscopic cholecystectomy

2002 ◽  
Vol 19 (3) ◽  
pp. 219-220
Author(s):  
M. Zink ◽  
A. Waltensdorfer ◽  
G. Weiss ◽  
I. Wöhry ◽  
M. Rath ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Desflurane Anaesthesia
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