Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1438486. ProQuest document ID: 1192191231. Includes bibliographical references (p. 49-52)

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-22Bitstream added on 2014-06-13T19:19:21Z : No. of bitstreams: 1 rocha_apc_dr_botfm.pdf: 1024893 bytes, checksum: 0e64a9e23240bce6205f3161a978ae84 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A sedação para a realização de cateterismo cardíaco, apesar de pouco estudada, tem sido alvo de preocupação de alguns anestesiologistas. Os benzodiazepínicos, os agonistas alfa-2 adrenérgicos e os opióides são comumente utilizados para este fim, entretanto, cada um destes medicamentos possui vantagens e desvantagens. O objetivo deste trabalho é avaliar a eficácia do sufentanil e da clonidina como medicação sedativa em pacientes submetidos a cateterismo cardíaco, comparando o impacto dos mesmos sobre os parâmetros hemodinâmicos e respiratórios apresentados, observando a presença de efeitos colaterais, além da satisfação do paciente e do hemodinamicista durante o exame. Trata-se de um ensaio clínico prospectivo, duplo-cego, randomizado e controlado, que envolveu sessenta pacientes divididos igualmente em dois grupos: GS e GC que receberam respectivamente, 0,1 mcg/kg de sufentanil e 0,5 mcg/kg de clonidina. Estes fármacos foram administrados antes da realização do cateterismo cardíaco. O escore de sedação segundo a escala de Ramsay, a necessidade de utilização de midazolam, os efeitos colaterais, a PAS, a PAD, a FC, a FR e a SpO2 foram registrados a cada cinco minutos, sendo os dados analisados em 06 diferentes momentos. Os grupos foram homogêneos em relação aos dados demográficos e avaliação clínica inicial. O comportamento da PAS, da PAD, da FC e da FR foi semelhante nos dois grupos, entretanto os pacientes do GS apresentaram menor escore de sedação segundo a escala de Ramsay no momento 2 e SpO2 menor que o GC no momento 6. Os pacientes do GS apresentaram maior incidência de NVPO que os pacientes do GC. A satisfação dos pacientes foi maior no GC. Os hemodinamicistas mostraram-se igualmente satisfeitos nos dois grupos. O sufentanil e a clonidina se mostraram efetivos como fármacos sedativos em pacientes submetidos a cateterismo cardíaco. / Sedation for cardiac catheterization, although not largely studied, has worried a number of anesthesiologists presently. Not only benzodiazepinic medicine, but also alpha- 2 adrenergic agonist and opioids are commonly used drugs to this end. Each one of these medicaments presents a series of advantages as well as disadvantages. The objective of this paper is to evaluate the effectiveness of sufentanil and clonidine as a sedative medicament to patients submitted to cardiac catheterization, comparing their impact over the hemodynamic and respiratory parameters witnessed, observing the occurrence of side effects, besides patient’s and hemodynamicist’s satisfaction during the examination. This consists of a prospective, double-blinded, randomized and controlled clinical essay, which involved sixty patients equally divided in two different groups: GS and GC, who, respectively, received 0,1mcg/kg of sufentanil and 0,5 mcg/kg of clonidine. Both administered before cardiac catheterization. The sedation score, according to Ramsay’s scale, the necessity of utilizing midazolam, side effects, SAP, DAP, CF and SpO2 were registered every five minutes and data analyzed in six different moments. The studied groups were homogeneous regarding demographic data and initial clinical evaluation. The behavior of SAP, DAP, CF and RF was similar in both groups. However, a lower sedation score regarding Ramsay’s scale was observed in GS patients at moment 2 and at moment 6 SpO2 was found to be lower than GC. All GS patients seemed to have had higher incidence of PONV compared to GC patients. Considering patients’ satisfaction, it was higher in GC. Hemodynamicists seemed equally satisfied in both groups. Sufentanil and clonidine seemed to have been more effective as sedative medicaments in patients submitted to cardiac catheterization.

No description available.

The purpose of this study was to describe the presence of uncertainty experienced by heart transplant recipients at one and two year diagnostic follow-up evaluations. Twelve one year and eleven two year transplant recipients completed the Mishel Uncertainty in Illness Scale (MUIS), prior to and after cardiac catheterization. There was a decrease in uncertainty levels from pre to post-catheterization, for both one and two year recipients, however, findings were not significant. Recipients prior experience with catheterization and the interaction effects of the complete evaluation process or future health status may have affected the subject's uncertainty response. Two year transplant recipients demonstrated significantly higher uncertaintly levels, before and after cardiac catheterization, when compared to one year recipients. These findings lend initial and tentative support to the proposal that uncertainty increases with time post-transplant. The yearly follow-up evaluation may represent an episodic focusing for the transplant recipient on health status.

