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Thoracic epidural AND heart failure

Lucy Geraghty, Pasquale Santangeli, Usha B Tedrow, Kalyanam Shivkumar, Saurabh Kumar
Cardiac electrical storm (ES) is characterised by three or more discrete episodes of ventricular arrhythmia within 24hours, or incessant ventricular arrhythmia for more than 12hours. ES is a distinct medical emergency that portends a significant increase in mortality risk and often presages progressive heart failure. ES is also associated with psychological morbidity from multiple implanted cardioverter defibrillator (ICD) shocks and exponential health resource utilisation. Up to 30% of ICD recipients may experience storm in follow-up, with the risk higher in patients with a secondary prevention ICD indication...
January 2019: Heart, Lung & Circulation
Guifang Sun, Fengqi Liu, Chunhong Xiu
INTRODUCTION: Coronary microcirculation disturbance plays an important role in chronic heart failure (CHF). High thoracic sympathetic block (HTSB) is effective to treat CHF, but its impact on coronary microcirculation is unclear. METHODS: Forty male Wistar rats were subcutaneously injected with isoproterenol (340 mg/kg) for 2 days. Eight weeks later, 24 surviving rats were randomized to the CHF and HTSB groups and 10 rats were used as the control group. 50 μl of saline and ropivacaine (0...
December 1, 2018: Microvascular Research
Christ Ordookhanian, Sean W Kaloostian, Paul E Kaloostian
Anti-coagulation medications are widely used in clinical practice, especially in the United States as cardiac-related emergencies are on the rise. An overarching caveat in using anti-coagulation drugs as a long-term treatment regimen, such as warfarin, is that patients are closely monitored by their primary care provider. Routine monthly laboratory examinations are strictly required to assess the international normalized ratio (INR) which measures prothrombin time (PT), providing insight into how long it takes for blood to clot...
September 22, 2018: Curēus
Dan Ma, Lei Liu, Hongwei Zhao, Ruiying Zhang, Fengxiang Yun, Lulu Li, Yang Wang, Renhai Qu, Pengfei Liu, Fengqi Liu
OBJECTIVE: To verify that high thoracic epidural anesthesia (TEA) could reverse myocardial fibrosis in heart failure caused by dilated cardiomyopathy (DCM). DESIGN: Hospitalized patients with DCM and heart failure. SETTING: Harbin Medical University, Harbin, Heilongjiang, China. PARTICIPANTS: Eight patients. INTERVENTIONS: 0.5% lidocaine was administered epidurally at the T4-T5 interspace for 4 weeks...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
Guifang Sun, Fengqi Liu, Renhai Qu
OBJECTIVES: The impact of high thoracic sympathetic block (HTSB) on myocardial fibrosis in chronic heart failure (HF) is unclear. Myocardial collagen synthesis can be assessed by measuring circulating biomarkers. We observed the effect of HTSB on serum collagen biomarkers in HF. METHODS: Forty-four patients were randomized to a control and a HTSB group. They received routine medications. Repeated epidural injections were given to the HTSB group for 4 weeks. Echocardiography and measurements of serum carboxy-terminal propeptide of procollagen type I (PICP) and amino-terminal propeptide of procollagen type III (PIIINP) were performed at baseline and 4 weeks later...
2017: Cardiology
Sherif M Soaida, Mohammed S ElSheemy, Ahmed M Shouman, Ahmed I Shoukry, Hany A Morsi, Doaa M Salah, Fatina I Fadel, Hafez M Bazaraa
PURPOSE: 'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics...
February 2016: Journal of Anesthesia
S Heschl, C Colantonio, B Pieske, W Toller
Diastolic heart failure leads to an increase in perioperative morbidity and mortality. The prevalence of this disease is rising and multiple risk factors have already been identified. Besides higher age and female gender, arterial hypertension, diabetes mellitus and coronary artery disease in particular have to be considered. Clinical examination and laboratory analyses are important for preoperative evaluation; however, echocardiography plays the most important role in the diagnostics of diastolic heart failure...
