}|2D2L @@@ @@@@;; 6-2XC2h EN DB 2pP     & . 6f7 @]n  U A   KY , O l   # Hv~+ 4 v ?2; Latimer1995'ïnô`öP5{Àñ&windë`keybóhiobÜetrgï0cntl"#õacce îÀ95{ò`@ñ@ó@ò@@ïp@óP@ñ@ñ@ò@ó0@ð@ði@òh@ðg@ïe@òp3@ñ@ò@ñ@@ñ @ñ` @ð @ð @ò @ò@ñó@ï@ï@ï`@ð@ð0@ðP}pÀ'upñ@DEADC]CCACAPnavs þEND ÷ø þô Pe" 7@È ýpupp@ upÈýøPøÉ`øAh]`\? Latimer1995. Latimer1996+ Latimer1997, Latimer1997- Latimer1997 Latimer2000" Latimer2000% Latimer2000& Latimer2000( Latimer2000p Lethen19969& Levy200002 Lin19953 Lin1995\ Little1995& Lynch20004 Mackay19912 Mackay199553 Mackay19951 Mackay2002@ Mahmood1994A Mahmood1994_ Mahmood1994UMarcuson1972' Matta2000o Max1999n Max2000) Menon1999 Menon2000' Menon2000 Menon2002)Messahel19999'Messahel20000 Mills2000" Milner20000! Mist20010@ Moors1994A Moors1994? 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Moors1995- Mur1997; Mur1997Y Mur1997" Mur2000) Nandate1999' Nandate2000 Nanson19919 Newman19989 Newman19999 Newman20000 Nicol1998O Noble1984" Nordlander20002& Nordlander200027 Nordlander20002& Nystrom20007 Nystrom2000I Oduro1988H Oduro1989E Oduro1990F Oduro1990G Oduro1990D Oduro1991C Oduro1993@ Oduro1994A Oduro1994B Oduro1994] Oduro1994^ Oduro1994_ Oduro1994> Oduro1995Z Oduro1995[ Oduro1995\ Oduro1995, Oduro1997- Oduro1997: Oduro1997; Oduro1997X Oduro1997Y Oduro1997) Oduro-Dominah1999' Oduro-Dominah2000  Olufolabi19981 Osgathorp2002 Paoloni2000  Parameshwar2001* Petyaev1998@ Pickett1994A Pickett1994] Pickett1994^ Pickett1994_ Pickett1994[ Potter199590 Pouleur1989. Poulton1996< Poulton19961 Powell2002> Powroznyk1995Z Powroznyk19952 Prough19955 Pugsley1998_ Raine1994' Ratsep20000 Ravalia1996_ Rennie19944 Reves2000&Ricksten200007Ricksten20000% Ritchie2000( Ritchie20006 Ritchie20008 Ritchie2000 Ritchie2001 Robertshaw19980Rousseau198991 Rozario2002  Sanderson1998 Satchithananda2001 Senthuran2002# Sharma2000 Sharples20011P Shelley1983L Shelly1986 Smith1996 Smith2001B Snow1994` Snow1994 Solesbury2002 Soppitt1998 Stoica2001n Stygall1998  Timberlake1998 Toff2002 Tsui200113 Uchida199550van Eyll19890 van Mechelen1989T0 Vuylsteke1989/ Vuylsteke1994. Vuylsteke1996< Vuylsteke1996+ Vuylsteke1997, Vuylsteke1997- Vuylsteke19979 Vuylsteke1997: Vuylsteke1997; Vuylsteke1997X Vuylsteke1997Y Vuylsteke1997* Vuylsteke1998) Vuylsteke1999 Vuylsteke2000 Vuylsteke2000" Vuylsteke2000# Vuylsteke2000$ Vuylsteke2000% Vuylsteke2000& Vuylsteke2000' Vuylsteke2000( Vuylsteke20005 Vuylsteke20006 Vuylsteke20007 Vuylsteke20008 Vuylsteke2000 Vuylsteke2001  Vuylsteke2001! Vuylsteke2001 Vuylsteke2002 Vuylsteke2002 Vuylsteke2002 Vuylsteke20024 Walker1991OWallwork1984[Wallwork1995 Wallwork20011 Webb1990B Wells1994[Wheeldon1995F White1990 White2001Williams1991eWoodhead19909Woodhead1991Woodhead19919 Wooding1991 Woods20013 Woodson1995! Zammit20011`` "(!'7-5,)1%+* StA 5{!vEND 5{,*1 )pp ¨LG@0 `o{ZKKǀ;ʆ1@º!v@c AuthorsJournals %Keywords 0)                               #3"0  <Ahluwalia, J. S. Alexander, R.Arrowsmith, J.Arrowsmith, J. E. Bacon, R. C. Bethune, D.Bethune, D. W. Bevan, D. H. Bodman, R. I. Borland, C. Boyd, J. D. Burns, T. I.Callingham, B. A. Calne, R. Y. Cardan, E.Chamberlain-Webber, R. Chandler, J.Charman, S. C. Collis, J. Collis, J. M.Cory-Pearce, R.Crosbie, A. E. Cummin, A. R. Dalton, H. R.Davidson, H. J. Davies, A. Dear, G. L. Dembinski, R. Denny, N. M. Deyo, D. J. Dhir, A. K. Dimech, J. Doyle, A. R. Duncan, N. Dunning, J.Dunning, J. J.Dunning, J. L.English, T. A. Ericsson, H. Etienne, J. Falter, F. Farman, J. V.Feerick, A. E. Feneck, R. O. Feniuk, W.Fernando, S. S.Flachskampf, F. A.3 Fleming, B. Foubert, L. Foulds, R.Frossard, R. J. Gan, T. J. Gerrard, C. Ghosh, S. Graham, T. R. Gray, B.@ Gray, B. M. Gray, S.@ Gray, S. J. Grixti, K.Grocott, H. P. Guo, X.@ Hakim, M. Hanrath, P. Hardy, I.Harrison, M. J. Hartshorn, S. Harvey, P.Harwood, R. J.Higenbottam, T.Higenbottam, T. W.2” Hiley, C. R. Hill, R. P. Ho, W. S. Hoffmann, R.Humphrey, P. P. Hunt, J. V. Ilgner, J.Ismail-Zade, I. A.2$ Jani, K.@ Janssens, U.Jenkins, L. W.Johnston, W. E.Jolin-Mellgard, A.2$ Jonas, M.Kelsall, A. W.Kendall, S. W.Kennedy, D. J. Kipling, R. Klinowski, J. Kneeshaw, J.Kneeshaw, J. D.Knowles, P. R. Kuhlen, R. Kuzumi, E. Large, S. Large, S. R. Laszlo, G.Latimer, K. E.Latimer, M. D. Latimer, R.Latimer, R. D. Lethen, H. Levy, J. H. Lin, C. Y. Little, J. P.Lynch, C., 3rd Mackay, J. H. Mahmood, M. Mahmood, N.Marcuson, R. W. Matta, B. F. Max, M.@ Menon, D. K. Messahel, S. Mills, R. J. Milner, Q. Mist, B.@ Moors, A. H. Mur, D.@ Nandate, K. Nanson, E. M. Newman, M. F. Newman, S. P. Nicol, M. E. Noble, J.Nordlander, M.Nordlander, M. L. Nystrom, P. Oduro, A.Oduro-Dominah, A. Olufolabi, A. Osgathorp, J.Paoloni, C. C.Parameshwar, J.Petyaev, I. M. Pickett, J.Pickett, J. A. Potter, C. D. Pouleur, H.Poulton, B. B. Powell, S. J.Powroznyk, A. V. Prough, D. S.Pugsley, W. B. Raine, J. Ratsep, I. Ravalia, A. Rennie, J. M. Reves, J. G.Reyle-Hahn, M.Ricksten, S. E.Ritchie, A. J.Robertshaw, H. J. Rolles, K. Rossaint, R.Rousseau, M. F.Rozario, C. J.Sanderson, I. C.Satchithananda, D. K. Senthuran, S. Sharma, R. Sharples, L. Shelley, M. Shelly, M. Smith, D. P. Smith, G. B. Smith, H. S. Smith, S. Snow, D.@ Snow, D. J.Solesbury, P. M.Soppitt, A. J.Stevens, J. J. Stoica, S. C. Stygall, J. Thomas, T. A.Timberlake, N. Toff, W. D. Tsui, S. L. Uchida, T. van Eyll, C.van Mechelen, H. Vuylsteke, A. Walbert, E. Walker, I. A. Wallwork, J. Webb, A. R. Wells, F. C. Westhofen, M.Wheeldon, D. R. White, D. A. White, R. Williams, I.Woodhead, M. A. Wooding, S. Woods, M. J.Woodson, L. C. Zammit, M.  %Acta Anaesthesiol BelgActa Anaesthesiol Scand Acta PaediatrAnaesth Intensive Care Anaesthesiat Anesth AnalgtAnesthesiologyAnn Fr Anesth Reanim0Ann Thorac SurgBasic Res CardiolBmjh Br J AnaesthtBr J Clin Pract SupplBr J Dis Chest Br J Hosp Med Can J Anaesth Cardiology2tClin Sci (Lond) Crit Care Med Eur Heart JtEur J Cardiothorac SurgIntensive Care Med0J Appl PhysiolJ Cardiothorac Anesth J Cardiothorac Vasc Anesth%WJ Cardiovasc PharmacolJ Heart Lung TransplantJ Laryngol Otol J Nucl Med2tJ Pharm PharmacolJ Thorac Cardiovasc Surg Lancet@ Med Biol Engt Nurs Times2t Respir Med2t Stroke@ Thorax@  9 O *Anesthesia8*Anesthesia, Conduction/*,'*Anesthesia, Inhalation/instrumentation_*Anesthesiology*Blood PressureP *Blood Pressure/drug effects *Bronchi *Burns, Chemical/drug therapy*Carbon Dioxide/blood *Cardiac Pacing, Artificial˜ *Cardiac Surgical Procedures*Cardiopulmonary Bypasss/$*Cardiopulmonary Resuscitationver*Catheterization*Central Venous Pressure *Cerebrovascular Circulation*Cesarean Section*Coronary Artery Bypassio*Drug Labelingand0**Echocardiography, Transesophageal/methods*Endarterectomy B *Ethyl Ethers*Exercise Testphy *Exertion *Firesepo*Fluorocarbonsudy*Gas ScavengersP*Heart Massagetio*Heart Transplantation*Heart Valve Prosthesison*Heart-Assist Devices *Heart-Lung Transplantation˜*Heat *Hemodynamics *Humidity*Hypothermia, Induced *Income Taxin*Infant, Prematureona(#*International Educational Exchange *Intubation, Intratracheal2,84*Intubation, Intratracheal/contraindications/methods *Laparoscopyl*Length of StayUn *Lidocaine/me*Liver Transplantation*Lung Transplantation*Medication Errorsngi(%*Nitric Oxide/administration & dosage*Nitrogen Dioxide*Nurse AnesthetistsP8 *Periodicalse("*Platelet Aggregation/drug effectsnsy*Platelet Countco,&*Positive-Pressure Respiration/methods *Postoperative Complicationsa *Posturex *Pulmonary Diffusing Capacity*Pulmonary Gas Exchangeir$*Radiology Department, Hospitals*Respiration, Artificialr*Tissue Donorsent*TonsillectomyAbs*Ventilators, Mechanical*@=15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic$ Abdomen, Acute/etiology/*surgery Absorption8(#Acetamides/*administration & dosage@Acid-Base EquilibriumAcid/pharmacology Acute Disease$Adenine Nucleotides/metabolismP Administration, Inhalation2,Administration, Topical Adolescent/*a41Adrenergic Agonists/*pharmacology/therapeutic use,&Adrenergic beta-Agonists/*pharmacologyAdultAgedeAged, 80 and over    '  ","%,**+1'(!+77 )(,)))), ''- ,'5,,-(",, F 9624086 316A 7147 1998 Jun 13f`Audit commission tackles anaesthetic services. Anaesthesia should remain physician based service 1827vpArrowsmith, J. E. Alexander, R. Dear, G. L. Gan, T. J. Hill, R. P. Olufolabi, A. Sanderson, I. C. Soppitt, A. J.