scholarly journals Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jurgen van Limmen ◽  
Piet Wyffels ◽  
Frederik Berrevoet ◽  
Aude Vanlander ◽  
Laurent Coeman ◽  
...  
Keyword(s):  
Blood Flow ◽  
Hepatic Blood Flow ◽  
Controlled Trial ◽  
Direct Access ◽  
Portal Vein Pressure ◽  
Flow Measurements ◽  
Link Type ◽  
Vasopressor Support ◽  
Time Flow ◽  
Significant Difference

Abstract Background Maintaining adequate perioperative hepatic blood flow (HBF) supply is essential for preservation of postoperative normal liver function. Propofol and sevoflurane affect arterial and portal HBF. Previous studies have suggested that propofol increases total HBF, primarily by increasing portal HBF, while sevoflurane has only minimal effect on total HBF. Primary objective was to compare the effect of propofol (group P) and sevoflurane (group S) on arterial, portal and total HBF and on the caval and portal vein pressure during major abdominal surgery. The study was performed in patients undergoing pancreaticoduodenectomy because - in contrast to hepatic surgical procedures - this is a standardized surgical procedure without potential anticipated severe hemodynamic disturbances, and it allows direct access to the hepatic blood vessels. Methods Patients were randomized according to the type of anesthetic drug used. For both groups, Bispectral Index (BIS) monitoring was used to monitor depth of anesthesia. All patients received goal-directed hemodynamic therapy (GDHT) guided by the transpulmonary thermodilution technique. Hemodynamic data were measured, recorded and guided by Pulsioflex™. Arterial, portal and total HBF were measured directly, using ultrasound transit time flow measurements (TTFM) and were related to hemodynamic variables. Results Eighteen patients were included. There was no significant difference between groups in arterial, portal and total HBF. As a result of the GDHT, pre-set hemodynamic targets were obtained in both groups, but MAP was significantly lower in group S (p = 0.01). In order to obtain these pre-set hemodynamic targets, group S necessitated a significantly higher need for vasopressor support (p < 0.01). Conclusion Hepatic blood flow was similar under a propofol-based and a sevoflurane-based anesthetic regimen. Related to the application of GDHT, pre-set hemodynamic goals were maintained in both groups, but sevoflurane-anaesthetized patients had a significantly higher need for vasopressor support. Trial registration Study protocol number is AGO/2017/002 – EC/2017/0164. EudraCT number is 2017–000071-90.Clin.trail.gov,NCT03772106, Registered 4/12/2018, retrospective registered.

Duplex Sonography of Normal Renal Allografts

1989 ◽  
Vol 30 (1) ◽  
pp. 53-56 ◽  
Author(s):  
B. Schwaighofer ◽  
F. Kainberger ◽  
F. Fruehwald ◽  
P. Huebsch ◽  
N. Gritzmann ◽  
...  
Keyword(s):  
Blood Flow ◽  
Resistive Index ◽  
Duplex Sonography ◽  
Invasive Technique ◽  
Flow Measurements ◽  
Renal Allografts ◽  
Significant Difference ◽  
Main Renal Artery ◽  
Long Term Follow Up ◽  
Blood Flow Measurements

Thirty-five patients with normal renal allografts as well as 10 healthy volunteers with normal native kidneys were examined by duplex sonography. Blood flow measurements were performed in the main renal artery as well as in segmental, interlobar and arcuate arteries. In both groups the normal range of variation in blood flow was defined by using the resistive index (RI). Doppler wave forms and RI of main renal arteries were both similar to those of their branches. In renal allografts as well as in native kidneys the blood flow pattern showed a rapid up-slope in systole followed by a gradual down-slope in early diastole, with a persistent flow throughout diastole. In addition, there was no significant difference in the RI between allografted and native kidneys. The interobserver variability was less than 10 per cent. The mean RI was 0.68 using all data points. Vascular rejection in 11 patients could be discriminated significantly (p<0.001). Duplex sonography is useful in evaluating renal blood flow. This simple and non-invasive technique seems to be useful in long-term follow-up of renal allograft recipients.

