Anesthetic regimen effects on a pediatric porcine model of asphyxial arrest

Jasani, Melinda; Salzman, Steven K.; Tice, Lisa; Ginn, Andrew N.

doi:10.1016/s0300-9572(96)01094-5

Cited by 16 publications

(10 citation statements)

References 21 publications

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“…Studies have confirmed that the measurement of ETCO 2 is predictive of the outcomes of CPR. 56,60 Human studies have suggested that ETCO 2 correlates closely with successful resuscitation and predicts the outcome of CA reliably 61,62 The initial ETCO 2 immediately after unclamping the ETT did not correlate with ROSC in the present study. This has already been described in previous animal studies.…”

Section: Discussioncontrasting

confidence: 53%

Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/Large-White swine model

et al. 2011

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The vast majority of laboratory studies on animals have focused on ventricular fibrillation (VF) and not on cardiac arrest (CA) resulting from asphyxia. The aim of this study was to develop a clinically relevant animal model in Landrace/Large-White swine of asphyxial CA resuscitated using the European Resuscitation Council guidelines. Survival and 24 h neurological outcome in terms of functional deficit were also evaluated. Asphyxial arrest was induced by clamping the endotracheal tube (ETT) in 10 Landrace/Large-White piglets. After 4 min of untreated arrest, resuscitation was initiated by unclamping the ETT, 100% oxygen mechanical ventilation, 2 min chest compressions and epinephrine administration. Advanced Life Support algorithm was followed. In case of restoration of spontaneous circulation, the animals were supported for one hour and then observed for 23 h. Coronary perfusion pressure was significantly higher in surviving animals (P , 0.001) during cardiopulmonary resuscitation. End-tidal CO 2 was significantly higher in the animals that survived than in non-surviving animals (P ¼ 0.001). All of the animals were severely neurologically impaired 24 h after CA. This refined model of asphyxia CA is easily reproducible and may be used for pharmacological studies in CA.

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Section: Discussioncontrasting

confidence: 53%

Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/Large-White swine model

et al. 2011

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“…Our data further underscore the importance of anaesthesia in animal models of cardiovascular research (Hunt & Ross 1988, Bardaji et al 1990, Haessler et al 1994, Rath et al 1995, Jasani et al 1997. Pentobarbital anaesthesia, which preserves cardiovascular function better than medetomidine-ketamine-fentanyl anaesthesia, would be more advisable when the purpose is to evaluate interventions for cardiodepressive effects.…”

Section: Discussionmentioning

confidence: 65%

Pentobarbital versus medetomidine-ketamine-fentanyl anaesthesia: effects on haemodynamics and the incidence of ischaemia-induced ventricular fibrillation in swine

et al. 2004

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SummaryThe present study was performed to compare haemodynamic variables at baseline and the incidence of ventricular brillation during the early phase of ischaemia in swine during pentobarbital or medetomidine-ketamine-fentanyl anaesthesia. Twenty-two swine (mean ± SD: 29 ± 3 kg) were anaesthetized with sodium pentobarbital (induction with 36 mg/kg intraperitoneally, and maintenance with 5-20 mg/kg/h intravenously [i.v.]) and 6 swine (27± 3 kg) were anaesthetized with ketamine and fentanyl (premedicated with medetomidine 0.1 mg/kg and ketamine 10 mg/kg intramuscularly, induction with ketamine 20 mg/kg and fentanyl 0.025 mg/kg i.v., and maintenance with ketamine 20 mg/kg/h and fentanyl 0.025 mg/kg/h i.v.). After a stabilization period of 30 min, the left anterior descending coronary artery (LAD) was occluded for 10 min. Haemodynamic data and occurrence of ventricular brillation were recorded. The ischaemic area was measured by uorescing microspheres. Swine anaesthetized with medetomidine-ketamine-fentanyl had signi cantly lower heart rate, myocardial contractility, peak left ventricular pressure, arterial blood pressure, aortic blood ow, myocardial blood ow and cardiac index at baseline, than swine anaesthetized with pentobarbital. Whereas none of the swine anaesthetized with pentobarbital brillated during the LAD occlusion, ventricular brillation occurred in 83% of the animals anaesthetized with medetomidine-ketamine-fentanyl (P , 0.001). No signi cant difference was found in size of ischaemic area between the two groups. Thus, we show a depression in haemodynamic variables at baseline and a higher incidence of ventricular brillation during the early phase of ischaemia in swine anaesthetized with medetomidine-ketamine-fentanyl compared to swine anaesthetized with pentobarbital.