(!98288227 0959-8138 Comment Letter0 BmjzLE*Anesthesiology Great Britain Human *Nurse Anesthetists United StatesRjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=96240869466033451 1998 JanLENasotracheal intubation in the presence of frontobasal skull fracture 71-5NHPURPOSE: To present a case of maxillofacial trauma and basal skull fracture (BSF) in whom nasotracheal intubation (NTI) was successfully used, without complication, to facilitate surgical fixation. To present alternative methods of airway management in this situation and to review the evidence supporting the notion that NTI is contraindicated in the presence of basal skull fracture. CLINICAL FEATURES: A 17-yr-old man was referred for surgical fixation of bilateral mandibular fractures. Cranial computed tomography revealed intracranial air and blood in all four sinuses and distortion of the nasal passage on the right. There was no cerebral injury and the left nasal passage appeared patent. In order to facilitate intraoperative intermaxillary fixation fibreoptic NTI was undertaken in preference to tracheostomy. The patient made an uneventful recovery without evidence of meningitis or direct cerebral injury. CONCLUSION: In selected patients NTI may be performed in the presence of BSF. Available evidence suggests that BSF-should not be regarded as an absolute contraindication to NTI.'d]Department of Anaesthesia, St George's Healthcare NHS Trust, London, UK. arrow002@mc.duke.eduu6/Arrowsmith, J. E. Robertshaw, H. J. Boyd, J. D.@:98127181 0832-610x Journal Article Review Review, Tutorial Can J AnaesthAdolescent Brain Injuries/prevention & control Case Report Cerebrospinal Fluid Rhinorrhea/prevention & control Fiber Optics Fracture Fixation Human *Intubation, Intratracheal/contraindications/methods Laryngoscopy Male Mandibular Fractures/radiography/*surgery Meningitis/prevention & control Nasal Cavity/injuries/radiography Paranasal Sinuses/injuries/radiography Respiration Skull Base/*injuries/radiography Skull Fractures/radiography/*surgery Tomography, X-Ray Computed Tracheostomy Zygomatic Fractures/radiography/*surgeryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=946603310622661136 1999 DecLENeurologic risk assessment, monitoring and outcome in cardiac surgery 736-43'ZTDepartment of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.4.Arrowsmith, J. E. Grocott, H. P. Newman, M. F.B;20086373 1053-0770 Journal Article Review Review Literatures J Cardiothorac Vasc Anesth*Cardiac Surgical Procedures Cerebrovascular Accident/*etiology Cognition Disorders/*etiology Human Monitoring, Intraoperative/*methods Risk Assessment Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Treatment Outcome lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10622661r10405148407 1999 JulD>On effect of coronary artery bypass surgery on brain perfusion 1225Arrowsmith, J. E.(!99332034 0161-5505 Comment Letterr J Nucl MedBrain/*radionuclide imaging *Cerebrovascular Circulation Coronary Artery Bypass/*adverse effects Human Neuropsychological Testselehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10405148m11103202853 2000 Sep.(Off-pump revascularization and the brain 492-3 $Arrowsmith, J. E. Large, S. R.(!20554551 0007-0912 Comment Letter Br J AnaesthxqBrain Injuries/*prevention & control Cardiopulmonary Bypass/adverse effects Coronary Artery Bypass/*methods Humanlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=111032022  6opical40_8P802DP 08P8P8PP8`40P2D`08YX]41H"H"2\"32D] 2D＿#Ambulatory Care/methods40_8P802DP 08P8P8PP8`40P2D`08YX]410793601843p 2000 Mar>7Central nervous system complications of cardiac surgery 378-93pjThe neurological complications of cardiac surgery are associated with significantly increased mortality, morbidity and resource utilization. The use of new surgical techniques, introduction of wider indications for surgery and increased public expectation has led to an increase in the average age of cardiac surgical patients and an increased incidence of repeat procedures. With these changes has come an increased risk of neurological complications. The likelihood of perioperative stroke varies between 1% and 5% in most published series and is dependent on a multitude of risk factors. Of these, patient age, aortic atheroma, symptomatic cerebrovascular disease, diabetes mellitus and the type of surgery appear to be most important. Cognitive deterioration after cardiac surgery is far more common, affecting as many as 80% of patients a few days after surgery and persisting in one-third. Despite an increase in the age of the cardiac surgical population, the reported incidence of cognitive dysfunction after cardiac surgery seems to have fallen in recent years. Whether this is a real phenomenon or the result of changes in the use of psychometric testing and the definition of cognitive decline remains unclear. Recognition that certain equipment, surgical practices and patient factors contribute to neurological morbidity has prompted 'neuroprotective' interventions. Some of these (e.g. arterial line filtration and alpha-stat management) have been shown to improve outcome. Despite these measures, a small number of patients will inevitably sustain cerebral injury during otherwise successful cardiac surgery. Although pharmacological neuroprotection may, in the future, offer some of these patients an improved outcome, it is unlikely that any single agent will prevent neurological injury. In the meantime, the CNS complications of cardiac surgery remain a fertile area of research.'TNDepartment of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, UK.B;Arrowsmith, J. E. Grocott, H. P. Reves, J. G. Newman, M. F.@:20254071 0007-0912 Journal Article Review Review, Tutorial Br J AnaesthBiological Markers/analysis Brain Diseases/diagnosis/*etiology/prevention & control Cardiac Surgical Procedures/*adverse effects Human Neuroprotective Agents/therapeutic use Risk Factors Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S.lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10793601e10594452551 2000 Jan:3Self reports of postoperative cognitive dysfunction  94-5Arrowsmith, J. E.P(!20062338 0003-2409 Comment Lettere AnaesthesiaVPCardiac Surgical Procedures/*adverse effects Cognition Disorders/*etiology Humanlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10594452411432367195 2001 MayNormothermic cardiopulmonary bypass is beneficial for cognitive brain function after coronary artery bypass grafting--a prospective randomized trial 732-4& Arrowsmith, J. E. Dunning, J. L.(!21323984 1010-7940 Comment LetterEur J Cardiothorac Surg2Cardiopulmonary Bypass/adverse effects/*methods Cognition Disorders/*etiology/prevention & control *Coronary Artery Bypass Human Hypothermia, Induced/adverse effects Prospective Studies Randomized Controlled Trialslehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=114323671 t#ation, Inhalation3P2@۫8P80YP 8]2@@2t2t"=`Y"> P83АPYX]3H$H"2\ꐠ8"33#"2@32t]꠿|lY Animalstration, Inhalation3P2@Ã8P80YP 8]2@@2t2t"=`12204734223 2002 SepHBSix-year prospective audit of chest reopening after cardiac arrest 421-5 : 4OBJECTIVE: To identify which patients benefit from chest reopening after cardiac arrest. SETTING: Cardio-thoracic hospital undertaking full range of adult cardio-thoracic surgery. METHODS: In-hospital arrests were prospectively audited over a 6-year period. Information was collected for every patient whose chest was reopened following cardiac arrest: location of arrest, type of arrest, specialty, time since surgery, time to chest reopening, location of chest opening, surgical findings on reopening, time to cardiopulmonary bypass (if used) and patient outcomes. Exclusions: Arrests in theatre and chest openings for reasons other than cardiac arrest. RESULTS: There were 818 confirmed in-hospital arrests following 'cardiac arrest calls'. Chest reopening was undertaken in 79 surgical patients. Overall survival to discharge was 20/79 (25%). Favourable determinants of outcome were: arrest on intensive care unit (ICU), arrest within 24 h of surgery and reopening within 10 min of arrest. Nineteen of 58 (33%) chest openings following arrests on the ICU survived to discharge compared to one of 21 (5%) patients whose initial arrest was outside the ICU (P=0.017). One of nine ward arrests scooped to ICU for chest reopening survived whereas all 12 patients reopened on the ward died. Fifteen of 40 patients (38%) reopened within 24 h surgery survived compared to five of 39 patients where reopening was undertaken more than 24 h after surgery (P=0.02). Fourteen of 29 (48%) patients opened within 10 min of arrest survived to discharge compared to six of 50 (12%) patients where time to reopening was more than 10 min (P=<0.001). Seven of 22 patients (32%) patients where emergency bypass was utilised survived to discharge. CONCLUSION: This study strongly confirms the benefit of chest reopening after cardiac arrest in the cardiac surgical ICU. Patients who arrest within 24 h of surgery and in whom reopening is instituted within 10 min are particularly likely to benefit. The value of chest reopening in arrests outside the ICU remains unresolved. All patients reopened on the ward died, suggesting that this practice should be discontinued. Early 'scoop and run' resulted in one solitary survivor though it should probably be restricted to patients who arrest within 72 h of surgery as surgically remediable problems are unlikely after this time.'TNPapworth Hospital, Cambridge CB3 8RE, UK. jon.mackay@papworth-tr.anglox.nhs.uk>8Mackay, J. H. Powell, S. J. Osgathorp, J. Rozario, C. J.