-
Anesthesiology Mar 1987The authors studied the effects of dihydroergotamine (DHE) and etilefrine hydrochloride (E) on the regional distribution of 99mTc-marked erythrocytes during epidural...
The authors studied the effects of dihydroergotamine (DHE) and etilefrine hydrochloride (E) on the regional distribution of 99mTc-marked erythrocytes during epidural anesthesia in eight supine men to determine if vasoactive agents with venoconstrictor action would enhance cardiac filling during epidural anesthesia. Radioactivity was recorded with a gamma camera, and its distribution determined in the thorax, abdomen, and limbs. Arterial and central venous pressure, heart rate, and calf volume by plethysmography were measured. During epidural anesthesia with a sensory block up to T4/5, DHE (7.5 micrograms/kg) reduced the radioactivity, i.e., blood volume, in both the innervated (-5.9 +/- 3.5%) and denervated muscle/skin (-16.9 +/- 7%) regions, and increased it in both the intrathoracic (+7.0 +/- 2.3%), and splanchnic vasculature (+4.2 +/- 3.2). In contrast, E (6 micrograms X kg-1 X min-1) decreased the blood volume most markedly in the splanchnic region (-5.4 +/- 0.7%) and increased it in the thorax (+2 +/- 0.6%). All these changes were statistically significant. The combined effects were estimated to be equivalent to a transfusion of nearly 1.01 of blood. Both drugs reversed the hypotensive action of epidural anesthesia. During epidural anesthesia, DHE preferentially constricted the capacitance vessels in skeletal muscle and skin irrespective of the state of innervation, whereas E preferentially constricted the splanchnic vasculature. In the doses used, the two agents replenished in an additive fashion the central circulation during epidural anesthesia.
Topics: Adult; Anesthesia, Epidural; Blood Circulation; Coronary Circulation; Dihydroergotamine; Erythrocytes; Etilefrine; Humans; Male; Posture; Technetium; Vasoconstrictor Agents
PubMed: 2881503
DOI: 10.1097/00000542-198703000-00009 -
BMC Surgery Feb 2017Chylous leakage is a well-known complication after esophagectomy, but cervical chylous leakage is relatively rare, and considerable controversy remains regarding the...
BACKGROUND
Chylous leakage is a well-known complication after esophagectomy, but cervical chylous leakage is relatively rare, and considerable controversy remains regarding the appropriate management strategies. We herein report a case of cervical chylous leakage treated successfully by lipiodol lymphangiography.
CASE PRESENTATION
The patient, a 70-year-old man with middle thoracic esophageal cancer, underwent radical esophagectomy with 3-field lymph node dissection and subsequently developed cervical chylous leakage. From the second postoperative day (POD2), the amount of fluid in the cervical drainage tube increased by 200-300 ml/day. We started octreotide (300 μg/day) on POD5 and etilefrine (120 mg/day) on the POD6. However, the amount of cervical discharge did not decrease. We performed lipiodol lymphangiography on POD8. Thereafter, the amount of cervical discharge finally began to decrease. We removed the drainage tube on POD13, and the patient was discharged from the hospital on POD23.
CONCLUSIONS
Our case suggests the clinical efficacy of lipiodol lymphangiography for cervical chylous leakage after esophagectomy.
Topics: Aged; Carcinoma, Squamous Cell; Chyle; Contrast Media; Drainage; Esophageal Neoplasms; Esophagectomy; Ethiodized Oil; Humans; Lymph Node Excision; Lymphography; Male; Neck; Thoracic Duct
PubMed: 28245822
DOI: 10.1186/s12893-017-0218-x -
British Journal of Anaesthesia Jan 2000We have compared two hyperbaric bupivacaine solutions for spinal anaesthesia in 7-18-yr-old school-aged children in a double-blind, randomized, parallel group,... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
We have compared two hyperbaric bupivacaine solutions for spinal anaesthesia in 7-18-yr-old school-aged children in a double-blind, randomized, parallel group, prospective study. Children were premedicated with diazepam orally. Half of the patients were sedated with either midazolam or thiopental. After lumbar puncture with a 27-gauge spinal needle, bupivacaine 5 mg ml-1 in either 0.9% or 8% glucose was injected in a dose of 0.3 mg kg-1. Maximum cephalad spread and regression of block were tested by transcutaneous electrical stimulation. Success rate, spread and duration of sensory block were similar in both groups. The highest median level of sensory block was T4 (10-90th percentiles T1-T7) in the 0.9% glucose group and T4 (T1-T5) in the 8% glucose group. Time to two segment regression of block was 83 (50-143) min in the 0.9% glucose and 85 (53-150) min in the 8% glucose group. The incidence of adverse effects was similar. Six children were given etilefrin to treat hypotension and six atropine for bradycardia. Nausea was associated with a high level of block. Shivering was detected in 16 children.
Topics: Adolescent; Anesthesia, Spinal; Anesthetics, Local; Bupivacaine; Child; Double-Blind Method; Female; Glucose; Humans; Male; Movement; Prospective Studies; Sensation; Solutions
PubMed: 10740548
DOI: 10.1093/oxfordjournals.bja.a013382 -
American Journal of Hematology Sep 2003We report a case of severe priapism occurring in a patient with unstable hemoglobin, hemoglobin Köln, and underline several factors that may have contributed to this...
