No abstract available.
Basilar Artery* ; Rabbits* ; Vasoconstrictor Agents* ; Vasodilator Agents*

Animals ; Humans ; Pyrazines ; pharmacology ; Vasodilator Agents

Animals ; Enflurane* ; Halothane* ; Isoflurane* ; Rats* ; Relaxation* ; Vasodilator Agents*

Nicardipine is a potent coronary and systemic vasodilator without depression of ventricular function. We investigated the changes in local myocardial perfusion (LMP) according to the nicardipine administration after coronary reperfusion in a beating canine model. A Doppler probe was placed around the left anterior descending coronary artery (LAD) and thermal diffusion microprobe was implanted in the myocardium perfused by the exposed LAD. To define the nicardipine effects, we compared the two groups (control group, n=7 vs nicardipine group, n=7). In nicardipine group, 5 microgram/kg/min nicardipine was infused continuously. After the release of the LAD occlusion, LAD blood flow were increased compared to the baseline of both groups. However, there was no difference between groups in the LAD blood flow. The LMP after LAD reperfusion did not recover to the baseline level until 30 min after LAD reperfusion in control group (74%, 52% and 70% at 10, 20 and 30 min after LAD reperfusion, respectively). In nicardipine group, however, the LMP recovered to the baseline level at 20 min (99%), and increased more than the baseline level at 30 min (141%) after LAD reperfusion. Our findings suggest that the nicardipine augments the LMP following the release of a coronary occlusion.
Animals ; Coronary Circulation/drug effects* ; Dogs ; Drug Evaluation, Preclinical ; Myocardial Reperfusion* ; Myocardial Reperfusion Injury/prevention & control* ; Nicardipine/pharmacology* ; Nicardipine/therapeutic use ; Vasodilator Agents/pharmacology* ; Vasodilator Agents/therapeutic use

PURPOSE: The unique properties of remifentanil make it ideal for pediatric use despite a lack of wide randomized clinical trials and fear of adverse events due to its high potency. We aimed to consolidate preliminary conclusions regarding the efficacy of remifentanil use in pediatric scoliosis surgery. MATERIALS AND METHODS: The medical charts of children with idiopathic scoliosis who underwent primary spinal fusion between 1998 and 2007 at a large tertiary university-affiliated hospital were retrospectively reviewed and divided into two groups according to anesthetic regime (remifentanil vs. morphine). Demographic, surgery-related details and immediate postoperative course were recorded and compared. RESULTS: All 36 remifentanil children were extubated shortly after termination of surgery, compared to 2 of the 84 patients in the morphine group. The remaining patients in the morphine group were extubated hours after surgery [5.4 hours; standard deviation (SD) 1.7 hours]. Six remifentanil children were spared routine intensive care hospitalization (vs. 2 morphine children-significant difference). Shorter surgeries [5.6 hours (SD 1.82 hours) vs. 7.14 hours (SD 2.15 hours); p=0.0004] were logged for the remifentanil group. To achieve controlled hypotension during surgery, vasodilator agents were used in the morphine group only. A comparison of early postoperative major or minor complication rates (including neurological and pulmonary complications) between the two groups yielded no significant differences. CONCLUSION: Remifentanil use can shorten operating time and facilitate earlier spontaneous ventilation and extubation, with less of a need for intensive care hospitalization and no increase in significant complications.
Child ; Critical Care ; Hospitalization ; Humans ; Hypotension, Controlled ; Morphine* ; Retrospective Studies* ; Scoliosis* ; Spinal Fusion ; Vasodilator Agents ; Ventilation

Raynaud's syndrome causes discolorization, ischemic claudication(pain) and necrosis of the digits through insufficiency in the circulation which is induced by intermittent spasms of the digital arteries. From January, 2002 to December, 2004, 10 patients were surgically treated for Raynaud's syndrome. 9 patients were female and 1 patient was male. 2 patients showed unilateral involvement, 8 patients were operated on both hands. 6 patients had necrotic changes on the finger tips due to the disease. Ages ranged from 21 to 60 with an average of 39.1. Ischemic pain, discolorization, and cold intolerance of the digits were the common symptoms. All patients were evaluated with color doppler before the surgery. Two different procedures were applied according to the severity of the disease: Patients with decreased circulation received, what we call a limited digital sympathectomy, i.e. stripping of the adventitia of the ulnar, radial and common digital arteries. An extended procedure, radical digital sympathectomy, was performed on patients with a complete block of circulation. Stripping of the adventitia in these patients also involved the proper digital arteries. Symptoms like discolorization, ischemic pain, and cold intolerance improved immediately after the surgery. The patients did not suffer from pain even with exposure to cold weather. We conclude that digital sympathectomy could improve the symptoms in Raynaud's patients who do not respond to conservative treatment such as calcium channel blocker and other vasodilators.
Adventitia ; Arteries ; Calcium Channels ; Female ; Fingers ; Hand ; Humans ; Male ; Necrosis ; Spasm ; Sympathectomy* ; Vasodilator Agents ; Weather