("22193979 1010-7940 Journal ArticleEur J Cardiothorac SurgngCardiac Surgical Procedures/adverse effects *Cardiopulmonary Resuscitation Commission on Professional and Hospital Activities Emergencies Heart Arrest/etiology/*therapy *Heart Massage Human Intensive Care Units Operating Rooms Postoperative Complications Prospective Studies Reoperation Sternum/surgery Thoracic Surgical Procedures/adverse effects Thoracotomyolehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12204734 & B., A.2”2¨YX2 p2¨2"lNY"2 ]ȿD2 ]2¼H$M"2\Y"32 ]2¨"2¨"p2 ]2œD @&CпD]2¼P2œpYr8Y Feneck, R. O.2”2¨YX2 p2¨2"lNY"2 ]ȿD2 ]2¼H"M"2\Y"32 ]2¨"2¨"p2 ]2œD @&CпD]10890479143 2000 JunjcPerioperative blood pressure control: a prospective survey of patient management in cardiac surgery 269-73d^OBJECTIVE: To conduct a survey of current cardiac anesthetic practice in Europe and the United States, as a first step toward establishing guidelines for the management of perioperative hypertension. DESIGN: Prospective, multicenter study. SETTING: University hospitals. PARTICIPANTS: Unselected patients (n = 1,930) requiring cardiac surgery. INTERVENTIONS: Data extending from the preoperative evaluation to 120 hours or more after surgery were collected from all patients. MEASUREMENTS AND MAIN RESULTS: Only the data from patients undergoing coronary artery bypass surgery, valve surgery, or combined procedures were analyzed, leaving a final total of 1,660 patients from the original 1,930. Of these, 88% were treated at least once perioperatively to lower arterial blood pressure. Deepening of anesthesia was the most commonly used antihypertensive measure (68%), regardless of the ongoing anesthetic regimen, and was usually combined with vasodilator therapy, most frequently nitroglycerin (53%) or sodium nitroprusside (28%). Reported perioperative mean arterial pressure (MAP) was 15 to 20 mmHg lower than MAP before anesthesia induction, regardless of the use of antihypertensive therapy. The MAP at which antihypertensive treatment was initiated varied markedly among the various phases of surgery and showed no clear correlation with preoperative MAP. CONCLUSIONS: The results of this survey show that current anesthetic practice tries to prevent perioperative hypertension wherever possible during cardiac surgery. Blood pressure measurements taken before surgery have little influence on the development of hypertension intraoperatively, and the main determinants of perioperative blood pressure control and the need for therapeutic intervention are factors arising from the surgical procedure itself, such as aortic cross-clamping and activation of adrenergic mechanisms.'B;Department of Anesthesia, Papworth Hospital, Cambridge, UK.nVuylsteke, A. Feneck, R. O. Jolin-Mellgard, A. Latimer, R. D. Levy, J. H. Lynch, C., 3rd Nordlander, M. L. Nystrom, P. Ricksten, S. E.:420346533 1053-0770 Journal Article Multicenter Study J Cardiothorac Vasc Anesth*Blood Pressure *Coronary Artery Bypass Heart Valves/*surgery Human Hypertension/*drug therapy/physiopathology Prospective Studies Support, Non-U.S. Gov'tlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10890479e 0 jMolecular ConformationMolecular Sequence Datahi0+Monitoring, Intraoperative/*instrumentation(#Monitoring, Intraoperative/*methodsMonitoring, Physiologicds,'Monitoring, Physiologic/instrumentationan,'Multiple Organ Failure/*physiopathology_$Muscle Contraction/drug effectssa0*Muscle Contraction/drug effects/physiology(%Muscle, Smooth, Vascular/drug effects($Myocardial Contraction/*drug effectsp$!Nasal Cavity/injuries/radiography<6Neuromuscular Blocking Agents/*administration & dosageS`0+Neuromuscular Blocking Agents/*pharmacology4/Neuroprotective Agents/*administration & dosage,&Neuroprotective Agents/therapeutic useffeNeuropsychological Testsa0*NG-Nitroarginine Methyl Ester/pharmacology NigeriaAg(%Nitric Oxide/*administration & dosage85Nitric Oxide/*administration & dosage/adverse effects4.Nitric Oxide/*administration & dosage/analysisNitric Oxide/*analysismisNitric Oxide/*chemistry Nitric Oxide/*pharmacologyysi Nitric Oxide/*therapeutic use85Nitric Oxide/administration & dosage/*therapeutic useNitric Oxide/metabolism E Nitrogen Dioxide/*chemistry, Nitroprusside/pharmacologyter4.Nitrous Oxide/administration & dosage/analysisOctreotide/pharmacologyr/Operating RoomsUnOpium/adverse effectsOrgan Preservationman Organ Preservation/*methodsOrgan Procurement4.Organ Procurement/*statistics & numerical data Oscillometryr(#Ovarian Cysts/complications/surgery@ OximetryV Oxygenen  Oxygen/*blood Oxygen/*blood/therapeutic useOxygen/analysis/*bloody,&Pacemaker, Artificial/*adverse effectsffe(%Pain/*chemically induced/drug therapy Pamphlets,&Paranasal Sinuses/injuries/radiographyeryPartial Pressureb Patient Education/*standards Peptides, Cyclic/pharmacologyPeriodicals/*standardsds/ Perioperative Care/methodsers$Peritonsillar Abscess/*surgery Phenylephrine/pharmacologyterHBPhosphodiesterase Inhibitors/administration & dosage/*pharmacologyP80,Phosphodiesterase Inhibitors/therapeutic use PhysicstyPlasma/chemistry*40Platelet Aggregation Inhibitors/*adverse effectsz$Pneumonia, Aspiration/*etiologys($Pneumonia/drug therapy/*microbiology@Pneumothorax/*etiologyatiPolytetrafluoroethylenemePorphobilinogen/urine82Porphyria, Acute Intermittent/*complications/urine Positive-Pressure Respiration4.Positive-Pressure Respiration/*instrumentationPostoperative Carenou(#Postoperative Care/*instrumentation@ Postoperative Complicationsap,)Postoperative Complications/*drug therapy(%Postoperative Complications/*etiology85Postoperative Complications/mortality/physiopathology("Postoperative Hemorrhage/*etiologydvePostoperative Periodo PostureiaPotassium Chloride/*mPotassium/pharmacologylogPrazosin/pharmacology Pregnancy Preoperative Care/*methods, D Pressurea Propanolamines/*pharmacologytPropofol/*adverse effectsPropofol/*pharmacologygyePropofol/adverse effectssProspective Studiesd/Prosthesis Implantation(#Protamines/*administration & dosage<9Pulmonary Alveoli/blood supply/metabolism/physiopathologyPulmonary Artery/*surgery Pulmonary Artery/drug effects,)Pulmonary Artery/drug effects/*physiologyPulmonary Circulation Pulmonary Emphysema/surgeryen$!Pyridines/blood/*pharmacokinetics Radial Artery,&Radial Artery/*drug effects/physiologyogy@;Radial Artery/drug effects/physiopathology/*transplantation8Radiography, ThoracicRandom Allocation Randomized Controlled Trials Ratso Rats, Wistarr @_V8038549833 1994 Mar:4Safety of inhaled nitric oxide in premature neonates 347-8~xAhluwalia, J. S. Kelsall, A. W. Raine, J. Rennie, J. M. Mahmood, M. Oduro, A. Latimer, R. Pickett, J. Higenbottam, T. W. 94312817 0803-5253 Letter Acta Paediatr Administration, Inhalation Human Hypertension, Pulmonary/*drug therapy Infant, Newborn *Infant, Premature Methemoglobinemia/etiology Nitric Oxide/*administration & dosage/adverse effectsjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=80385498214475488  1993 Aug>8The laryngeal mask airway: safe in the X ray department? 7346/Alexander, R. Arrowsmith, J. E. Frossard, R. J. 94027810 0003-2409 Letter Anaesthesia{Case Report Child Equipment Safety Female Human Laryngeal Masks/*adverse effects Pneumonia, Aspiration/*etiology Posture *Radiology Department, Hospitaljdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=821447519520234610 1991 OctZSExtracorporeal pseudoaneurysm: an unusual complication of radial artery cannulation  894-5 Arrowsmith, J. E. 92059865 0003-2409 Letter Anaesthesia{|vAged Aneurysm/*etiology Arm/*blood supply Bandages Case Report Catheterization, Peripheral/*adverse effects Human Malejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19520231651564461 1991 JanPIDigital gangrene in small cell lung cancer: response to aspirin treatment 63-4A patient who had small cell lung cancer complicated by symmetrical peripheral gangrene, secondary to spontaneous platelet aggregation, improved dramatically after starting aspirin treatment.u'F?Department of Thoracic Medicine, St. George's Hospital, London.pPJArrowsmith, J. E. Woodhead, M. A. Bevan, D. H. Nanson, E. M. Cummin, A. R.