Introdução: A linfangioleiomiomatose (LAM) está associada a HP e está incluída no grupo 5 da classificação atual (mecanismos multifatoriais desconhecidos). No entanto, os dados referentes à ocorrência de HP na LAM são escassos. Os objetivos do estudo foram avaliar a prevalência e as características da HP em pacientes com LAM em diferentes estágios de evolução, além de comparar as características clínicas, funcionais, do teste de caminhada de 6 minutos (TC6M) e da qualidade de vida das pacientes com e sem HP. Metodologia: Cento e cinco pacientes com LAM foram submetidos a ecocardiograma, prova de função pulmonar (PFP) e TC6M. Pacientes com suspeita de HP no ecocardiograma, definida pela presença de pressão arterial pulmonar sistólica estimada (PsAP) acima de 35 mmHg, ou PFP mostrando DLco abaixo de 40% do valor previsto, foram submetidos a cateterismo cardíaco direito para confirmar o diagnóstico de HP. Resultados: Oito pacientes (7,6%) tinham HP confirmada no cateterismo cardíaco direito, seis pacientes (5,7%) tinham padrão pré-capilar e dois pacientes (1,9%) tinham padrão pós-capilar. Apenas um paciente (1%) apresentou pressão média de artéria pulmonar (PAPm) acima de 35 mmHg. Os pacientes com HP apresentaram menor VEF1 e DLco em PFP e maior dessaturação de oxigênio e intensidade de dispneia durante o TC6M comparado com aqueles sem PH. Em 63% dos pacientes com HP confirmada, o cateterismo cardíaco direito foi realizado devido ao resultado do DLco. Conclusões: A prevalência de HP é baixa em pacientes com LAM. A hipertensão pulmonar é de pouca gravidade e significativamente associada ao envolvimento parenquimatoso pulmonar. A capacidade de difusão de monóxido de carbono foi bastante útil na identificação de HP em pacientes com LAM / Introduction: Lymphangioleiomyomatosis (LAM) is associated with pulmonary hypertension (PH) and is included in group 5 of the current classification (unknown multifactorial mechanisms). However, data regarding the occurrence of PH in LAM are scarce. The objectives of the study were to evaluate the prevalence and characteristics of PH in patients with LAM at different stages of evolution, as well as to compare the clinical and functional characteristics of the 6-minute walk test (6MWT) and the quality of life of patients with and without PH. Methodology: One hundred and five patients with LAM underwent echocardiogram, pulmonary function test (PFT) and 6MWT. Patients with suspected PH on the echocardiogram, defined as the presence of estimated systolic pulmonary arterial pressure (PsAP) above 35 mmHg, or PFT showing carbon monoxide diffusion (DLco) below 40% of the predicted value, were submitted to right cardiac catheterization to confirm the diagnosis of PH. Results: Eight patients (7.6%) had PH confirmed in right cardiac catheterization, six patients (5.7%) had a pre-capillary pattern and two patients (1.9%) had a post capillary pattern. Only one patient (1%) presented mean pulmonary artery pressure (PAPm) above 35 mmHg. Patients with PH had lower FEV1 and DLco in PFP and greater oxygen desaturation and dyspnea intensity during the 6MWT compared to those without PH. In 63% of patients with confirmed PH, right heart catheterization was performed because of the DLco result. Conclusions: The prevalence of PH is low in patients with LAM. Pulmonary hypertension is commonly mild and is significantly associated with pulmonary parenchymal involvement. The measure DLco has improved the identification of PH in patients with LAM