December 2014: Der Anaesthesist
Tong Ge, Hao Qin, Xu Wang, Shu-Sen Yang, Li Guo, Wei Han, Hui-Ying Chang
OBJECTIVE: This study aimed to investigate the effects of thoracic epidural anesthesia (TEA) on cardiac function and myocardial cell apoptosis in isoproterenol (ISO) induced chronic heart failure (CHF) rats. METHOD: Rats were classified into 4 groups: the healthy control, ISO-induced CHF, ISO + TEA, and sham-treated groups. After 4 weeks, the animals in each group were examined by echocardiography. Invasive hemodynamic measurements were also preformed. RESULTS: Echocardiographic findings suggested that rats in the ISO + TEA group exhibited decreased left ventricular end-systolic (LVES) and left ventricular end-diastolic (LVED), and increased left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS) compared with rats in the ISO-induced CHF group...
October 2014: Journal of Interventional Cardiology
X Wang, G Y Chen, S S Yang, Y Tian, T Ge, H Qin, W Han, H Y Chang
We aimed at observing the effects of high thoracic epidural anesthesia (HTEA) on cardiac structure and function, heart rate variability (HRV), and QT interval variation (QTV) in ischemic cardiomyopathy (ICM) patients with chronic heart failure. We divided 30 ICM patients into HTEA (N = 16) and control (N = 14) groups.The control group was treated with medication, and the HTEA group was treated with HTEA and medication for 4 weeks. We measured the changes in the left-ventricular end-diastolic diameter (LVEDd) and left-ventricular ejection fraction (LVEF) before and after treatment by using echocardiography and examined changes in HRV and QTV using ambulatory electrocardiogram...
August 29, 2014: Genetics and Molecular Research: GMR
Tanyong Pipanmekaporn, Yodying Punjasawadwong, Somrat Charuluxananan, Worawut Lapisatepun, Pavena Bunburaphong, Somchareon Saeteng
OBJECTIVE: The purpose of this study was to explore the influence of positive fluid balance on cardiovascular complications after thoracotomy for noncancer lesions. METHODS: After approval from an institutional review board, a retrospective cohort study was conducted. All consecutive patients undergoing thoracotomy between January 1, 2005 and December 31, 2011 in a single medical center were recruited. The primary outcome of the study was the incidence of cardiovascular complications, which were defined as cardiac arrhythmia, cardiac arrest, heart failure, myocardial ischemia, and pulmonary embolism...
2014: Risk Management and Healthcare Policy
Cengiz Kaya, Ersin Koksal, Yasemin Burcu Ustun, Yasemin Semizoglu, Nurullah Yilmaz
Idiopathic dilated cardiomyopathy is a primary myocardial disease with unknown aetiology. This disease follows a prospective course that is characterized by ventricular dilation and impaired myocardial dilation. Congestive heart failure and malignant arrhythmias are the most widespread complications. The incidence of idiopathic dilated cardiomyopathy in the general population is 5-8/100.000. Because of the increased risks of perioperative complications, anesthetic management of this disease requires the application of a specific technique...
2014: Medical Archives
Anjum Saiyed, Reema Meena, Indu Verma, C K Vyas
BACKGROUND: Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients. METHODS: Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute...
January 2014: Saudi Journal of Anaesthesia
Qing-Shu Li, Feng-Qi Liu
BACKGROUND AND AIM: The progression of heart failure is affected by several factors, including chronic stimulation of the β-adrenoceptor. This clinical study was designed to measure the effects of thoracic epidural analgesia (TEA) on the plasma levels of norepinephrine (NE), cAMP, and cGMP in patients with heart failure and assess the clinical implication of TEA. METHODS: Forty patients with heart failure were randomly assigned to TEA (TEA plus standard care) and control groups (standard care)...
November 26, 2013: Journal of Cardiothoracic Surgery
Yu-juan Zhao, Feng-qi Liu, Chun-hong Xiu, Jie Jiang, Jian-hua Wang, Yan-song Xu, Shi-ying Fu, Qi Huang
OBJECTIVE: To evaluate the effect of high thoracic epidural analgesia (HTEA) in congestive heart failure (CHF). DESIGN: Rat model of CHF. SETTING: Harbin Medical University, Harbin, Heilongjiang, China. PARTICIPANTS: One hundred thirty-five rats. INTERVENTIONS: HTEA involved 5 times daily injections of 0.1% lidocaine at the T3-T4 level. MEASUREMENTS AND MAIN RESULTS: The authors examined myocardial norepinephrine (NE), angiotensin II (Ang II), endothelin-1 (ET1), and tumor necrosis factor-α (TNF-α) concentrations 2, 4, and 6 weeks after the start of HTEA...