("91335368 0040-6376 Journal Article ThoraxAspirin/pharmacology/therapeutic use Blood Platelet Disorders/drug therapy/*etiology Carcinoma, Small Cell/*complications Case Report Fingers/*pathology Gangrene Human Lung Neoplasms/*complications Male Middle Age *Platelet Aggregation/drug effectsjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16515647551479541 1995 Jun 21-Jul 11L("Anaesthesia during carotid surgery54Arrowsmith, J. E.  96006865 0007-1064 Lettern Br J Hosp MedCarotid Artery Diseases/*surgery/ultrasonography Cerebrovascular Circulation Human Monitoring, Intraoperative/*methods Ultrasonography, Doppler, Transcranial/*methodsjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=75514798735040559h 1996May 1-14<5Emergency laparoscopy in a patient with severe asthma  593c'<5Department of Anaesthesia, Kingston Hospital, Surrey.$Arrowsmith, J. E. Smith, G. B.("96323468 0007-1064 Journal Article Br J Hosp Med Abdomen, Acute/etiology/*surgery Adult *Anesthesia, Conduction Asthma/*complications Case Report Emergencies Female Human *Laparoscopy Laparotomy Ovarian Cysts/complications/surgeryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=87350408694199515 1996 May4.The accuracy of references in journal articles 517-8Arrowsmith, J. E. 96263040 0003-2409 Letter AnaesthesiavoChild Child, Preschool Databases, Bibliographic/standards Documentation/*standards Human Periodicals/*standardskjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=86941999849305539 1998 Sep@9The Budget: bad news for British anaesthetists in the USA1 93322+Arrowsmith, J. E. Nicol, M. E. Bacon, R. C. 99066167 0003-2409 Letter AnaesthesiarkAnesthesiology/*economics Great Britain Human *Income Tax *International Educational Exchange United Statesjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=984930598046482911 1998 NovNeuroprotection of the brain during cardiopulmonary bypass: a randomized trial of remacemide during coronary artery bypass in 171 patients2357-62BACKGROUND AND PURPOSE: Neuropsychological impairment may follow coronary artery bypass surgery as a result of peroperative cerebral microembolism. The hypothesis that remacemide, an NMDA receptor antagonist, would provide protection against such ischemic damage has been tested in a randomized trial. METHODS: One hundred seventy-one patients undergoing coronary artery bypass surgery by a single cardiothoracic surgical team were randomized to receive remacemide (up to 150 mg every 6 hours) or placebo from 4 days before to 5 days after their bypass procedure. Peroperative monitoring included an estimate of the number of microembolic events detected by transcranial Doppler ultrasonography of the middle cerebral artery. A battery of 9 neuropsychological tests was administered before and 8 weeks after surgery. RESULTS: The proportion of patients showing a decline in performance of 1 SD or more in 2 or more tests was reduced in the treated group (9% versus 12%), but this was not statistically significant. On the other hand, overall postoperative change (reflecting learning ability in addition to reduced deficits) was more favorable in the remacemide group, which demonstrated significantly greater improvement in a global z score (P=0.028) and changes in 3 individual tests (P<0.05). The 2 patient groups were well matched, including for the burden of microembolic events. CONCLUSIONS: This is the first study to show statistically significant drug-based neuroprotection during cardiac surgery. In addition to offering improvement in cerebral outcome for such at-risk patients, it supports the hypothesis that drugs acting on the excitotoxic mechanism of ischemic cerebral damage can be effective in humans.'Departments of Anaesthesiology, Neurology, Psychiatry and Behavioural Sciences and Cardiothoracic Surgery, University College London Hospital and Medical School, London, UK.`YArrowsmith, J. E. Harrison, M. J. Newman, S. P. Stygall, J. Timberlake, N. Pugsley, W. B.TM99021801 0039-2499 Clinical Trial Journal Article Randomized Controlled Trial StrokezAcetamides/*administration & dosage Adolescent Aged Brain/blood supply/*physiology Cerebral Arteries/ultrasonography *Cerebrovascular Circulation *Coronary Artery Bypass Coronary Disease/*surgery Female Human Male Middle Age Neuroprotective Agents/*administration & dosage Neuropsychological Tests Support, Non-U.S. Gov't Treatment Outcome Ultrasonography, Doppler, Transcranialjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9804648come for such at-risk patients, it supports the hypothesis that drugs acting on the excitotoxic mechanism of ischemic cerebral damage can be effective in humans.'Departments of Anaesthesiology, Neurology, Psychiatry and Behavioural Sciences and Cardiothoracic Surgery, University College London Hospital and Medical School, London, UK.`YArrowsmith, J. E. Harrison, M. J. Newman, S. P. Stygall, J. Timberlake, N. Pugsley, W. B.TM99021801 0039-2499 Clinical Trial Journal Article Randomized Controlled Trial StrokezAcetamides/*administration & dosage Adolescent Aged Brain/blood supply/*physiology Cerebral Arteries/ultrasonography *Cerebrovascular Circulation *Coronary Artery Bypass Coronary Disease/*surgery Female Human Male Middle Age Neuroprotective Agents/*administration & dosage Neuropsychological Tests Support, Non-U.S. Gov't Treatment Outcome Ultrasonography, Doppler, Transcranialjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9804648 9 _("Cardiotonic Agents/*diagnostic use40Cardiotonic Agents/*pharmacology/therapeutic use,)Cardiotonic Agents/*supply & distribution(#Cardiotonic Agents/*therapeutic use<8Cardiotonic Agents/administration & dosage/*pharmacology@;Cardiotonic Agents/administration & dosage/*therapeutic use882Cardiotonic Agents/classification/*therapeutic use83Cardiovascular Surgical Procedures/*adverse effects40Carotid Artery Diseases/*surgery/ultrasonography Case Report80,Catheterization, Peripheral/*adverse effects$ Catheterization/*instrumentationtCause of Deathysi$!Cerebral Arteries/ultrasonography83Cerebrospinal Fluid Rhinorrhea/prevention & control$Cerebrospinal Fluid/physiologyP("Cerebrovascular Accident/*etiology Cerebrovascular Circulationrg84Cerebrovascular Circulation/drug effects/*physiologyChildChild, Preschool Chloroformrap$Cholinergic Agents/pharmacology*pCircadian Rhythm Cognition Disorders/*etiology82Cognition Disorders/*etiology/prevention & controlColdbColor82Commission on Professional and Hospital ActivitiesComparative StudyConstriction, PathologicnCoronary AngiographyoCoronary Artery Bypasstio,'Coronary Artery Bypass/*adverse effects$Coronary Artery Bypass/*methodsef$Coronary Artery Bypass/methods$!Coronary Disease/*physiopathologyCoronary Disease/*surgery<9Coronary Disease/physiopathology/*surgery/ultrasonographyCoronary Disease/surgerya4.Coronary Vessels/*drug effects/physiopathologyCross-Over Studiesrcu("Databases, Bibliographic/standards0,Defibrillators, Implantable/*adverse effects$Deglutition Disorders/etiologyPDepression, Chemical8 Dobutamine/*diagnostic useholDocumentation/*standards/Dogsb Dopamine Agents/*pharmacology0,Dopamine/*analogs & derivatives/pharmacology@Mammary Arteries/*drug effects/physiopathology/transplantationP802DP 0110945808550 2000 NovPharmacokinetics and pulmonary extraction of clevidipine, a new vasodilating ultrashort-acting dihydropyridine, during cardiopulmonary bypass 683-9Clevidipine is a new vascular-selective, calcium channel antagonist of the dihydropyridine type with an ester side chain susceptible to esterase metabolism. In healthy volunteers, it has high clearance (0.069 litres min-1 kg-1) with a small volume of distribution at steady state (0.19 litres kg-1). The half-lives of the two initial rapid phases, accounting for approximately 95% of the area under the curve after an i.v. bolus, are 0.7 and 2.3 min, respectively. The aims of this study were to determine the pharmacokinetics and the pulmonary extraction ratio of clevidipine in patients undergoing cardiac surgery. Seventeen patients