Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson, Geoffrey P.; Faggian, Giuseppe; Onorati, Francesco; Vinten‐Johansen, Jakob

doi:10.3389/fphys.2013.00228

Cited by 66 publications

(77 citation statements)

References 370 publications

(469 reference statements)

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“…Thereafter, a bolus of 2 mmol/kg KCl was given and flushed with 2 ml normal saline via the central venous catheter to induce diastolic cardiac arrest [17]. Furthermore, 3 mmol KCl/kg/h were given continuously to maintain hyperkalemia.…”

Section: Methodsmentioning

confidence: 99%

Reliability of Pulse Oximetry during Cardiopulmonary Resuscitation in a Piglet Model of Neonatal Cardiac Arrest

et al. 2014

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Background: Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. Objective: To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during cardiopulmonary resuscitation (CPR). Methodology: In a prospective cohort study in 30 healthy newborn piglets, cardiac arrest was induced, and thereafter each piglet received CPR for 20 min. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO₂). Arterial blood was analyzed for functional oxygenation (SaO₂) every 2 min. SpO₂ was compared with coinciding SaO₂ values and bias considered whenever the difference (SpO₂ - SaO₂) was beyond ±5%. Results: Bias values were decreased at the baseline measurements (mean: 2.5 ± 4.6%) with higher precision and accuracy compared with values across the experiment. Two minutes after cardiac arrest, there was a marked decrease in precision and accuracy as well as an increase in bias up to 13 ± 34%, reaching a maximum of 45.6 ± 28.3% after 10 min over a mean SaO₂ range of 29-58%. Conclusion: Pulse oximetry showed increased bias and decreased accuracy and precision during CPR in a model of neonatal cardiac arrest. We recommend further studies to clarify the exact mechanisms of these false readings to improve reliability of pulse oximetry during the marked desaturation and hypoperfusion found during CPR. © 2014 S. Karger AG, Basel

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Section: Methodsmentioning

confidence: 99%

Reliability of Pulse Oximetry during Cardiopulmonary Resuscitation in a Piglet Model of Neonatal Cardiac Arrest

et al. 2014

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“…However, further in vivo studies are required to test this hypothesis. Also our work may have clinical applicability on the ancillary properties of lidocaine at the site of injection during infiltration, nerve block, or epidural anesthesia [14], and on damaged endothelium such as in plaque formation, arterial and venous conduit protection for cardiopulmonary bypass grafting [69], prevention of vascular spasm during neurosurgery [70], lowering elevated intracranial pressure [71], lidocaine cardioplegia [72, 73], and other surgical applications [54]. …”

Section: Discussionmentioning

confidence: 99%

Lidocaine relaxation in isolated rat aortic rings is enhanced by endothelial removal: possible role of Kv, KATP channels and A2a receptor crosstalk

Arsyad

Dobson

2016

BMC Anesthesiol

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BackgroundLidocaine is an approved local anesthetic and Class 1B antiarrhythmic with a number of ancillary properties. Our aim was to investigate lidocaine’s vasoreactivity properties in intact versus denuded rat thoracic aortic rings, and the effect of inhibitors of nitric oxide (NO), prostenoids, voltage-dependent Kv and KATP channels, membrane Na+/K+ pump, and A2a and A2b receptors.MethodsAortic rings were harvested from adult male Sprague Dawley rats and equilibrated in an organ bath containing oxygenated, modified Krebs-Henseleit solution, pH 7.4, 37 °C. The rings were pre-contracted sub-maximally with 0.3 μM norepinephrine (NE), and the effect of increasing lidocaine concentrations was examined. Rings were tested for viability after each experiment with maximally dilating 100 μM papaverine. The drugs 4-aminopyridine (4-AP), glibenclamide, 5-hydroxydecanoate, ouabain, 8-(3-chlorostyryl) caffeine and PSB-0788 were examined.ResultsAll drugs tested had no significant effect on basal tension. Lidocaine relaxation in intact rings was biphasic between 1 and 10 μM (Phase 1) and 10 and 1000 μM (Phase 2). Mechanical removal of the endothelium resulted in further relaxation, and at lower concentrations ring sensitivity (% relaxation per μM lidocaine) significantly increased 3.5 times compared to intact rings. The relaxing factor(s) responsible for enhancing ring relaxation did not appear to be NO- or prostacyclin-dependent, as L-NAME and indomethacin had little or no effect on intact ring relaxation. In denuded rings, lidocaine relaxation was completely abolished by Kv channel inhibition and significantly reduced by antagonists of the MitoKATP channel, and to a lesser extent the SarcKATP channel. Curiously, A2a subtype receptor antagonism significantly inhibited lidocaine relaxation above 100 μM, but not the A2b receptor.ConclusionsWe show that lidocaine relaxation in rat thoracic aorta was biphasic and significantly enhanced by endothelial removal, which did not appear to be NO or prostacyclin dependent. The unknown factor(s) responsible for enhanced relaxation was significantly reduced by Kv inhibition, 5-HD inhibition, and A2a subtype inhibition indicating a potential role for crosstalk in lidocaine’s vasoreactivity.

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“…To ensure that return of spontaneous circulation (ROSC) was not possible, we used a hyperkalemia model. With diastolic arrest, this model can be used to assess gas exchange during resuscitation, although we admit that an animal model with asphyxia adds other circumstances relevant to resuscitation after hypoxic ischemic exposure [15]. However, an asphyxia model carries the ‘risk' of ROSC.…”

Section: Discussionmentioning

confidence: 99%

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

Mendler¹,

Maurer²,

Hassan

et al. 2015

Neonatology

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Background: There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). Objectives: We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO₂ during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC. Methods: Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO₂) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H₂O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H₂O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H₂O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations. Results: We found no significant differences in SaO₂ between the three groups. However, there was a trend toward a higher SaO₂ [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO₂ [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group. Conclusions: We found no significant effect on gas exchange using different respiratory support strategies during CPR.

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Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Cited by 66 publications

References 370 publications

Reliability of Pulse Oximetry during Cardiopulmonary Resuscitation in a Piglet Model of Neonatal Cardiac Arrest

Reliability of Pulse Oximetry during Cardiopulmonary Resuscitation in a Piglet Model of Neonatal Cardiac Arrest

Lidocaine relaxation in isolated rat aortic rings is enhanced by endothelial removal: possible role of Kv, KATP channels and A2a receptor crosstalk

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

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