No abstract

de-Figueiredo LF. Low hematocrit impairs gastric mucosal co 2 removal during experimental severe normovolemic hemodilution. CLINICS. 2006(5):445-52. OBJECTIVE: The net effects of acute normovolemic hemodilution with different hemoglobin levels on splanchnic perfusion have not been elucidated. The hypothesis that during moderate and severe normovolemic hemodilution, systemic and splanchnic hemodynamic parameters, oxygen-derived variables, and biochemical markers of anaerobic metabolism do not reflect the adequacy of gastric mucosa, was tested in this study. METHODS: Twenty one anesthetized mongrel dogs (16 ± 1 kg) were randomized to controls (CT, n = 7, no hemodilution), moderate hemodilution (hematocrit 2 5% ± 3%, n = 7) or severe hemodilution (severe hemodilution, hematocrit 15% ± 3%, n = 7), through an isovolemic exchange of whole blood and 6% hydroxyethyl starch, at a 20 mL/min rate, to the target hematocrit. The animals were followed for 120 min after hemodilution. Cardiac output (CO, L/min), portal vein blood flow (PVF, mL/min), portal vein-arterial and gastric mucosa-arterial CO 2 gradients (PV-artCO 2 and PCO 2 gap, mm Hg, respectively) were measured throughout the experiment. RESULTS: Exchange blood volumes were 33.9 ± 3.3 and 61.5 ± 5.8 mL/kg for moderate hemodilution and severe hemodilution, respectively. Arterial pressure and systemic and regional lactate levels remained stable in all groups. There were initial increases in cardiac output and portal vein blood flow in both moderate hemodilution and severe hemodilution; systemic and regional oxygen consumption remained stable largely due to increases in oxygen extraction rate. There was a significant increase in the PCO 2-gap value only in severe hemodilution animals. CONCLUSION: Global and regional hemodynamic stability were maintained after moderate and severe hemodilution. However, a very low hematocrit induced gastric mucosal acidosis, suggesting that gastric mucosal CO 2 monitoring may be useful during major surgery or following trauma.

No abstract

Objectives: In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rates. Primary or direct angioplasty has been found to be an excellent means of achieving reperfusion in acute ST-elevation MI compared to thrombolytic therapy in randomized trials. However, no mortality benefit of primary angioplasty over thrombolysis was observed in several registries, in which delays in performing primary angioplasty were longer. Our objectives were to evaluate the door-to-balloon time (DBT) in our institution and investigate its relationship with clinical and prognostic variables.

Background Problems related to inadequate oxygen or ventilation remain an important issue regarding anesthesia care, representing more than 30% of primary airway complications in both North America and United Kingdom. Several guidelines have been proposed since the early 1990's. Although they have had important effects on patient's outcome and survival, it is difficult to identify the optimal guideline. This project prospectively evaluated the success rate of a simple intubation management algorithm with costless and low learning curve equipment.Methods this study included all adult patients (18 years or older) who underwent induction of elective general anesthesia performed by the researchers. A total of 293 patients were included. Their ASA physical status ranged from 1 to 4. After induction of general anesthesia and confirmation of adequate ventilation the algorithm was followed. If ventilation with face mask was impossible or oxygen saturation reached below 90%, the protocol was interrupted. The algorithm was centered on the use of McCoy laryngoscope, "backward, upward and right upward and rightward pressure" BURP maneuver and bougie. All patients were evaluated before the induction of anesthesia. The following characteristics were noted: age, sex, dental status (good, regular and poor, defined by the patients themselves), Mallampati index, personal history of apnea or snoring, mouth opening (mm), body mass index (m2/kg), cervical circumference (cm), previous history of difficult airway, thyromental distance and previous treatment with cervical radiation.Results all patients were successfully intubated following the algorithm.Conclusions this algorithm, centered on the use of McCoy laryngoscope, BURP maneuver and bougie, was able to be used successfully in patients of daily practice with a high success rate.