received clevidipine as an i.v. infusion before cardiopulmonary bypass (CPB), and eight of these patients were also given clevidipine during hypothermic CPB. Mixed venous and arterial blood samples were taken for pharmacokinetic analysis and calculation of pulmonary extraction ratio. A two-compartment pharmacokinetic model with zero-order input was used to describe the pharmacokinetics of clevidipine before and during CPB. Virtually identical concentrations in mixed venous and arterial blood suggest negligible pulmonary metabolism of clevidipine. The total blood clearance of clevidipine is extremely high (0.055 litres min-1 kg-1). During CPB, clearance of clevidipine was significantly reduced, to 0.03 litres min-1 kg-1 (P < 0.005), probably as a consequence of reduced body temperature.'B[p.q+,- * o) (n'%#"$&! m1Npn Fr Anesth ReanimAdult *Burns, Chemical/drug therapy Calcium Gluconate/therapeutic use Case Report English Abstract Female Hand Injuries/*chemically induced/drug therapy Human Hydrofluoric Acid/*adverse effects Infusions, Intra-Arterial Pain/*chemically induced/drug therapy Radial Arteryjdhttp://www.ncbi.nlm.nih.gov/ organ baths containing physiological saline solution aerated with 95% O2/5% CO2 at 37 degrees C. Contractions were obtained by either the use of a thromboxane analogue (U46619), L-phenylephrine, KCl or CaCl2. The effects of glibenclamide on these contractions were observed and pEC50 values were determined after manipulation of a logistic curve-fitting equation. Concentration-dependent relaxation of U46619-contracted LIMA and radial artery was observed in the presence of glibenclamide, with calculated pEC50 values of 4.2+/-0.17 (n = 7) for LIMA and 3.26+/-0.48 (n = 5) for radial artery. Incubation of both LIMA and radial artery with glibenclamide (50 microM) caused the concentration-response curves for U46619 and L-phenylephrine to shift significantly to the right. Similarly the KCl tension relationship was caused to shift to the right. Finally, glibenclamide (100 microM) also had an inhibitory effect on Ca2+-induced tension in radial artery. These results show that the inhibitory effects of glibenclamide on human peripheral blood vessels are not restricted to prostanoid-induced contractions. Furthermore, evidence has been provided to suggest that these effects might be mediated through an interaction with voltage-sensitive Ca2+ channels.'TNDepartment of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, UK.RLCrosbie, A. E. Vuylsteke, A. Ritchie, A. J. Latimer, R. D. Callingham, B. A.("20218349 0022-3573 Journal ArticleJ Pharm Pharmacol15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid/pharmacology Calcium/pharmacology *Coronary Artery Bypass Dose-Response Relationship, Drug Glyburide/*pharmacology Human In Vitro Indomethacin/pharmacology Mammary Arteries/*drug effects/physiology Phenylephrine/pharmacology Potassium/pharmacology Radial Artery/*drug effects/physiology Tolbutamide/pharmacology Vasoconstriction/*drug effects Vasoconstrictor Agents/pharmacology5lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10757423 a:d2 do\10416921256` 1999 JunxqThe necessity of performing transesophageal echocardiography in patients with acute respiratory distress syndrome  637JCFalter, F. Kuhlen, R. Janssens, U. Max, M. Walbert, E. Rossaint, R. 99343329 0342-4642 LetteraIntensive Care MedCase Report Echocardiography, Transesophageal/*methods Fatal Outcome Heart Valve Diseases/diagnosis Human Respiration, Artificial Respiratory Distress Syndrome, Adult/*diagnosistlehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=104169217856909822 1995 Feb`YHyperglycemia during hypothermic canine cardiopulmonary bypass increases cerebral lactaten 512-20BACKGROUND: Hyperglycemia frequently occurs during cardiopulmonary bypass (CPB), although its direct effects on cerebral perfusion and metabolism are not known. Using a canine model of hypothermic CPB, we tested whether hyperglycemia alters cerebral blood flow and metabolism and cerebral energy charge. METHODS: Twenty anesthetized dogs were randomized into hyperglycemic (n = 10) and normoglycemic (n = 10) groups. The hyperglycemic group received an infusion of D50W, and the normoglycemic animals received an equal volume of 0.9% NaCl. Both groups underwent 120 min of hypothermic (28 degrees C) CPB using membrane oxygenators, followed by rewarming and termination of CPB. Cerebral blood flow (radioactive microspheres) and the cerebral metabolic rate for oxygen were measured intermittently during the experiment and brain tissue metabolites were obtained after bypass. RESULTS: Before CPB, the glucose-treated animals had higher serum glucose levels (534 +/- 12 mg/dL; mean +/- SE) than controls (103 +/- 4 mg/dL; P < 0.05), and this difference was maintained throughout the study. Cerebral blood flow and metabolism did not differ between groups at any time during the experiment. Sagittal sinus pressure was comparable between groups throughout CPB. Tissue high-energy phosphates and water contents were similar after CPB, although cerebral lactate levels were greater in hyperglycemic (37.2 +/- 5.7 mumol/g) than normoglycemic animals (19.7 +/- 3.7 mumol/g; P < 0.05). After CPB, pH values of cerebrospinal fluid for normoglycemic (7.33 +/- 0.01) and hyperglycemic (7.34 +/- 0.01) groups were similar. CONCLUSIONS: Hyperglycemia during CPB significantly increases cerebral lactate levels without adversely affecting cerebral blood flow and metabolism, cerebrospinal fluid pH, or cerebral energy charge.'`YDepartment of Anesthesiology, University of Texas Medical Branch at Galveston 77555-0591.ZTFeerick, A. E. Johnston, W. E. Jenkins, L. W. Lin, C. Y. Mackay, J. H. Prough, D. S.("95160303 0003-3022 Journal ArticleAnesthesiologyJCAdenine Nucleotides/metabolism Animal Brain/*metabolism *Cardiopulmonary Bypass Cerebrospinal Fluid/physiology Cerebrovascular Circulation Cold Dogs Female Hemodynamics Hydrogen-Ion Concentration Hyperglycemia/*metabolism *Hypothermia, Induced Lactates/*metabolism Male Support, U.S. Gov't, P.H.S. Water-Electrolyte Balancejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=78569091351591 339 8809 1992 Jun 270)Safety guidelines for use of nitric oxide  1615-6ZSFoubert, L. Fleming, B. Latimer, R. Jonas, M. Oduro, A. Borland, C. Higenbottam, T. 92301172 0140-6736 Letter  LancetAdministration, Inhalation Dose-Response Relationship, Drug Human Nitric Oxide/*administration & dosage Respiratory Distress Syndrome, Adult/*drug therapy Safetyjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1351591826845175 1993 Oct^XUse of inhaled nitric oxide to reduce pulmonary hypertension after heart transplantation 640-1PJFoubert, L. Latimer, R. Oduro, A. Gray, S. Snow, D. Wallwork, J. Large, S.(!94092993 1053-0770 Comment LetterR J Cardiothorac Vasc Anesth*Heart Transplantation Human Hypertension, Pulmonary/*drug therapy/etiology Nitric Oxide/*therapeutic use Postoperative Complications/*drug therapy jdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=82684519361531 315 7113 1997 Oct 11&The oesophageal Doppler monitorr 893-4{"Gan, T. J. Arrowsmith, J. E.*$98027602 0959-8138 Comment Editorial BmjnhBlood Flow Velocity Esophagus Human Monitoring, Intraoperative/*instrumentation Ultrasonography, Dopplerjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9361531/HqBL#J11052451145 2000 Oct6/An unusual postoperative pulmonary complication 615-6'>7Papworth Hospital NHS Trust, Cambridge, United Kingdom. Sharma, R. Vuylsteke, A.("20505636 1053-0770 Journal Article J Cardiothorac Vasc AnesthAdult Case Report Esophagectomy/*adverse effects Human Intubation, Gastrointestinal/*adverse effects Lung Diseases/*etiology Male Postoperative Complications/*etiology Radiography, Thoracicolehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11052451a3728912415 1986 May81A comparison of five heat and moisture exchangers 527-32Five heat and moisture exchangers were investigated to compare their efficiency of humidification, their ability to filter bacterial spores and their various physical properties. The results are presented and the various mechanisms of heat and moisture exchange are reviewed. The Pall Ultipor BB50, because of its hydrophobic properties, has a slightly different action from heat and moisture exchangers already in use, The place of the Pall Ultipor BB50 in clinical practice is discussed.=.(Shelly, M. Bethune, D. W. Latimer, R. D.