We report a case of severe priapism occurring in a patient with unstable hemoglobin, hemoglobin Köln, and underline several factors that may have contributed to this complication: abnormal plasticity of red cells, splenectomy, and cytomegalovirus infection. Since emergency treatment may prevent impotence, patients and parents should be educated about this complication.
Topics: Adult; Cytomegalovirus Infections; Erythrocyte Deformability; Etilefrine; Hemoglobins, Abnormal; Humans; Injections; Male; Priapism; Splenectomy; Vasoconstrictor Agents
PubMed: 12949895
DOI: 10.1002/ajh.10374 -
British Journal of Anaesthesia Oct 1998We have compared bupivacaine 5 mg ml-1, either isobaric in saline 0.9% or hyperbaric in 8% glucose, for spinal anaesthesia in 100 children, aged 2-115 months, in a... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
We have compared bupivacaine 5 mg ml-1, either isobaric in saline 0.9% or hyperbaric in 8% glucose, for spinal anaesthesia in 100 children, aged 2-115 months, in a double-blind, randomized, parallel group, prospective study. Children were premedicated with diazepam 0.5 mg kg-1 orally. Seventy-two children were sedated before, and 25 children after, lumbar puncture, with either propofol or thiopental (thiopentone). After lumbar puncture in the lateral decubitus position with a 24-27-gauge paediatric spinal needle, isobaric or hyperbaric bupivacaine 5 mg ml-1 was injected in a dose of 0.3-0.5 mg kg-1 using a blinded procedure. Maximum cephalad extent of the block was tested by transcutaneous electrical stimulation. The success rate of the block was greater with hyperbaric bupivacaine (96%) compared with isobaric bupivacaine (82%) (P = 0.025, 95% confidence intervals (CI) 0-28%). Intense motor block was associated with adequate sensory block. Spread and duration of sensory block showed a similar wide scatter in both groups. The highest median level of sensory block was T4 (range T1-12) in the isobaric group and T4 (T1-7) in the hyperbaric group. Times to two segment regression of block were similar: 80 (55-190) min in the isobaric and 80 (30-190) min in the hyperbaric group. Cardiovascular stability was good. Etilefrin was administered to one child to treat hypotension and atropine to one child to treat bradycardia. The study gave an impression of a delayed onset time of spinal block, as most of the nine children who required either fentanyl or a sedative for a mild reaction to skin incision had complete block when transferred to the recovery room after operation. Five children developed a mild, position-dependent headache.
Topics: Ambulatory Surgical Procedures; Anesthesia, Spinal; Anesthetics, Local; Bupivacaine; Child; Child, Preschool; Double-Blind Method; Female; Glucose; Humans; Infant; Male; Movement; Prospective Studies; Sensation; Sodium Chloride; Specific Gravity
PubMed: 9924220
DOI: 10.1093/bja/81.4.502 -
Sante (Montrouge, France) 2002Priapism is a common complication of sickle cell anemia. Two different patterns are described: acute priapism, a prolonged painful erection generally lasting more than 6...
Priapism is a common complication of sickle cell anemia. Two different patterns are described: acute priapism, a prolonged painful erection generally lasting more than 6 hours, and stuttering priapism, which consist of brief repeated self-resolving episodes. Until 1990, priapism in sickle-cell patients has relied on measures aimed at lowering blood viscosity and acidosis and reducing the level of circulating hemoglobin S (alcalinization, hyperhydration, exsanguinotransfusion). But these means are not consistently successful. Surgical cavernous-venous shunt was proposed after 12 to 24 hours when conservative treatment failed. These therapeutic modalities are based on the pathophysiology of sickle-cell priapism. Priapism in sickle-cell disease may be due to sequestered sickled red cells in the corpus cavernosum with venous outflow obstruction. For some years, the treatment of priapism in sickle-cell anemia was changed by the use of alpha-adrenergic agonists. These therapeutics (mainly etilefrine and epinephrine) were first reserved for priapism resulting from intrapenile injections of vasoactive drugs which are used for the treatment of impotence. In acute priapism, alpha-adrenergic agonists are used in intracavernous injections (ICI). In stuttering priapism, treatment consists in an oral administration associated, if necessary, with self-administered ICI. ICI results mainly depend on when treatment occurs. Detumescence is achieved in patients treated within 30 hours, as opposed to the few patients treated beyond this delay. This finding is in agreement with experimental findings demonstrating histological evidence of necrosis of endothelial cells and cavernous smooth muscle fibers after 24 hours. Surgery is only used after failure of ICI. The result of oral treatment is not very satisfactory because many patients do not respond well or are dependent on ICI. However, self-administered ICI associated with the oral treatment protects patients with stuttering priapism against acute strokes. The safety of alpha-adrenergic agonists is good as both oral and ICI have few side-effects. The excellent efficacy of ICI in sickle-cell priapism leads to suggest that the pathogenic mechanism could involve a neuromuscular dysfunction.
Topics: Administration, Oral; Adrenergic alpha-Agonists; Anemia, Sickle Cell; Humans; Infusions, Intravenous; Male; Priapism
PubMed: 12473531
DOI: No ID Found