Increase in BP began after the respiratory
changes, peaked (50%) at 5 min and remained at that level throughout. The decrease in heart rate (HR) began after 5 min, peaked (60%) at 10 min and recovered subsequently (40%) but remained below the initial level. In terazosin pretreated animals, the venom-induced cardiorespiratory changes were attenuated significantly. Whereas in vagotomized group, venom-induced respiratory changes and HR changes were blocked but not the BP changes. The findings suggest that the venom-induced vasosensory responses involve alpha(1)-adrenoceptors for BP and vagal efferents for HR changes. (C) 2009 Elsevier Ireland Ltd. All rights reserved.”
“Objective: To assess the association of perioperative cardiac dysfunction during elective vascular surgery with postoperative outcome.
Background: Z-IETD-FMK molecular weight Patients with normal systolic function can have isolated diastolic dysfunction. Routine preoperative evaluation of left ventricular (LV) function does not include
an assessment of diastolic function for risk stratification. We hypothesized that perioperative assessment of both diastolic and systolic function PRN1371 cost with transesophageal echo (TEE) may improve our ability to predict postoperative outcome.
Methods. Perioperative TEE examinations were carried out on patients undergoing elective vascular surgery under general anesthesia. Abnormal systolic function was defined as LV ejection fraction no (LVEF) <40%. Left ventricular diastolic function was assessed using transmittal flow propagation velocity (Vp); Vp <45 cm/sec was considered abnormal. We determined the association between LV function and the primary outcome of postoperative adverse outcome, defined as one or more adverse events: myocardial infarction (MI), congestive heart failure (CHF), significant arrhythmia, prolonged intubation, renal failure, and death.
Results. Three hundred thirteen patients undergoing vascular surgery were studied. We found that 8% (n = 24) of patients had isolated systolic dysfunction,
43% (n = 134) had isolated diastolic dysfunction, and 24% (n = 75) both systolic and diastolic dysfunction. The most common postoperative adverse outcome was CHF 20% (n = 62). By multivariate logistic regression, we found that patient age, Vp, type of surgery, female gender, and renal failure were predictive of postoperative adverse outcome.
Conclusion: The presence of perioperative diastolic dysfunction as assessed with Vp is an independent predictor of postoperative CHF and prolonged length of stay after major vascular surgery. Patient age, gender, type of surgery, and renal failure were also predictors of outcome. Perioperative systolic function was not a predictor of postoperative outcome in our patients. (J Vase Surg 2009;50:70-6.