("86266397 0003-2409 Journal Article AnaesthesiaComparative Study Filtration/instrumentation *Humidity Physics Respiration, Artificial/economics/*instrumentation Spores, Bacterial Support, Non-U.S. Gov'tcjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=37289128110572722 1994 FebtnInhaled nitric oxide in patients with normal and increased pulmonary vascular resistance after cardiac surgery 185-9We studied the haemodynamic effects of inhaled nitric oxide 40 p.p.m. in two groups of patients after cardiac surgery (mitral valve surgery or coronary artery bypass grafting). Nitric oxide caused a significant reduction in pulmonary vascular resistance after mitral valve surgery in patients who had pre-existing pulmonary hypertension, but no change in haemodynamic state in the coronary artery bypass group of patients, who had normal pulmonary arterial pressures.'>8Department of Anaesthesia, Papworth Hospital, Cambridge.lfSnow, D. J. Gray, S. J. Ghosh, S. Foubert, L. Oduro, A. Higenbottam, T. W. Wells, F. C. Latimer, R. D.("94153697 0007-0912 Journal Article Br J Anaesth Administration, Inhalation Coronary Artery Bypass Hemodynamics/drug effects Human Hypertension, Pulmonary/physiopathology Mitral Valve/surgery Nitric Oxide/*pharmacology Postoperative Period Pulmonary Artery/drug effects/*physiology Vascular Resistance/*drug effectsjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=81105728561352822 1996 FebNGMitral valve replacement in a patient with acute intermittent porphyria5 416-8'`ZDepartment of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.$Stevens, J. J. Kneeshaw, J. D.("96153970 0003-2999 Journal Article Anesth AnalgAnesthesia Cardiopulmonary Bypass Case Report *Heart Valve Prosthesis Human Hypothermia, Induced Male Middle Age Mitral Valve/*surgery Mitral Valve Insufficiency/complications/surgery Porphobilinogen/urine Porphyria, Acute Intermittent/*complications/urinejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=85613527992954133 199460[Hydrofluoric acid: an unrecognised toxic agent] 429-32Hydrofluoric acid has widespread uses in industry and at home. Its mechanism of toxicity is the basis of a specific treatment. Cutaneous burns are the most common form of toxicity and the consequences can be catastrophic. Its insidious presentation can delay any therapeutic action, except if the physician is aware about it. A case report underlines the beneficial action of the intra-arterial infusion of calcium gluconate.'VPService d'Anesthesiologie, Cliniques Universitaires St-Luc, Bruxelles, Belgique. Vuylsteke, A.a("95085123 0750-7658 Journal ArticleAnn Fr Anesth ReanimAdult *Burns, Chemical/drug therapy Calcium Gluconate/therapeutic use Case Report English Abstract Female Hand Injuries/*chemically induced/drug therapy Human Hydrofluoric Acid/*adverse effects Infusions, Intra-Arterial Pain/*chemically induced/drug therapy Radial Arteryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7992954tation&list_uids=842849211573680862 2001 FebNHSerum S100 protein as a marker of cerebral damage during cardiac surgery 289-90& Grocott, H. P. Arrowsmith, J. E.(!21457583 0007-0912 Comment Letter Br J AnaesthBiological Markers/blood Brain Injuries/blood/*diagnosis Cardiovascular Surgical Procedures/*adverse effects Human S100 Proteins/*blood lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=115736800* .186269505864941 1998 JanztPlasma oxygen during cardiopulmonary bypass: a comparison of blood oxygen levels with oxygen present in plasma lipid 35-41a.'1. Although not often appreciated, it is a fact that molecular oxygen is more soluble in lipids than in aqueous solution. We have recently developed a method to monitor oxygen within the lipid content of plasma. Monitoring plasma oxygen is one essential element during open heart surgery using a cardiopulmonary bypass pump and oxygenator. Currently oxygen is monitored electrochemically and is based upon monitoring the partial pressure of oxygen in a gas equilibrated with whole blood. 2. To determine the relative importance of lipid-associated oxygen in blood and assess the potential use of such a measurement we present comparisons of changes in oxygen associated with whole blood and lipid content of plasma before, during and after cardiac surgery. 3. In a limited number of patients studied (n = 28), aged between 34 and 86 years, oxygen in lipid increased with decreased extracorporeal blood temperature during cardiopulmonary bypass, increased in proportion to oxygen supplied and appeared to be a better monitor of oxygen than conventional electrochemical systems currently in use. Oxygen associated with whole blood and plasma lipid was markedly below normal on aortic declamping after cardiopulmonary bypass, suggesting an hypoxic episode at this point. Levels of oxygen in the lipid phase of plasma returned to normal presurgical values 6-8 h after surgery. 4. Calculation of the concentration of lipid-associated oxygen present in plasma suggests that plasma lipids contain up to 25% of that typically ascribed to haemoglobin. Thus, we suggest that monitoring lipid-associated oxygen may prove a better alternative to current methods of measuring oxygen status. Furthermore, we suggest that plasma lipid is a hitherto unsuspected pool of circulating oxygen which may play a significant role in tissue oxygen supply.e'TMDivision of Chemical Pathology, Glenfield Hospital-NHS Trust, Leicester, U.K.w>7Petyaev, I. M. Vuylsteke, A. Bethune, D. W. Hunt, J. V.("98166763 0143-5221 Journal ArticleClin Sci (Lond)Adult Aged Aged, 80 and over *Cardiopulmonary Bypass Female Human Lipids/blood/*chemistry Male Middle Age Oxygen/analysis/*blood Plasma/chemistry Postoperative Period Support, Non-U.S. Gov'tjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9505864-,8PP83_鉠8P802DP 08P8P8PP8`3P2D`08YX]3H$H"2\"32D]2D＿#Agedt8PP83_鉠8P802DP 089412879117 1997 Dec:4Effect of aspirin in coronary artery bypass grafting 831-4eOBJECTIVES: To evaluate the effect of aspirin (ASA) therapy on postoperative blood loss, transfusion requirements, reoperation for bleeding, duration of stay in the intensive care unit and in the hospital in a selected population undergoing a first coronary artery bypass grafting (CABG) surgery. DESIGN: Prospective observational study in consecutive patients during a 3-month period. SETTING: A teaching cardiothoracic center. PARTICIPANTS: Two hundred forty consecutive patients undergoing elective coronary artery bypass grafting surgery for the first time. INTERVENTIONS: Two hundred forty consecutive patients admitted for a first CABG the day before surgery were visited. patients with an abnormal routine coagulation screen or taking drugs that might have affected their coagulation mechanisms were prospectively excluded (n = 96). The date of the last dose of ASA was recorded in the 144 remaining patients, and data were acquired prospectively. MEASUREMENTS AND MAIN RESULTS: Total mediastinal blood drainage, blood products usage, reopening, and duration of intensive care unit and hospital stay were recorded. Patients were grouped by days free of ASA. There were no significant differences detected between groups. CONCLUSIONS: In patients undergoing a first CABG and with no known factors affecting their coagulation, ASA therapy did not appear to increase blood loss, reopening for bleeding, or blood products usage requirements during the hospital stay. ASA therapy did not influence the duration of stay in intensive care or in the hospital.'B.8942343774 1996 Octf_Extraction of nitric oxide and nitrogen dioxide from an oxygen carrier using molecular sieve 5A 534-6zNitric oxide (NO) is effective in the management of pulmonary hypertension and shunt-related hypoxia. Nitrogen dioxide (NO2) is formed when the gas is delivered with oxygen. Both oxides of nitrogen have well recognized adverse effects. The scavenging properties of several forms of soda lime have been investigated. A gas flow containing NO 70 ppm and NO2 5 ppm in oxygen was introduced into a vertically mounted Waters' canister containing: (i) 125 g of molecular sieve 5A (a calcium aluminosilicate zeolite) and (ii) 135 g of soda lime containing a potassium permanganate marker. NO and NO2 concentrations were measured at hourly intervals at the entry and exit points using an electrochemical analyser. Extraction ratios (gradient/ inlet x 100) were calculated for a 24-h period. High extraction ratios (in excess of 90%) of NO and NO2 were observed with both compounds for up to 1 h but these declined rapidly after this time with soda lime. In contrast, the molecular sieve produced extraction ratios in excess of 98% for both gases over the 24-h period. We conclude that the molecular seive 5A is a highly effective scavenger of NO and NO2.'