Acute heart failure (HF) is commonly encountered in the emergency department and thus, the hospital admissions for worsening HF are increasing. However, the patients presenting with acute HF are heterogenous and complex at high risk of morbidity and mortality. The main goals of treatment for hospitalized patients with HF are to restore euvolemia and to maintain the hemodynamic status without causing adverse events. Currently, the recommendations are usually based on a clinical factor considering the initial systolic blood pressure and other symptoms. Accordingly, initial managements in the hospital generally include diuretics, vasodilators, morphine, and inotropic agents, all of which have been considered as traditional therapies. These agents should mainly increase cardiac output and improve symptoms, and importantly it should improve the clinical outcomes. The aim of this review is to describe the available and new pharmacologic drugs for patients presenting with acute HF.
Blood Pressure ; Cardiac Output ; Diuretics ; Emergencies ; Heart ; Heart Failure ; Hemodynamics ; Humans ; Morphine ; Vasodilator Agents

BACKGROUND: The measurement of transepidermal water loss(TEWL) is widely used in evaluating the stratum corneum barrier function. It is also possible to evaluate the penetration of substances into the skin as an additional parameter of the straturn corneum barrier function. OBJECTIVE: The purpose of the present study is to investigate ihe relationship between TEWL and the percutaneous absorptic n of methyl nicotinate(MN) in the normal and acute perturbative state of the epidermal barrier. METHOD: Vascular response 10 MN penetration were rneasured by both laser Doppler flowmetry (LDF) and visual erythema oii the forearms of 30 healthy volunteers. Stratum corneum of the ar ea of 2x10cm on the volar for earm was removed by repeated tape stripping when TEWL reached 12-30g/rnh measured with Evaporimeter. The left forearm received no treatrnent as a control site. Each time the profile of the vascular response to MN penetration was analysed using the following parameters:the 1ag-time between MN application and initial response(T0), the time between MN application and maximal response(T(max)), and the rnaximal response(LDF), the time between MN application and initial visual erythema(VT0), and the time between MN application and maxirnum visual erythema(VT(max)). RESULTS: The data showed a negative correlation between TEWL and T0(r=-12.89, p<0.001), TEWL and Tmax=(r=-14.87, p<0.001), and TEWL and VT0(r= -3.99, p<0.001), TEWL and VTmax(r = -9.29, p<0.001). And there was a positive correlation between VT0 and T0(r=1.19, p<0.001), and between VTmax and Tmax(r=1.05, p<0.001). However, there was no detectable correlation between TEWL and LDFmax(p>0.05). CONCLUSION: Vascular response to percutaneous absorption of MN measured by LDF as well as TEWL is a useful non-invasiv method for objective evaluation of the stratum corneum barrier function. In addition, visual erythema induced by topical vasodilators such as MN is also a good method for skin barrier function assessment.
Erythema ; Forearm ; Healthy Volunteers ; Laser-Doppler Flowmetry ; Niacin* ; Skin Absorption* ; Skin* ; Vasodilator Agents

PURPOSE: Raynaud's phenomenon is characterized by recurrent episodes of arterial vasospasm of the digits upon exposure to cold, and this can occur alone or in association with other underlying conditions. The aim of this study was to investigate the clinical course of Raynaud's phenomenon and the effects of treatment. METHOD: Between September 1994 and December 2004, 69 patients with Raynaud's phenomenon were retrospectively evaluated. The symptoms of the patients and the results of photoplethysmography were reviewed before and after medical treatment. RESULT: The mean age of the patients was 47.4 years and 33 patients (47.8%) were in their 30s and 40s. Thirty seven patients (53.6%) were male and 32 patients (46.4%) were female. Twelve patients (17.4%) had combined disease and the majority of the total patients (n=58, 84%) presented with bilateral lesions. After treating with aspirin, cilostazol, PGI2 and PGE1, the symptoms improved in 27 cases (39.1%) and the photoplethysmographic findings improved in 20 cases (45.5%). However, there was no association between the period of treatment and the clinical results or the results of performing photoplethysmography. CONCLUSION: The majority of patients with Raynauds phenomenon develop bilateral symptoms without the presence of any underlying diseases. Antiplatelet agents and vasodilator drugs can have a positive effect on the management of Raynaud's phenomenon.
Alprostadil ; Aspirin ; Epoprostenol ; Female ; Humans ; Male ; Photoplethysmography ; Platelet Aggregation Inhibitors ; Retrospective Studies* ; Vasodilator Agents

Nonocclusive mesenteric ischemia (NOMI) is a rare complication that occurs in about 0.05% of patients after open- heart surgery, and NOMI refers to the mesenteric ischemia that's caused by splanchnic vasospasm without occlusion of the great intestinal vessels. In the presently reported case, NOMI developed to maintain the blood flow to the heart and brain after several minutes of a hypotensive status and the latter was caused by acute aortic dissection that complicated an aortic cannulation procedure. Unfortunately, the patient died even though the problems were diagnosed early and proper treatment was administered. Early diagnosis of NOMI by angiography and the selective infusion of vasodilators are thought to be the only way to improve survival for patients with clinically suspected NOMI.
Angiography ; Brain ; Catheterization ; Early Diagnosis ; Heart ; Humans ; Intestines ; Ischemia ; Mesentery ; Thoracic Surgery ; Vasodilator Agents