Introdução: A linfangioleiomiomatose (LAM) está associada a HP e está incluída no grupo 5 da classificação atual (mecanismos multifatoriais desconhecidos). No entanto, os dados referentes à ocorrência de HP na LAM são escassos. Os objetivos do estudo foram avaliar a prevalência e as características da HP em pacientes com LAM em diferentes estágios de evolução, além de comparar as características clínicas, funcionais, do teste de caminhada de 6 minutos (TC6M) e da qualidade de vida das pacientes com e sem HP. Metodologia: Cento e cinco pacientes com LAM foram submetidos a ecocardiograma, prova de função pulmonar (PFP) e TC6M. Pacientes com suspeita de HP no ecocardiograma, definida pela presença de pressão arterial pulmonar sistólica estimada (PsAP) acima de 35 mmHg, ou PFP mostrando DLco abaixo de 40% do valor previsto, foram submetidos a cateterismo cardíaco direito para confirmar o diagnóstico de HP. Resultados: Oito pacientes (7,6%) tinham HP confirmada no cateterismo cardíaco direito, seis pacientes (5,7%) tinham padrão pré-capilar e dois pacientes (1,9%) tinham padrão pós-capilar. Apenas um paciente (1%) apresentou pressão média de artéria pulmonar (PAPm) acima de 35 mmHg. Os pacientes com HP apresentaram menor VEF1 e DLco em PFP e maior dessaturação de oxigênio e intensidade de dispneia durante o TC6M comparado com aqueles sem PH. Em 63% dos pacientes com HP confirmada, o cateterismo cardíaco direito foi realizado devido ao resultado do DLco. Conclusões: A prevalência de HP é baixa em pacientes com LAM. A hipertensão pulmonar é de pouca gravidade e significativamente associada ao envolvimento parenquimatoso pulmonar. A capacidade de difusão de monóxido de carbono foi bastante útil na identificação de HP em pacientes com LAM / Introduction: Lymphangioleiomyomatosis (LAM) is associated with pulmonary hypertension (PH) and is included in group 5 of the current classification (unknown multifactorial mechanisms). However, data regarding the occurrence of PH in LAM are scarce. The objectives of the study were to evaluate the prevalence and characteristics of PH in patients with LAM at different stages of evolution, as well as to compare the clinical and functional characteristics of the 6-minute walk test (6MWT) and the quality of life of patients with and without PH. Methodology: One hundred and five patients with LAM underwent echocardiogram, pulmonary function test (PFT) and 6MWT. Patients with suspected PH on the echocardiogram, defined as the presence of estimated systolic pulmonary arterial pressure (PsAP) above 35 mmHg, or PFT showing carbon monoxide diffusion (DLco) below 40% of the predicted value, were submitted to right cardiac catheterization to confirm the diagnosis of PH. Results: Eight patients (7.6%) had PH confirmed in right cardiac catheterization, six patients (5.7%) had a pre-capillary pattern and two patients (1.9%) had a post capillary pattern. Only one patient (1%) presented mean pulmonary artery pressure (PAPm) above 35 mmHg. Patients with PH had lower FEV1 and DLco in PFP and greater oxygen desaturation and dyspnea intensity during the 6MWT compared to those without PH. In 63% of patients with confirmed PH, right heart catheterization was performed because of the DLco result. Conclusions: The prevalence of PH is low in patients with LAM. Pulmonary hypertension is commonly mild and is significantly associated with pulmonary parenchymal involvement. The measure DLco has improved the identification of PH in patients with LAM

Abstract available in Journal of the Academy of Nutrition and Dietetics.

<p>Cardiac catheterization has for a long time been a valuable way to evaluate the hemodynamics of a patient. One of the benefits is that the entire blood pressure waveform can be recorded and visualized to the cardiologist. These measurements are however disturbed by different phenomenon, such as respiration and the dynamics of the fluid filled catheter, which introduces artifacts in the blood pressure waveform. If these disturbances could be removed, the measurement would be more accurate. This report focuses on the effects of respiratory artifacts in blood pressure signals during cardiac catheterization. </p><p>Four methods, a standard bandpass filter, two adaptive filters and one wavelet based method are considered. The difference between respiratory artifacts in systolic and diastolic pressure is studied and dealt with during compensation. All investigated methods are implemented in Matlab and validated against blood pressure signals from catheterized patients. </p><p>The results are algorithms that try to correct for respiratory artifacts. The rate of success is hard to determine since only a few measured blood pressure signals have been available and since the size and appearance of the actual artifacts are unknown.</p>

Cardiac catheterization has for a long time been a valuable way to evaluate the hemodynamics of a patient. One of the benefits is that the entire blood pressure waveform can be recorded and visualized to the cardiologist. These measurements are however disturbed by different phenomenon, such as respiration and the dynamics of the fluid filled catheter, which introduces artifacts in the blood pressure waveform. If these disturbances could be removed, the measurement would be more accurate. This report focuses on the effects of respiratory artifacts in blood pressure signals during cardiac catheterization. Four methods, a standard bandpass filter, two adaptive filters and one wavelet based method are considered. The difference between respiratory artifacts in systolic and diastolic pressure is studied and dealt with during compensation. All investigated methods are implemented in Matlab and validated against blood pressure signals from catheterized patients. The results are algorithms that try to correct for respiratory artifacts. The rate of success is hard to determine since only a few measured blood pressure signals have been available and since the size and appearance of the actual artifacts are unknown.