Efficacy and Safety of Intravenous Mesenchymal Stem Cells for Ischemic Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011440
Author(s):  
Jong-Won Chung ◽  
Won Hyuk Chang ◽  
Oh Young Bang ◽  
Gyeong Joon Moon ◽  
Suk Jae Kim ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Controlled Trial ◽  
Outcome Evaluation ◽  
Autologous Serum ◽  
Secondary Outcome ◽  
Control Group ◽  
Link Type ◽  
Significant Difference ◽  
Major Stroke

ObjectiveTo test whether autologous modified mesenchymal stem cells (MSCs) improve recovery in patients with chronic major stroke.MethodsIn this prospective, open-label, randomized controlled trial with blinded outcome evaluation, patients with severe middle cerebral artery territory infarct within 90 days of symptom onset were assigned, in a 2:1 ratio, to receive preconditioned autologous MSC injections (MSC group) or standard treatment alone (control group). The primary outcome was the score on the modified Rankin Scale (mRS) at 3 months. The secondary outcome was to further demonstrate motor recovery.ResultsA total of 39 and 15 patients were included in the MSC and control groups, respectively, for the final intention-to-treat analysis. Mean age of patients was 68 (range, 28–83) years, and mean interval between stroke onset to randomization was 20.2 (range, 5–89) days. Baseline characteristics were not different between groups. There was no significant difference between the groups in the mRS score shift at 3 months (p = 0.732). However, secondary analyses showed significant improvements in lower extremity motor function in the MSC group compared to the control group (change in the leg score of the Motricity Index, p = 0.023), which was notable among patients with low predicted recovery potential. There were no serious, treatment-related adverse events.ConclusionsIntravenous application of preconditioned, autologous MSCs with autologous serum was feasible and safe in patients with chronic major stroke. MSC treatment was not associated with improvements in the 3-month mRS score, but we did observe leg motor improvement in detailed functional analyses.Classification of evidenceThis study provides Class III evidence that autologous mesenchymal stem cells do not improve 90-day outcomes in patients with chronic stroke.Trial registrationclinicaltrials.gov Identifier: NCT01716481.

Intraoperative use of transit time flow measurement improves patency of newly created radiocephalic arteriovenous fistulas in patients requiring hemodialysis

2020 ◽  
Vol 21 (6) ◽  
pp. 990-996
Author(s):  
Anna E Cyrek ◽  
Johannes Bernheim ◽  
Benjamin Juntermanns ◽  
Peri Husen ◽  
Arkadius Pacha ◽  
...  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Transit Time ◽  
Intraoperative Ultrasound ◽  
Low Flow ◽  
Flow Measurements ◽  
Technical Problems ◽  
Arteriovenous Fistulas ◽  
Time Flow ◽  
Observation Period

Background: The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency. Methods: Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5–10 min after the creation of a standardized anastomosis using 3–6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (< 200 mL/min) were enrolled. Patients were assessed clinically and with ultrasound every 3 months. Data were analyzed retrospectively. Results: In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p < 0.005) (11). Conclusion: The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.

Predicting Arteriovenous Fistula Maturation with Intraoperative Blood Flow Measurements

2008 ◽  
Vol 9 (4) ◽  
pp. 241-247 ◽  
Author(s):  
S.S. Berman ◽  
B. Mendoza ◽  
A. Westerband ◽  
R.C. Quick
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
Native American ◽  
Arteriovenous Fistula ◽  
Threshold Value ◽  
Operating Characteristics ◽  
Chi Square ◽  
Flow Measurements ◽  
Significant Difference ◽  
Blood Flow Measurements

