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Incidence and clinical course of right ventricular infarction: Assessment with radionuclide ventriculography
LITERATURE Carol L. Lake, MD, Editor
Hasenbos M, Van Egmond J, Gielen M, et al: &&qverative aualgesia by high thoracic epidurnl versus intramuscuhrr nicomorphine after thoracotomy. Part III: The effects of per- and ive auaIgesia on morbidity. Acta Anaesthesiil Scand 31:608-615,1987 A comparison of thoracic epidural nicomorphine, postoperatively, with intramuscular (IM) nicomorphine was ma& in 129 patients undergoing thoracotomy for various pulmonary procedures. Nicomorphine is the 3,6-dinicotinoyl ester of morphine that acts as a prodrug and is equipotent to morphine. Nicomorphine is hydrolyzed to 6-mononicotinoylmorphine and then to morphine. All patients received general endotracheal anesthesia during thoracotomy. The group receiving only IM narcotic postoperatively received epidural bupivacaine with epinephrine intraoperatively, while the postoperative epidural narcotic group received nitrous, halothane, pancuronium anesthesia. Assessment of differences between the two groups included analysis of PaCOr, chest radiographs for atelectasis, subjective pain relief, and evaluation of drowsiness during the first three postoperative days. Pair relief was significantly better in patients with epidural analgesia at four days postoperatively (57% painfree v 31%). Total JM narcotic requirements were leas in the epidural group (42 mg v 92 mg). Ventilation on postoperative day 2 was itho better in the epidural group. The incidence of atelatasis and need for tracheobronchial toilet by bronchoscopy were reduced by epidural narcosis. Despite these apparently favorable results without significant respiratory or other complications secondary to epidural narcosis, the statistical evaluation presents a problem. There were more patients with chronic obstructive lung disease in the IM narcotic group and the epidural group was less obese. Also, analysis of variance was used to test sequentially obtained data.
Konishi T, Ichikawa T, Yamamuro T, et al: Inci$ence and cIinica1 course of right ventricular infarction: Assessment with radionuclide ventriculography. Angiology 38:741-749,1987 Right ventricular (RV) infarction was found to occur in 6#% of patients with inferior myocardial infarctions (MI) and 83%of patients with anterior MI. A lesion proximal to the right ventricular branch of the right coronary artery was found in all patients with RVMI. Other criteria for RV infarction included 2+ accumulation of technetium pyrophosphate in the RV free wall, mean right atria1 pressure increased by 10 mmHg or more, right atrial/pulmonary wedge pressure ratio increased by 0.8 or more, and an ST-segment elevation of 0.05 mV or more in lead V,,. Acute Jownid
of Cardiofhoracic
Anesthesia,
Vol2, No 3 (June). 1988:
right ventricular infarction was associated with a marked reduction in right ventricular ejection fraction to 28% as assessedby radionuclide ventriculography. However, election fraction normalized within 1 month of MI.
Miyoshi S, Nakahara Exercise toIerance test in The rehvtiouship between post-thoracotomy hospital Surg 44:487-490,1987
K, Ohno K, et al:
Several recent studies have suggested the value of oxygen uptake to assesspost-thoracotomy pulmonary reser\re. However, blood lactate threshold is superior to maximal oxygen uptake because the limiting factors of maximal oxygen consumption such as ventilation or circulation differ between patients, maximal oxygen consumption is subjective, and blood lactate threshold is detected at submaximal exercise, limiting patient stress. The authors evahrated a group of 84 patients with bronchogenic carcinoma scheduled for pulmonary resections using maximal oxygen uptake-to-body surface area ratios at an empiric blood lactate threshold of 20 mg/dL (bicycle ergometer). While pulmonary function tests such as forced expiratory volume in one second/body surface area (FEV,/&SA), FEV, as percent forced vital capacity (FEV,%), diffuting capacity for carbon monoxide/lung volume (DLCOIVL), and maximal voluntary ventilation (MVV/SSA) demonstrated significant differences between those patients with and without postoperative pulmonary complications, they failed to predict mortality. The oxygen consumption-to-body surface area ratio at an arterial lactate level of 20 mg~dL differentiated between surviving (471 t 53 mL/min/m’) and deceased patients (296 r 72 mL/min/m*). This finding suggests that endurance is strongly related to mortality risk.
