ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Currently, numerous intravenous pharmacological agents to treat cardiovascular dysfunction are available for perioperative use, and some new drugs are still undergoing clinical investigations. Patients with congenital or acquired cardiac diseases undergoing noncardiovascular surgery may develop acute cardiovascular dysfunction during anesthesia or in the intensive care unit. Furthermore, patients undergoing cardiovascular surgery may have preexisting congestive heart failure due to ischemic or valvular heart disease with down-regulated β1-adrenergic receptors [1], or may develop new acute ventricular dysfunction after surgery due to multiple causes such as aortic clamping, reperfusion injury, or inflammatory responses to cardiopulmonary bypass [2]. When these abnormalities occur, the mainstay of therapeutic agents used to improve ventricular function in cardiac surgical patients or patients undergoing noncardiac surgery has been inotropic agents and vasodilators. Understanding the cardiovascular effects of pharmacological interventions is important for anesthesiologists and intensivists when deciding about therapeutic interventions. New cardiac drugs are reviewed in this chapter to understand their mechanisms of action, pharmacology, and appropriate usage. Catecholamines also are discussed for comparison and because the use of drugs like epinephrine and norepinephrine may not be familiar. Although certain drugs like the intravenous dihydropyridine calcium-channel blockers have been widely available in most parts of the world, intravenous nicardipine is the first drug of its class to be available in the United States, and is reviewed.

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In the early 1980s the clinical use of nondepolarizing neuromuscular blocking drugs (muscle relaxants) made a significant leap forward with the introduction of vecuronium and atracurium. These two drugs have an intermediate duration of action, vecuronium is free of cardiovascular effects, and atracurium has a unique non-organ-dependent mode of elimination [1]. Vecuronium and atracurium were a significant improvement over the previously available muscle relaxants, and the usefulness of intermediate-acting drugs became firmly established. Any muscle relaxant introduced since vecuronium and atracurium must have some aspect of its pharmacology that gives it a clinical advantage over these two drugs. In recent years, four new muscle relaxants, pipecuronium (Arduan), doxacurium (Neuromax), mivacurium (Mivacron), and rocuronium (Zemuron) have been introduced into clinical practice in the United States. Other muscle relaxants are at the stage of clinical trials. I will discuss the pharmacology of the drugs recently released into clinical practice, and provide an outline of the drugs undergoing clinical trials.

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Clonidine, an α2-adrenoceptor agonist, was introduced into clinical practice as an antihypertensive medication more than 25 years ago [1]. Apart from its use as an antihypertensive medication, clonidine has been used for many conditions ranging from a variety of psychiatric disorders to the management of children with delayed growth [2–6]. In veterinary practice, α2agonists have been used for several years in the practice of anesthesia. Experimental and clinical studies have progressed to the point where anesthesiologists are now focusing on the use of this class of agent for its analgesic and anesthetic effects. This renewed interest has coincided with the development and clinical introduction of superselective agonists such as dexmedetomidine.

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Critically ill patients in the intensive care unit (ICU) who are intubated and mechanically ventilated typically experience pain, anxiety, and other forms of discomfort that are often accompanied by agitation, sleep deprivation, and psychosis [1–4]. Inadequately treated discomfort and agitation in these patients can have detrimental cardiopulmonary and metabolic consequences such as tachycardia, hypertension, arrhythmias, myocardial ischemia, and increases in oxygen consumption and carbon dioxide production which can contribute significantly to increased morbidity and mortality [5–9]. Traditionally, opioids, benzodiazepines, and neuroleptics have been used most commonly for sedation of patients in the ICU [10]. Long-term administration of these medications to critically ill patients may result in persistent sedation, cognitive deficits, and/or respiratory depression following discontinuation of these drugs due to accumulation of either the parent compound or active metabolites [11–18]. Propofol is a short-acting intravenous sedative-hypnotic agent which has been used for several years in both the United States and in Europe for general anesthesia and intra-operative sedation. Propofol has become an attractive alternative to other medications used for sedation of patients in the ICU because of its rapid onset and offset of sedation and its low side-effect profile, even with long-term administration to critically ill patients.

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Nitric oxide (NO) is a truly unique compound, and although ubiquitous, it has only been used therapeutically since 1991. NO is a free radical, is widely present in many biological systems, and exerts pivotal roles in multiple metabolic and regulatory processes. This chapter focuses on inhaled NO: It describes the physiological basis for the effects of inhaled NO; reviews the literature concerning the medical uses of inhaled NO in the acute care of a variety of adult and pediatric patient populations; discusses the potential adverse effects associated with inhaled NO; and describes delivery and monitoring strategies.

ISSN:0020-5907    

出版商:OVID    

年代:1994

数据来源: OVID