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Vasodilatory shock requiring treatment with catecholamines occurs in some patients following cardiopulmonary bypass. We investigated the use of vasopressin in the treatment of this syndrome. Forty patients with a left main coronary artery disease and a poor left ventricular function (ejection fraction 60 mm Hg and a systemic vascular resistance of greater than 900 dynes.sec.cm5 on maximal doses of pharmacological and mechanical support were selected. Patients underwent a standard cardiac anaesthesia protocol. All patients had a Swan-ganz catheter inserted pre-operatively. Arginine vasopressin was administered as a bolus of 0.015 units/kg intravenously followed by an infusion of 0.03 units/kg/hour. This dose increased the mean arterial pressure from 67+/-7 to 95+/-5 mm Hg and the systemic vascular resistance from 860+/-55 to 1502+/-71 dynes.sec.cm-5. It was also associated with a decrease in pharmacological support. All subjects responded to vasopressin administration. Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass.

Introduction: Sevoflurane, inhalational anaesthetic of choice in children, is associated with high incidence of emergence agitation (EA). But that "one drug" which can significantly reduce or prevent EA still eludes us. Thus we aimed at studying the efficacy of intravenous ketamine and varying doses of intravenous fentanyl on postoperative emergence agitation in children receiving sevoflurane anaesthesia. Materials and methods: This prospective, double blind, randomized comparative study was conducted on 114 children, 2-10 years, with ASA physical status I-II. They were undergoing herniotomy under sevoflurane anaesthesia and were randomly divided into Group A receiving ketamine 0.5 mg/kg, Group B fentanyl 2mcg/kg and Group C fentanyl 3mcg/kg at the time of induction. Postoperatively emergence agitation was assessed every 5 min during first 60 min of PACU stay using Aono's four point scale. We also observed recovery characteristics including time to extubation, time to emergence, discharge from PACU and postoperative complications. Results: The incidence of EA was significantly low in Group A (31.6%) and Group C (28.9%) compared to group B (65.8%), with no significant difference between Group A and Group C. Incidence of EA was higher in preschool children. A prolonged PACU stay was observed in all children who developed EA, with lesser duration of PACU stay noted in fentanyl 3 mcg/kg group. Conclusion: Intravenous administration of either ketamine 0.5 mg/kg or fentanyl 3mcg/kg i.v. at the time of induction reduces the incidence of EA effectively when compared with fentanyl 2mcg/kg, without delaying recovery. [ABSTRACT FROM AUTHOR]

Background: Split-thickness skin grafts can be used for foot wound closure in diabetic and nondiabetic patients. It is unknown whether this procedure is reliable for all diabetic patients, with or without comorbidities of diabetes, including cardiovascular disease, neuropathy, retinopathy, and nephropathy., Methods: We retrospectively reviewed 203 patients who underwent this procedure to determine significant differences in healing time, postoperative infection, and need for revisional surgery and to create a predictive model to identify diabetic patients who are likely to have a successful outcome., Results: Overall, compared with nondiabetic patients, diabetic patients experienced a significantly higher risk of delayed healing time and postoperative complication/infection and, hence, are more likely to require revisional surgery after undergoing the initial split-thickness skin graft procedure. These differences seemed to be related more to the presence of comorbidities than to diabetic status itself. Diabetic patients with preexisting comorbidities experienced a significantly increased risk of delayed healing time and postoperative infection and a higher need for revisional surgery compared with nondiabetic patients or diabetic patients without comorbidities. However, there were no significant differences in outcome between diabetic patients without comorbidities and nondiabetic patients., Conclusions: For individuals with diabetes but without exclusionary comorbidities, split-thickness skin grafting may be considered an effective surgical alternative to other prolonged treatment options currently used in this patient population.

The development of metabolic acidosis during cardio-pulmonary bypass (CPB) is a well recognized but poorly explained phenomenon. It has been hypothesized that it is purely a development after the delivery of pump prime. A retrospective study was conducted at our hospital on 68 patients who underwent elective coronary artery bypass grafting (CABG). Sampling of arterial blood was performed at three time intervals: (T(1)) Baseline, prior to induction; (T(2)) 5 minutes after initiation of CPB and prior to administration of cardioplegia solution; (T3) during rewarming prior to weaning the patient off CPB. Measurements of Na(+), K(+), Cl(-), pH, pCO(2), HCO(3) (-), Base excess, Anion gap, Strong ion difference at each collection point were performed. Results were analyzed in a quantitative manner. On delivery of pump prime, all patients' developed metabolic acidosis. However, it is very important to distinguish the metabolic acidosis as their management varies. Anion gap has been found to be useful in managing peri-operative metabolic acidosis.

The implant material hydroxylapatite (HA) has been shown in numerous studies to be highly biocompatible and to osseointegrate well with existing bone; however, the molecular mechanisms at work behind this osseointegration remain largely unexplored. One possibility is that the implant, exposed to the patient's blood during surgery, adsorbs known cell adhesive proteins such as fibronectin and vitronectin from the serum. Osteoblast precursors could then adhere to these proteins through integrin-mediated mechanisms. In the present study, we have used a quantitative ELISA assay to test the hypothesis that hydroxylapatite will adsorb more fibronectin and vitronectin from serum than two commonly used hard-tissue materials, commercially pure titanium, and 316L stainless steel. We further used the ELISA, as well as a standard cell adhesion assay, to test the hypothesis that increased protein adsorption will lead to better binding of purified integrins alpha5beta1 and alpha(v)beta3 and osteoblast precursor cells to the HA than to the metals. Our results show that fibronectin, vitronectin, alpha5beta1, alpha(v)beta3, and osteoblast precursor cells do indeed bind better to HA than to the metals, suggesting that improved integrin-mediated cell binding may be one of the mechanisms leading to better clinical bone integration with HA-coated implants., (Copyright 2001 John Wiley & Sons, Inc.)