Ruggeri ZM, Zimmerman brand Factor and van WiRebrand 70:895-904,1987 With the recent interest in desmopressin (DDAVP) 10 reduce postcardiotomy bleeding by increasing factor VlJJ (von Willebrand factor), review of this coagulation factor is in order. Von Willebrand factor (vWF) is a muftimeric glycoprotein with two roles: (1) plasma carrier of factar ViJl procoagulant factor, and (2) mediator of platelet adhesion and aggregation onto thrombogenic surfaces. Thus, its hition in normal hemostasis is to mediate the adhesion of platelets to exposed subendothelium, promote platelet thrombi at areas of vascular injury, and to form a noncovztient complex with factor VIII preventing rapid removal of this procoagulant protein from the circulation. This review qumPP 3X3-396
.?93
Hasenbos M, Van Egmond J, Gielen M, et al: &&qverative aualgesia by high thoracic epidurnl versus intramuscuhrr nicomorphine after thoracotomy. Part III: The effects of per- and ive auaIgesia on morbidity. Acta Anaesthesiil Scand 31:608-615,1987 A comparison of thoracic epidural nicomorphine, postoperatively, with intramuscular (IM) nicomorphine was ma& in 129 patients undergoing thoracotomy for various pulmonary procedures. Nicomorphine is the 3,6-dinicotinoyl ester of morphine that acts as a prodrug and is equipotent to morphine. Nicomorphine is hydrolyzed to 6-mononicotinoylmorphine and then to morphine. All patients received general endotracheal anesthesia during thoracotomy. The group receiving only IM narcotic postoperatively received epidural bupivacaine with epinephrine intraoperatively, while the postoperative epidural narcotic group received nitrous, halothane, pancuronium anesthesia. Assessment of differences between the two groups included analysis of PaCOr, chest radiographs for atelectasis, subjective pain relief, and evaluation of drowsiness during the first three postoperative days. Pair relief was significantly better in patients with epidural analgesia at four days postoperatively (57% painfree v 31%). Total JM narcotic requirements were leas in the epidural group (42 mg v 92 mg). Ventilation on postoperative day 2 was itho better in the epidural group. The incidence of atelatasis and need for tracheobronchial toilet by bronchoscopy were reduced by epidural narcosis. Despite these apparently favorable results without significant respiratory or other complications secondary to epidural narcosis, the statistical evaluation presents a problem. There were more patients with chronic obstructive lung disease in the IM narcotic group and the epidural group was less obese. Also, analysis of variance was used to test sequentially obtained data.
Konishi T, Ichikawa T, Yamamuro T, et al: Inci$ence and cIinica1 course of right ventricular infarction: Assessment with radionuclide ventriculography. Angiology 38:741-749,1987 Right ventricular (RV) infarction was found to occur in 6#% of patients with inferior myocardial infarctions (MI) and 83%of patients with anterior MI. A lesion proximal to the right ventricular branch of the right coronary artery was found in all patients with RVMI. Other criteria for RV infarction included 2+ accumulation of technetium pyrophosphate in the RV free wall, mean right atria1 pressure increased by 10 mmHg or more, right atrial/pulmonary wedge pressure ratio increased by 0.8 or more, and an ST-segment elevation of 0.05 mV or more in lead V,,. Acute Jownid
of Cardiofhoracic
Anesthesia,
Vol2, No 3 (June). 1988:
right ventricular infarction was associated with a marked reduction in right ventricular ejection fraction to 28% as assessedby radionuclide ventriculography. However, election fraction normalized within 1 month of MI.
Miyoshi S, Nakahara Exercise toIerance test in The rehvtiouship between post-thoracotomy hospital Surg 44:487-490,1987
K, Ohno K, et al:
Several recent studies have suggested the value of oxygen uptake to assesspost-thoracotomy pulmonary reser\re. However, blood lactate threshold is superior to maximal oxygen uptake because the limiting factors of maximal oxygen consumption such as ventilation or circulation differ between patients, maximal oxygen consumption is subjective, and blood lactate threshold is detected at submaximal exercise, limiting patient stress. The authors evahrated a group of 84 patients with bronchogenic carcinoma scheduled for pulmonary resections using maximal oxygen uptake-to-body surface area ratios at an empiric blood lactate threshold of 20 mg/dL (bicycle ergometer). While pulmonary function tests such as forced expiratory volume in one second/body surface area (FEV,/&SA), FEV, as percent forced vital capacity (FEV,%), diffuting capacity for carbon monoxide/lung volume (DLCOIVL), and maximal voluntary ventilation (MVV/SSA) demonstrated significant differences between those patients with and without postoperative pulmonary complications, they failed to predict mortality. The oxygen consumption-to-body surface area ratio at an arterial lactate level of 20 mg~dL differentiated between surviving (471 t 53 mL/min/m’) and deceased patients (296 r 72 mL/min/m*). This finding suggests that endurance is strongly related to mortality risk.
Ruggeri ZM, Zimmerman brand Factor and van WiRebrand 70:895-904,1987 With the recent interest in desmopressin (DDAVP) 10 reduce postcardiotomy bleeding by increasing factor VlJJ (von Willebrand factor), review of this coagulation factor is in order. Von Willebrand factor (vWF) is a muftimeric glycoprotein with two roles: (1) plasma carrier of factar ViJl procoagulant factor, and (2) mediator of platelet adhesion and aggregation onto thrombogenic surfaces. Thus, its hition in normal hemostasis is to mediate the adhesion of platelets to exposed subendothelium, promote platelet thrombi at areas of vascular injury, and to form a noncovztient complex with factor VIII preventing rapid removal of this procoagulant protein from the circulation. This review qumPP 3X3-396
.?93