Objective To establish the criteria for intraoperative blood flow measurements taken at the time of autologous arteriovenous fistula (AVF) construction to predict future access maturation and thereby avoid waiting periods for futile fistulas to declare themselves. Methods From April 2006 through to March 2007 consecutive patients undergoing native AVF construction at one institution underwent intraoperative measurements of blood flow using transit-time ultrasound technology. No action was taken based upon the flow measurement at the time of surgery. Patients were followed and data collected comprising demographics and AVF maturation. A fistula was considered mature when it was successfully accessed for hemodialysis (HD) at least three times. Statistical analysis was performed including receiver operating characteristics (ROC), ANOVA, and Chi square using the JMP software package. Results During the 12-month period, 70 autologous AVFs were created including 41 antecubital brachiocephalic, 21 radiocephalic, and 8 basilic vein transpositions in 35 females and 33 males with a mean age of 58 ± 1.7 (mean ± SEM). The group included 37 Hispanic, 17 Native American, 10 Caucasian, 3 African American and 1 Asian patient. The etiology of renal failure comprised 53 diabetics, 13 hypertensives, 1 polycystic kidney disease and 1 congenital abnormality. Complete follow-up was available in 69/70 AVFs in 67 patients. Patients were excluded from analysis if they had not yet started dialysis (n=12), stopped or died (n=4) before their fistula was accessed. Patients whose AVFs were patent, but required a secondary procedure to achieve a functional access were considered non-functional. There was a significant difference between the maximal intraoperative flow rates between functional and non-functional AVFs (573.6 ± 103 mL/min vs. 216.8 ± 35.8 mL/min; p<0.05). There was no difference between groups in regard to age, gender, race or etiology of renal failure. ROC analysis suggested a threshold value of 140 mL/min for radiocephalic and 308 mL/min for brachiocephalic AVFs to predict maturation to a functional access. Conclusion Intraoperative blood flow measurements obtained at the time of autologous AVF construction can identify fistulas that are unlikely to mature; and therefore, that require immediate revision or abandonment which will ultimately expedite the establishment of a useful access in the HD patient. This is the first study to establish the minimal flow values uniquely needed for both radial artery and brachial artery AVFs to expect primary maturation to a functional access.

The Haemodynamic Effects of Metabolic Acidosis in the Rat

1976 ◽  
Vol 50 (3) ◽  
pp. 177-184 ◽  
Author(s):  
J. Yudkin ◽  
R. D. Cohen ◽  
Barbara Slack
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cardiac Output ◽  
Metabolic Acidosis ◽  
Renal Blood Flow ◽  
Hepatic Blood Flow ◽  
Conscious Rats ◽  
Blood Ph ◽  
Significant Difference

1. The effect of metabolic acidosis of 4–6 h duration on cardiac output, blood pressure, heart rate, and hepatic and renal blood flow has been studied in the rat. 2. In anaesthetized rats, blood pressure and heart rate fell linearly with blood pH in both sham-operated and nephrectomized rats. There was no significant difference between the two groups in the effect of acidosis on either variable. 3. Cardiac output showed a significant fall with increasing acidosis in the conscious rat. 4. Estimated hepatic blood flow in conscious rats showed a significant positive correlation with blood pH in both sham-operated and nephrectomized animals. There was no significant difference in estimated hepatic blood flow between the two groups of animals at any blood pH. 5. In conscious rats, increasing acidosis caused a progressive decrease in estimated renal blood flow. 6. It is concluded that the increase in the previously described apparent renal contribution to lactate removal in the acidotic rat cannot be explained by any circulatory effect mediated by the kidney. The possible relevance of the findings to lactate homeostasis is discussed.

scholarly journals Malawian children with fast-breathing pneumonia with and without comorbidities

Pneumonia ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Amy Sarah Ginsburg ◽  
Tisungane Mvalo ◽  
Jun Hwang ◽  
Melda Phiri ◽  
Eric D. McCollum ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Link Type ◽  
Appropriate Treatment ◽  
Treatment Failure Rate ◽  
Significant Difference ◽  
Observational Cohort ◽  
Cure Rates