>8Department of Anaesthesia, Papworth Hospital, Cambridge.ZTPoulton, B. B. Foubert, L. Klinowski, J. Latimer, R. D. Knowles, P. R. Vuylsteke, A.("97097800 0007-0912 Journal Article Br J AnaesthpiAbsorption *Gas Scavengers Nitric Oxide/*chemistry Nitrogen Dioxide/*chemistry Oxygen Zeolites/*chemistryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=89423437577269752p 1995 Aug.'Design of nitric oxide delivery systems  25320)Powroznyk, A. V. Latimer, R. D. Oduro, A.g(!96090981 0007-0912 Comment Lettere Br J AnaesthleEquipment Design Human Nitric Oxide/*administration & dosage Respiration, Artificial/*instrumentationjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=75772698712349513 1996 Mar*$Anaesthesia for quinsy tonsillectomy 292-3n$Ravalia, A. Arrowsmith, J. E. (!96246747 0003-2409 Comment Letter AnaesthesiaVPAnesthesia, General/*methods Human Peritonsillar Abscess/*surgery *Tonsillectomyjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8712349[8PP83_0 8P802DP 08P8P8PP8`3P2D`08YX]34H$H"2\"32D]2D＿# Brain Death/*physiopathology_R8P802DP 082392794456 1990 JunpiLocal anaesthesia for fibreoptic bronchoscopy: transcricoid injection or the "spray as you go" technique?n 474-7oLocal anaesthesia for fibreoptic bronchoscopy should be given by a safe technique that is not unpleasant to the patient and should provide acceptable conditions for the bronchoscopist. Single injection transcricoid local anaesthesia was compared with the "spray as you go" technique in patients having day case fibreoptic bronchoscopy. Patients were randomised to receive either 100 mg lignocaine by a single cricothyroid puncture or 240 mg lignocaine instilled through the bronchoscope under direct vision. Further doses were given by the operator to both groups as required. The 30 patients receiving transcricoid lignocaine coughed less (3.56 (SD 3.1) coughs/min) than the 32 patients receiving lignocaine through the bronchoscope (5.89 (4.8)/min) despite receiving a lower total dose of lignocaine (322 (25.9) v 451 (20.9) mg). Cricothyroid puncture was not associated with any complications and was not unpleasant for the patients.'D>Department of Thoracic Medicine, St George's Hospital, London.`YWebb, A. R. Fernando, S. S. Dalton, H. R. Arrowsmith, J. E. Woodhead, M. A. Cummin, A. R.LTM90364587 0040-6376 Clinical Trial Journal Article Randomized Controlled Trialn ThoraxAdministration, Topical Ambulatory Care/methods Anesthesia, Local/*methods Bronchoscopy/*methods Comparative Study Female Fiber Optics Human Injections/methods *Lidocaine Male Middle Age Random Allocationjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2392794= v"M3754699414 1986 Apr,%Apparent postoperative recurarisation  440-1{JDDenny, N. M. Bethune, D. W. Hardy, I. Kneeshaw, J. D. Latimer, R. D. 86213021 0003-2409 Letter  AnaesthesiatmAtracurium Human Isoquinolines/*pharmacology Neuromuscular Blocking Agents/*pharmacology Postoperative Periodajdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=37546992877590419 1986 SepTMVecuronium and atracurium infusions during hypothermic cardiopulmonary bypassv 919-22}Two similar groups of patients undergoing coronary artery bypass grafting received either atracurium or vecuronium infusions for neuromuscular blockade. Both groups demonstrated a marked reduction in neuromuscular blocking requirements during hypothermic bypass at 30 C. The ratio of the dose rates at 30 C to that at 37 C was significantly less with vecuronium (p less than 0.01). "Denny, N. M. Kneeshaw, J. D.("87046710 0003-2409 Journal Article AnaesthesiaD>Atracurium/*administration & dosage *Cardiopulmonary Bypass Comparative Study Coronary Artery Bypass Female Human *Hypothermia, Induced Infusions, Intravenous Male Middle Age Muscle Contraction/drug effects Neuromuscular Blocking Agents/*administration & dosage Time Factors Vecuronium Bromide/*administration & dosagejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=28775908637186265 1995 NovSomatostatin-induced contraction of human isolated saphenous vein involves sst2 receptor-mediated activation of L-type calcium channels 721-8A range of somatostatin (SRIF) analogues have been used to characterize the SRIF receptor-mediating contraction of the human saphenous vein. SRIF produced concentration-dependent contractions with an EC50 value of approximately 20 nM. The peptidase inhibitors phosphoramidon and amastatin did not alter the potency of SRIF. The sst2 receptor-selective peptide BIM-23027 was approximately three times more potent than SRIF in contracting the vein, whereas the sst5 receptor-selective peptide L-362855 was approximately 50 times weaker. The sst3 receptor-selective peptide BIM-23056 did not contract the saphenous vein. Contractions to SRIF were not antagonised by the putative SRIF receptor blocker cyclo(7-aminoheptanoyl-Phe-D Trp-Lys-Thr[Bzl]) (CPP), phentolamine, or indomethacin. Decreasing the external calcium concentration reduced the maximum contraction to SRIF in a concentration-dependent manner without altering the EC50 value. Nifedipine and verapamil also markedly reduced the SRIF-induced contraction. SRIF and several SRIF analogues caused contraction of the human saphenous vein by what appeared to be a direct effect on the smooth muscle. Their relative potencies suggest that their effects were mediated by a somatostatin receptor that is like the recombinant sst2 receptor. The receptor transduction mechanism appears to involve activation of L-type calcium channels and entry of extracellular calcium.'lfGlaxo Institute of Applied Pharmacology, Department of Pharmacology, University of Cambridge, England.:4Dimech, J. Feniuk, W. Latimer, R. D. Humphrey, P. P.("96193999 0160-2446 Journal ArticleJ Cardiovasc PharmacoljdAged Amino Acid Sequence Calcium Channels/*drug effects/physiology Dose-Response Relationship, Drug Female Human In Vitro Male Middle Age Molecular Sequence Data Muscle, Smooth, Vascular/drug effects Octreotide/pharmacology Receptors, Somatostatin/*physiology Saphenous Vein/drug effects/physiology Somatostatin/*pharmacology Vasoconstriction/*drug effectsjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8637186( y61502922 8414 1984 Dec 181Veno-arterial bypass in orthotopic liver grafting 1269XRCalne, R. Y. Rolles, K. Farman, J. V. Kneeshaw, J. D. Smith, D. P. Wheeldon, D. R. 85059920 0140-6736 Letter LancetAdolescent Adult Child Female Human Iliac Artery/*surgery *Liver Transplantation Male Methods Middle Age Saphenous Vein/*surgeryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=615029211957181162 2002 AprHAAn unusual chest radiograph after pulmonary thromboendarterectomy 253-4'haDepartment of Cardiothoracic Anaesthesia, Papworth Hospital NHS Trust, Cambridge, United Kingdom.81Chandler, J. Grixti, K. Dunning, J. Vuylsteke, A. ("21953106 1053-0770 Journal Article J Cardiothorac Vasc AnesthCardiopulmonary Bypass Case Report *Endarterectomy Female Hemothorax/etiology/*radiography Human Middle Age *Postoperative Complications Pulmonary Artery/*surgerylehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11957181 10757423523 2000 Mar~xInhibitory effects of glibenclamide on the contraction of human arterial conduits used in coronary artery bypass surgery 333-40Glibenclamide has been shown to inhibit prostanoid-induced contraction in a number of blood vessel types. In this study, the effects of glibenclamide on the contraction of human peripheral arteries in response to both prostanoid and non-prostanoid agonists were compared and possible mechanisms of action were investigated. Segments of left internal mammary artery (LIMA) and radial artery, taken from patients undergoing coronary artery bypass graft (CABG) surgery, were mounted in organ baths containing physiological saline solution aerated with 95% O2/5% CO2 at 37 degrees C. Contractions were obtained by either the use of a thromboxane analogue (U46619), L-phenylephrine, KCl or CaCl2. The effects of glibenclamide on these contractions were observed and pEC50 values were determined after manipulation of a logistic curve-fitting equation. Concentration-dependent relaxation of U46619-contracted LIMA and radial artery was observed in the presence of glibenclamide, with calculated pEC50 values of 4.2+/-0.17 (n = 7) for LIMA and 3.26+/-0.48 (n = 5) for radial artery. Incubation of both LIMA and radial artery with glibenclamide (50 microM) caused the concentration-response curves for U46619 and L-phenylephrine to shift significantly to the right. Similarly the KCl tension relationship was caused to shift to the right. Finally, glibenclamide (100 microM) also had an inhibitory effect on Ca2+-induced tension in radial artery. These results show that the inhibitory effects of glibenclamide on human peripheral blood vessels are not restricted to prostanoid-induced contractions. Furthermore, evidence has been provided to suggest that these effects might be mediated through an interaction with voltage-sensitive Ca2+ channels.'TNDepartment of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, UK.RLCrosbie, A. E. Vuylsteke, A. Ritchie, A. J. Latimer, R. D. Callingham, B. A.