April 2014: Journal of Cardiothoracic and Vascular Anesthesia
George A Demetriou, Manojkumar S Nair, Eoin Dinneen, Olu Oluwajobi
We present a 74-year-old woman, who developed massive haematemesis and hypovolaemic shock. Her management was challenging, as the bleeding site could not be identified during oesophagogastroduodenoscopy, she was not fit for a general anaesthesia and not able to lie flat due to heart failure, caused by pericardial effusion. She underwent an emergency laparotomy and gastrotomy under a combined thoracic epidural and lumbar spinal regional anaesthesia in a sitting position, 45° to horizontal plane. The bleeding site was identified as a Dieulafoy lesion on the posterior wall of the stomach and was controlled by under running the lesion...
February 14, 2013: BMJ Case Reports
Weiyan Guo, Fengqi Liu, Lu Fu, Renhai Qu, Guizhen Wang, Cuili Zhang
OBJECTIVE: Beta blockers and angiotensin-converting enzyme inhibitors are known to attenuate the remodelling process in chronic heart failure, but the high mortality after heart failure must be resolved. We aimed to evaluate the effects of using high thoracic epidural sympathetic blockade (HTESB) as an adjunctive treatment to conventional therapy on the regression of left ventricular remodelling in chronic heart failure due to dilated cardiomyopathy. METHODS: We studied 40 patients with severe chronic heart failure due to dilated cardiomyopathy...
October 2012: Acta Cardiologica
Tomas Andri Axelsson, Martin Ingi Sigurdsson, Asgeir Alexandersson, Hunbogi Thorsteinsson, Gudmundur Klemenzson, Steinn Jonsson, Tomas Gudbjartsson
INTRODUCTION: Following resection for non-small cell lung cancer (NSCLC), patients are usually admitted to the post-anesthesia care unit (PACU)for a few hours before admission to a general ward (GW). However, some patients need ICU-admission, either immediately post-surgery or from the PACU or GW. The aim of this study was to investigate the indications and risk factors for ICU-admission. MATERIAL AND METHODS: A retrospective study of 252 patients who underwent lobectomy, wedge resection or segmentectomy for NSCLC in Iceland during 2001-2010...
May 2012: Læknablađiđ
Kenji Iwamuro, Yuko Hamada, Toshiya Koitabashi
We report a man with severe dilated cardiomyopathy with an implantable cardioverter-defibrillator (ICD) who underwent sigmoidectomy. During the operation, the defibrillation function of the ICD has been stopped to prevent malfunction caused by electrocautery artifacts, and the electrodes of the external defibrillator were placed on the chest wall. Pulmonary artery catheter was inserted under X-ray imaging to prevent the interference between ICD leads and the catheter. Anesthesia was maintained with combined general and thoracic epidural anesthesia...
September 2010: Masui. the Japanese Journal of Anesthesiology
Guo-zhong Chen, Qing-xiang Wang, Xiao-zhi Wu, Ren Liu, He-qun Jiang
OBJECTIVE: To investigate the effect of high thoracic epidural anesthesia on ventricular remodeling and cardiac function in rats with heart failure induced by myocardial infarction, and to investigate their mechanism. METHODS: Rats that had been established successively model were randomly divided into S group (n = 12), HTEA group and CHF group (24/group). 9.0 g/L normal sodium 100 microl/kg was injected to epidural cavity twice a day separately in group S and group CHF...
December 22, 2009: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Ze'ev Shenkman, David Hoppenstein, Ilan Erez, Tzipora Dolfin, Enrique Freud
PURPOSE: Continuous epidural anaesthesia attenuates perioperative stress and avoids the need for systemic opioids. In addition, it may prevent the need for postoperative mechanical ventilation. The aim of the study was to prospectively follow the perioperative course of young infants treated with continuous thoracic/lumbar epidural anaesthesia for major surgery. METHODS: Data were collected prospectively from 44 epidural anaesthetics in 40 infants (18 premature or former premature) weighing 1,400-4,300 g who underwent major abdominal surgery (33 cases), thoracic surgery (5), or both (1), or ano-rectal surgery (5) at our centre...
July 2009: Pediatric Surgery International
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