Abstract Background Due to high risk of mortality, children with comorbidities are typically excluded from trials evaluating pneumonia treatment. Understanding heterogeneity of outcomes among children with pneumonia and comorbidities is critical to ensuring appropriate treatment. Methods We explored whether the percentage of children with fast-breathing pneumonia cured at Day 14 was lower among those with selected comorbidities enrolled in a prospective observational study than among those enrolled in a concurrent randomized controlled trial evaluating treatment with amoxicillin in Lilongwe, Malawi. Results Among 79 children with fast-breathing pneumonia in the prospective observational cohort, 57 (72.2%) had HIV infection/exposure, 20 (25.3%) had malaria, 2 (2.5%) had severe acute malnutrition, and 17 (21.5%) had anemia. Treatment failure rate was slightly (not significantly) lower in children with comorbidities (4.1%, 3/73) compared to those without comorbidities (4.5%, 25/552) similarly treated. There was no significant difference in clinical cure rates by Day 14 (95.8% with vs 96.7% without comorbidity). Conclusions Children with fast-breathing pneumonia excluded from a concurrent clinical trial due to comorbidities did not fare worse. Children at higher risk whose caregivers seek care early and who receive appropriate risk assessment (e.g., pulse oximetry, hemoglobin, HIV/malaria testing) and treatment, can achieve clinical cure by Day 14. Trial registration ClinicalTrials.govNCT02960919; registered November 8, 2016.

Lack of gender difference in motion sickness induced by vestibular Coriolis cross-coupling

2003 ◽  
Vol 12 (4) ◽  
pp. 191-200 ◽  
Author(s):  
Bob Cheung ◽  
Kevin Hofer
Keyword(s):  
Blood Flow ◽  
Gender Difference ◽  
Motion Sickness ◽  
Sagittal Plane ◽  
Cross Coupling ◽  
Supporting Evidence ◽  
Flow Measurements ◽  
Calf Blood Flow ◽  
Significant Difference ◽  
Blood Flow Measurements

It has been reported that females are more susceptible to motion sickness than males. Supporting evidence is primarily based on retrospective survey questionnaires and self-reporting. We investigated if there is a gender difference in motion sickness susceptibility using objective and subjective measurements under controlled laboratory conditions. Thirty healthy subjects (14 males and 16 females) between the ages of 18-46 years were exposed to Coriolis cross-coupling stimulation, induced by 120°/s yaw rotation and a simultaneous 45° pitch forward head movement in the sagittal plane every 12 seconds. Cutaneous forearm and calf blood flow, blood pressure, and heart rate were monitored. Graybiel's diagnostic criteria were used to assess sickness susceptibility before and after motion exposure. Golding and Kerguelen's scale was used to assess the severity of symptoms during motion exposure. A significant (p < 0.01) increase of forearm and calf blood flow during cross-coupling stimulation was observed in both sexes. However, the subjective symptoms rating and blood flow measurements indicate that there was no significant difference between male and female subjects. Our data also suggests that females may be more inclined to admit discomfort as indicated by their responses to a survey of motion sickness history prior to the experiment.

Hepatic vascular response to epinephrine

1961 ◽  
Vol 201 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William C. Shoemaker ◽  
L. Newton Turk ◽  
Francis D. Moore
Keyword(s):  
Blood Flow ◽  
Portal Vein ◽  
Pressure Gradient ◽  
Hepatic Blood Flow ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Portal Vein Pressure ◽  
Pronounced Increase ◽  
Epinephrine Administration ◽  
Arterial Blood

Hepatic hemodynamic events were measured before and after epinephrine administration in unanesthetized dogs in which the hepatic vessels had been previously catheterized. Comparisons were made of the response after a single intravenous injection at various doses and after a constant infusion of epinephrine; comparisons were also made between portal vein and femoral vein injections. After femoral venous injection of epinephrine (1–10 µg/kg) there was a marked increase in hepatic blood flow, roughly increasing with the size of the dose. With doses of 25 µg/kg or more, an initial increase in hepatic blood flow was followed by a decreased flow; in some instances death ensued. Epinephrine injected into the femoral vein produced a rise in the arterial blood pressure, followed by a rise in the portal vein pressure, portal-hepatic venous pressure gradient, and mechanical impedance across the hepatic venous bed. When injected into the portal vein under comparable conditions, epinephrine produced little or no change in hepatic blood flow or arterial pressure, but did produce a more rapid and pronounced increase in portal vein pressure, portal-hepatic pressure gradient and hepatic venous impedance.

