A clinical method for detecting subendocardial ischemia after cardiopulmonary bypass

Philips, Peter A.; Marty, Alan T.; Miyamoto, Alfonso M.; McCurdy, Martin D.; White, Judith; Morgan, Barbara J.; Brewer, Lyman A.

doi:10.1016/s0022-5223(19)41608-5

Cited by 78 publications

(17 citation statements)

References 15 publications

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“…The DPTI/SPTI ratio dropped about 20% below control value, due to an excess of oxygen demand over oxygen supply. The reduction in DPTI/SPTI ratio is related to subendocardial ischemias (PHILIPS et al 1975, HOFFMAN 1978. A DPTI/SPTI ratio above 0.7-0.8 ensures adequate flow through the wall of the left ventricle, whereas a ratio below that level signifies a relative subendocardial underperfusion.…”

Section: Discussionmentioning

confidence: 99%

Effects of Low‐Dose Ketamine and Thiopentone on Cardiac Performance and Myocardial Oxygen Balance in High‐Risk Patients

Pedersen

Engbaek

Klausen

et al. 1982

Acta Anaesthesiol Scand

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Induction of anaesthesia may pose a significant hazard to patients with critical cardiovascular status. Ketamine has been advocated as the drug of choice for maintaining cardiovascular performance during induction of anaesthesia in severely ill surgical patients. The purpose of this study was to compare the relative changes in the haemodynamic effects of ketamine and thiopentone during the first 30 min of anaesthesia induction measured by thoracic impedance cardiography. Twelve adult high-risk surgical patients, ASA class III-V, were induced with thiopentone and fentanyl or with infusion of ketamine. Cardiac output decreased to 69% in the thiopentone group (P less than 0.05), but was hardly affected in the ketamine group. The pre-ejection period to left ventricular time (PEPI) and the pre-ejection period index ratio increased significantly after thiopentone (P less than 0.05), while ketamine caused only minimal changes in left ventricular performance. The diastolic pressure time index to systolic pressure time index ration decreased significantly in both groups.

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Section: Discussionmentioning

confidence: 99%

Effects of Low‐Dose Ketamine and Thiopentone on Cardiac Performance and Myocardial Oxygen Balance in High‐Risk Patients

Pedersen

Engbaek

Klausen

et al. 1982

Acta Anaesthesiol Scand

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“…The critical value of EVR appears to be much greater than previously proposed values of 0.4 and 0.7 [7,9]. This may not be surprising.…”

Section: Comparison Of Evr and Myocardial Regional Functionmentioning

confidence: 48%

“…In our study, EVR was calculated by planimetry, but EVR can be monitored if peripheral [9]. Note that DPTI is overestimated and SPTI underestimated, as compared with measurement by planimetry.…”

Section: Comparison Of Evr and Myocardial Regional Functionmentioning

confidence: 88%

“…Thus Hoffman and Buckberg [1] suggested that a more correct figure to choose for the critical value below which the inter:outer flow ratio begins to decrease is 0.4-0.5. However, in 35 patients, Philips and co-workers [9] showed that, in the early period after cardiopulmonary by-pass for correction of valvular or coronary artery disease, EVR had prognostic value: when EVR was less than 0.7, the patients needed cardiac assistance using intra-aortic balloon counterpulsation, and the five patients with EVR less than 0.55 died. There is no experimental study relating the reliability of EVR in presence of critical coronary constriction and anaesthesia.…”

Section: Comparison Of Evr and Myocardial Regional Functionmentioning

confidence: 99%

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Endocardial Viability Ratio and Ischaemic Dysfunction of the Left Ventricle During Halothane Anaesthesia §

Lehot

Leone

Francis

et al. 1988

British Journal of Anaesthesia

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In normal hearts, the critical value of the endocardial viability ratio (EVR) is thought to be less than 0.5. As myocardial regional dysfunction is a sensitive index of subendocardial ischaemia, the relationship between EVR and regional function has been studied in an experimental model of coronary artery constriction. In 13 dogs anaesthetized with halothane (0.5-2.0% inspired concentration), diastolic and systolic pressure time indices were obtained by planimetry, and their ratio (EVR) correlated with regional function. Halothane alone caused a significant reduction in EVR from 1.38 +/- 0.08 to 1.15 +/- 0.04 (mean +/- SEM). In the presence of coronary artery constriction a similar decrease in EVR was observed and was accompanied by post-systolic shortening (PSS), an indicator of regional dysfunction. At high concentrations of halothane, there was an inverse correlation between reduction in EVR and increase in PSS. Mean EVR of approximately 0.9 (mean = 0.92 +/- 0.02) was associated with significant worsening of regional function.

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“…The subendocardial perfusion (ratio of the flow from subendocardial to subepicardial layers) was predicted from the DPTIjSPTI ratio ( 7 ) . A reduction of this ratio is related to subendocardial ischaemia (13). A DPTIjSPTI ratio above 0.7-0.8 ensures adequate flow through the wall of the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

Effect of Vecuronium and Pancuronium on Cardiac Performance and Transmural Myocardial Perfusion During Ketamine Anaesthesia

Pedersen

Engbaek

Ørding

et al. 1984

Acta Anaesthesiol Scand

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The haemodynamic effects of vecuronium and pancuronium were studied in 20 healthy patients during diazepam/ketamine anaesthesia. Anaesthesia was induced with glycopyrrolate 3 micrograms/kg, diazepam 0.3 mg/kg and ketamine 1.0 mg/kg as a bolus and 1.0 mg/kg over 10 min. After induction, anaesthesia was maintained with ketamine infusion 1.0 mg/kg/h. The lungs were ventilated with 50% nitrous oxide in oxygen. Equipotent doses of vecuronium (74 micrograms/kg) or pancuronium (99 micrograms/kg) were administered for intubation. The thoracic impedance, ECG and phonocardiogram were recorded during the induction of anaesthesia. The results suggest that vecuronium has no cardiovascular effects during ketamine anaesthesia, whereas pancuronium due to its chronotropic effect, causes a deterioration in left ventricular performance.

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A clinical method for detecting subendocardial ischemia after cardiopulmonary bypass

Cited by 78 publications

References 15 publications

Effects of Low‐Dose Ketamine and Thiopentone on Cardiac Performance and Myocardial Oxygen Balance in High‐Risk Patients

Effects of Low‐Dose Ketamine and Thiopentone on Cardiac Performance and Myocardial Oxygen Balance in High‐Risk Patients

Endocardial Viability Ratio and Ischaemic Dysfunction of the Left Ventricle During Halothane Anaesthesia §

Effect of Vecuronium and Pancuronium on Cardiac Performance and Transmural Myocardial Perfusion During Ketamine Anaesthesia

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