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“…The isoflurane concentration needed was between 1% and 2% to maintain an acceptable level of anesthesia during the experiment. A single anesthetic agent, isoflurane, was used in an attempt to avoid potential physiologic confounders associated with many other agents (e.g., endogenous epinephrine release and hypertension with ketamine or myocardial depression with barbiturates or propofol) (11, 12). Ventilator settings were adjusted to maintain end-tidal carbon dioxide at 40 ± 4 mm Hg.…”

Section: Methodsmentioning

confidence: 99%

Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation

Berg

Banville

Chapman

et al. 2008

Pediatric Critical Care Medicine

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Objective-The optimal biphasic defibrillation dose for children is unknown. Postresuscitation myocardial dysfunction is common and may be worsened by higher defibrillation doses. Adult-dose automated external defibrillators are commonly available; pediatric doses can be delivered by attenuating the adult defibrillation dose through a pediatric pads/cable system. The objective was to investigate whether unattenuated (adult) dose biphasic defibrillation results in greater postresuscitation myocardial dysfunction and damage than attenuated (pediatric) defibrillation. Design-Laboratory animal experiment. Setting-University animal laboratory.Subjects-Domestic swine weighing 19 ± 3.6 kg.Interventions-Fifty-two piglets were randomized to receive biphasic defibrillation using either adult-dose shocks of 200, 300, and 360 J or pediatric-dose shocks of ~50, 75, and 85 J after 7 mins of untreated ventricular fibrillation. Contrast left ventriculograms were obtained at baseline and then at 1, 2, 3, and 4 hrs postresuscitation. Postresuscitation left ventricular ejection fraction and cardiac troponins were evaluated. Measurements and MainResults-By design, piglets in the adult-dose group received shocks with more energy (261 ± 65 J vs. 72 ± 12 J, p < .001) and higher peak current (37 ± 8 A vs. 13 ± 2 A, p < .001) at the largest defibrillation dose needed. In both groups, left ventricular ejection fraction was reduced significantly at 1, 2, and 4 hrs from baseline and improved during the 4 hrs postresuscitation. The decrease in left ventricular ejection fraction from baseline was greater after adult-dose defibrillation. Plasma cardiac troponin levels were elevated 4 hrs postresuscitation in 11 of 19 adult-dose piglets vs. four of 20 pediatric-dose piglets (p = .02).Conclusions-Unattenuated adult-dose defibrillation results in a greater frequency of myocardial damage and worse postresuscitation myocardial function than pediatric doses in a swine model of prolonged out-of-hospital pediatric ventricular fibrillation cardiac arrest. These data support the use of pediatric attenuating electrodes with adult biphasic automated external defibrillators to defibrillate children. Copyright Recognition and treatment of ventricular fibrillation (VF) are underappreciated pediatric problems. Ventricular fibrillation occurs in 5% to 22% of pediatric out-of-hospital cardiac arrests and is the initial documented rhythm in 10% of pediatric in-hospital cardiac arrests (1-4).Automated external defibrillators (AEDs) designed for adults are often the first defibrillators available for out-of-hospital cardiac arrests. Recognizing that some adult AEDs now have diagnostic algorithms that are accurate in children, recent international guidelines recommend that "For children 1 to 8 yrs of age the rescuer should use a pediatric dose-attenuator system if one is available. If the rescuer provides CPR to a child in cardiac arrest and does not have an AED with a pediatric attenuator system, the rescuer should use a standard AED" (5). A specific bip...

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Anesthetic regimen effects on a pediatric porcine model of asphyxial arrest

Cited by 16 publications

References 21 publications

Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/Large-White swine model

Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/Large-White swine model

Pentobarbital versus medetomidine-ketamine-fentanyl anaesthesia: effects on haemodynamics and the incidence of ischaemia-induced ventricular fibrillation in swine

Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation

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