The validity of chronic hepatic blood flow measurements obtained by the electromagnetic flow meter

1965 ◽  
Vol 5 (7) ◽  
pp. 313-317 ◽  
Author(s):  
John B. Price ◽  
Richard C. Britton ◽  
Lynn M. Peterson ◽  
John W. Reilly ◽  
Arthur B. Voorhees
Keyword(s):  
Blood Flow ◽  
Hepatic Blood Flow ◽  
Flow Meter ◽  
Flow Measurements ◽  
Electromagnetic Flow ◽  
Electromagnetic Flow Meter ◽  
Blood Flow Measurements

One-donor, two-recipient extracranial-intracranial bypass series for moyamoya and cerebral occlusive disease: rationale, clinical and angiographic outcomes, and intraoperative blood flow analysis

2021 ◽  
pp. 1-10
Author(s):  
Nickalus R. Khan ◽  
Victor M. Lu ◽  
Turki Elarjani ◽  
Michael A. Silva ◽  
Aria M. Jamshidi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Analysis ◽  
Measurement Data ◽  
Senior Author ◽  
Flow Index ◽  
Flow Measurements ◽  
Bypass Patency ◽  
Significant Difference ◽  
The Mean

OBJECTIVE Cerebral extracranial-intracranial (EC-IC) direct bypass is a commonly used procedure for ischemic vasculopathy. A previously described variation of this technique is to utilize one donor artery to supply two recipient arteries, which the authors designate as 1D2R. The purpose of this study is to present a single surgeon’s series of 1D2R direct bypasses for moyamoya and ischemia using detailed clinical, angiographic, and intraoperative blood flow measurement data. To the authors’ knowledge, this is the largest series reported to date. METHODS Hospital, office, and radiographic imaging records for all patients who underwent cerebral revascularization using a 1D2R bypass by the senior author were reviewed. The patients’ demographic information, clinical presentation, associated medical conditions, intraoperative information, and postoperative course were obtained from reviewing the medical records. RESULTS A total of 21 1D2R bypasses were performed in 19 patients during the study period. Immediate bypass patency was 100% and was 90% on delayed follow-up. The mean initial cut flow index (CFI(i)) was 0.64 ± 0.33 prior to the second anastomosis and the mean final value (CFI(f)) was 0.94 ± 0.38 after the second anastomosis (p < 0.001). The overall bypass flow increased on average by 50% (mean 17.9 ml/min, range −10 to 40 ml/min) with the addition of the second anastomosis. There was no significant difference in the overall flow measurements when the end-to-side anastomosis or side-to-side anastomosis was performed first. There was a statistically significant difference in the proportion of patients with a modified Rankin Scale (mRS) score of 0 or 1 postoperatively compared to preoperatively (p < 0.01). Through the application of Poiseuille’s law, the authors analyzed flow dynamics, deduced the component vascular resistances based on an analogy to electrical circuits and Ohm’s law, and introduced the new concepts of “second anastomosis relative augmentation” and “second anastomosis sink index” in the evaluation of 1D2R bypasses. CONCLUSIONS The application of the 1D2R technique in a series of 19 consecutive patients undergoing direct EC-IC bypass for flow augmentation demonstrated high patency rates, statistically significantly higher CFIs compared to 1D1R, and improved mRS scores at last clinical follow-up. Additionally, the technique allows a shorter dissection time and preserves blood flow to the scalp. The routine utilization of intraoperative volumetric flow measurements in such surgeries allows a deeper understanding of the hemodynamic impact on individual patients.

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