("20218349 0022-3573 Journal ArticleJ Pharm Pharmacol15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid/pharmacology Calcium/pharmacology *Coronary Artery Bypass Dose-Response Relationship, Drug Glyburide/*pharmacology Human In Vitro Indomethacin/pharmacology Mammary Arteries/*drug effects/physiology Phenylephrine/pharmacology Potassium/pharmacology Radial Artery/*drug effects/physiology Tolbutamide/pharmacology Vasoconstriction/*drug effects Vasoconstrictor Agents/pharmacology5lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10757423 pass surgery 333-40Glibenclamide has been shown to inhibit prostanoid-induced contraction in a number of blood vessel types. In this study, the effects of glibenclamide on the contraction of human peripheral arteries in response to both prostanoid and non-prostanoid agonists were compared and possible mechanisms of action were investigated. Segments of left internal mammary artery (LIMA) and radial artery, taken from patients undergoing coronary artery bypass graft (CABG) surgery, were mounted in organ baths containing physiological saline solution aerated with 95% O2/5% CO2 at 37 degrees C. Contractions were obtained by either the use of a thromboxane analogue (U46619), L-phenylephrine, KCl or CaCl2. The effects of glibenclamide on these contractions were observed and pEC50 values were determined after manipulation of a logistic curve-fitting equation. Concentration-dependent relaxation of U46619-contracted LIMA and radial artery was observed in the presence of glibenclamide, with calculated pEC50 values of 4.2+/-0.17 (n = 7) for LIMA and 3.26+/-0.48 (n = 5) for radial artery. Incubation of both LIMA and radial artery with glibenclamide (50 microM) caused the concentration-response curves for U46619 and L-phenylephrine to shift significantly to the right. Similarly the KCl tension relationship was caused to shift to the right. Finally, glibenclamide (100 microM) also had an inhibitory effect on Ca2+-induced tension in radial artery. These results show that the inhibitory effects of glibenclamide on human peripheral blood vessels are not restricted to prostanoid-induced contractions. Furthermore, evidence has been provided to suggest that these effects might be mediated through an interaction with voltage-sensitive Ca2+ channels.'TNDepartment of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, UK.RLCrosbie, A. E. Vuylsteke, A. Ritchie, A. J. Latimer, R. D. Callingham, B. A.("20218349 0022-3573 Journal ArticleJ Pharm Pharmacol15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid/pharmacology Calcium/pharmacology *Coronary Artery Bypass Dose-Response Relationship, Drug Glyburide/*pharmacology Human In Vitro Indomethacin/pharmacology Mammary Arteries/*drug effects/physiology Phenylephrine/pharmacology Potassium/pharmacology Radial Artery/*drug effects/physiology Tolbutamide/pharmacology Vasoconstriction/*drug effects Vasoconstrictor Agents/pharmacology5lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10757423 3 4\7885149 345 8951 1995 Mar 18@:Length of intensive care and outcome after cardiac surgery 729(!Little, J. P. Oduro, A. Ghosh, S.n(!95191299 0140-6736 Comment Letter  LancetzsAged *Cardiac Surgical Procedures Human Intensive Care Intensive Care Units/*utilization *Length of Stay Middle Agetjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=78851491934231385 1991 JuljdAmiodarone and anaesthesia: concurrent therapy with ACE inhibitors--an additional cause for concern? 687 0*Mackay, J. H. Walker, I. A. Bethune, D. W.(!92035230 0832-610x Comment Letter Can J Anaesth-2+Adult Amiodarone/*adverse effects Anesthesia, Intravenous/*adverse effects Case Report Enalapril/*adverse effects Fentanyl/adverse effects Human Hypotension/*chemically induced Male Midazolam/adverse effects Middle Age Opium/adverse effects Propofol/adverse effects Trichloroethylene/adverse effectsjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19342317774221236 1995 JunvpIncreasing organ blood flow during cardiopulmonary bypass in pigs: comparison of dopamine and perfusion pressure 1090-8  OBJECTIVE: To determine whether low-dose dopamine infusion (5 micrograms/kg/min) during cardiopulmonary bypass selectively increases perfusion to the kidney, splanchnic organs, and brain at low (45 mm Hg) as well as high (90 mm Hg) perfusion pressures. DESIGN: Randomized crossover trial. SETTING: Animal research laboratory in a university medical center. SUBJECTS: Ten female Yorkshire pigs (weight 29.9 +/- 1.2 kg). INTERVENTION: Anesthetized pigs were placed on normothermic cardiopulmonary bypass at a 100-mL/kg/min flow rate. After baseline measurements, the animal was subjected, in random sequence, to 15-min periods of low perfusion pressure (45 mm Hg), low perfusion pressure with dopamine (5 micrograms/kg/min), high perfusion pressure (90 mm Hg), and high perfusion pressure with dopamine. Regional perfusion (radioactive microspheres) was measured in tissue samples (2 to 10 g) from the renal cortex (outer two-third and inner one-third segments), stomach, duodenum, jejunum, ileum, colon, pancreas, and cerebral hemispheres. MEASUREMENTS AND MAIN RESULTS: Systemic perfusion pressure was altered by adjusting pump flow rate (r2 = .61; p < .05). In the kidney, cortical perfusion pressure increased from 178 +/- 16 mL/min/100 g at the low perfusion pressure to 399 +/- 23 mL/min/100 g at the high perfusion pressure (p < .05). Perfusion pressure augmentation increased the ratio of outer/inner renal cortical blood flow from 0.9 +/- 0.1 to 1.2 +/- 0.1 (p < .05). At each perfusion pressure, low-dose dopamine had no beneficial effect on renal perfusion or flow distribution. Similar results were found in the splanchnic organs, where regional perfusion was altered by perfusion pressure but not by dopamine. In contrast, neither changing perfusion pressure nor adding low-dose dopamine altered blood flow to the cerebral cortex. CONCLUSIONS: These data indicate that the lower autoregulatory limits of perfusion to the kidneys and splanchnic organs differ from those limits to the brain during normothermic bypass. Selective vasodilation from low-dose dopamine was not found in renal, splanchnic, or cerebral vascular beds. Increasing the perfusion pressure by pump flow, rather than by the addition of low-dose dopamine, enhanced renal and splanchnic but not cerebral blood flows during cardiopulmonary bypass.'b\Department of Anesthesiology, University of Texas Medical Branch, Galveston 77555-0591, USA.d]Mackay, J. H. Feerick, A. E. Woodson, L. C. Lin, C. Y. Deyo, D. J. Uchida, T. Johnston, W. E.J("95292563 0090-3493 Journal Article Crit Care MedIAnimal *Blood Pressure/drug effects Cardiopulmonary Bypass/*methods Cerebrovascular Circulation/drug effects/*physiology Comparative Study Cross-Over Studies Dopamine/administration & dosage/*pharmacology Drug Evaluation, Preclinical Female Homeostasis Infusions, Intravenous Random Allocation Renal Circulation/drug effects/*physiology Splanchnic Circulation/drug effects/*physiology Support, U.S. Gov't, P.H.S. Swinejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7774221d Pressure/drug effects Cardiopulmonary Bypass/*methods Cerebrovascular Circulation/drug effects/*physiology Comparative Study Cross-Over Studies Dopamine/administration & dosage/*pharmacology Drug Evaluation, Preclinical Female Homeostasis Infusions, Intravenous Random Allocation Renal Circulation/drug effects/*physiology Splanchnic Circulation/drug effects/*physiology Support, U.S. Gov't, P.H.S. Swinejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7774221 %