Thesis (Ph. D.)--Michigan State University. Dept. of Electrical and Computer Engineering, 2006. / Title from PDF t.p. (viewed on Nov. 20, 2008) Includes bibliographical references (p. 126-133). Also issued in print.

Thesis (Ph.D.)--Flinders University, School of Nursing and Midwifery. / Typescript bound. Includes bibliographical references: (leaves 234-259) Also available in an electronic version.

Orientador: Paulo Sérgio Patto dos Santos / Resumo: Objetivou-se avaliar os efeitos hemodinâmicos, hemogasométricos e sedativos da associação de xilazina e nalbufina em equinos hígidos. Foram utilizados 7 equinos adultos (385 ± 82kg), de ambos os sexos, com idade média de 7 ± 3 anos. Após a administração de bolus sequenciais de xilazina (0,8 mg/kg) e nalbufina (0,025 mg/kg), pela via intravenosa (IV), iniciou-se a infusão contínua de xilazina (0,7 mg/kg/hora) e nalbufina (0,03 mg/kg/hora). As variáveis FC, PAS, PAD, PAM, DC, PVC, PAPM, IS, IC, IRVS, FR, pH, PaO2, PaCO2, HCO3-, BE, temperatura corporal, sedação, ataxia e motilidade intestinal foram avaliadas antes do início da administração dos fármacos (Basal) e a cada vinte minutos após o início da infusão contínua até 80 minutos (T20, T40 e T60 e T80). Houve redução da FC, IC, FR e aumento do IRVS e da PaCO2 após o início da infusão contínua dos fármacos. Com os resultados obtidos é possível concluir que a associação de xilazina e nalbufina, nas doses empregadas neste estudo, promoveu sedação e manteve a motilidade reduzida, sem causar alterações clinicamente significativas nos parâmetros hemodinâmicos e hemogasométricos. / Abstract: The aim of this study was to evaluate the hemodynamic, hemogasometric and sedative effects of xylazine and nalbuphine in healthy horses. Seven adult horses (385 ± 82 kg), with a mean age of 7 ± 3 years, were used. Administration of sequential doses of xylazine (0.8 mg kg-1) and nalbuphine (0.025 mg kg-1), both intravenous (IV), continuous rate infusion of xylazine (0.7 mg kg-1 hour-1) and nalbuphine (0.03 mg kg-1 hour-1). The variables HR, RR SAP, DAP, MAP, CO, CVP, MPAP, SI, CI, SVRI RR pH, PaO2, PaCO2, HCO3-, BE, body temperature, sedation, ataxia and motility were taken immediately before the administration of the drugs (Basal) and then at 20-minute intervals during 80 minutes (T20, T40, T60 and T80). Reduction of HR, CI, respiratory rate (RR) and increase of ISVR and PaCO2 were observed after the administration of xylazine and nalburphine combination. The results allow us to conclude that the xylazine and nalbuphine association, at the doses used in this study, promoted sedation and maintenance of motility reduction without causing clinically significant changes in hemodynamic and hemogasometric parameters. / Mestre

Cardiovascular disease is a large problem in the intensive care unit (ICU) due to its high prevalence in modern society. In the ICU, intensive monitoring is required to help diagnose cardiac and circulatory dysfunction. However, complex interactions between the patient, disease, and treatment can hide the underlying disorder. As a result, clinical staff must often rely on their skill, intuition, and experience to choose therapy, increasing variability in care and patient outcome. To simplify this clinical scenario, model-based methods have been created to track subject-specific disease and treatment dependent changes in patient condition, using only clinically available measurements. The approach has been tested in two pig studies on acute pulmonary embolism and septic shock and in a human study on surgical recovery from mitral valve replacement. The model-based method was able to track known pathophysiological changes in the subjects and identified key determinants of cardiovascular health such as cardiac preload, afterload, and contractility. These metrics, which can be otherwise difficult to determine clinically, can be used to help provide targets for goal-directed therapies to help provide deliver the optimal level of therapy to the patient. Hence, this model-based approach provides a feasible and potentially practical means of improving patient care in the ICU.

臂叢阻滯麻醉可以阻斷同側正中神經，尺神經，橈神經和肌皮神經，故其經常被用於上肢手術中麻醉和/或鎮痛。臂叢阻滯麻醉也可以阻滯同側交感神經，導致同側上肢血管擴張（動脈和靜脈）和血流增加。脈沖多普勒超聲技術可以檢測到這些局部的血流動力學變化。文獻回顧表明迄今為止發表的大部分報道片面地評估了臂叢阻滯麻醉後上肢的局部血流動力學變化缺乏全面而系統的研究，並且報道中關於脈沖多普勒超聲技術用於上肢局部血流動力學測量的可靠性和可重復性的數據也很有限。此外，上肢的局部血流動力學變化是否與測量的位置或者使用的臂叢阻滯麻醉技術有關尚且未知。 / 我假設脈沖多普勒超聲是壹種可靠的測量上肢血流動力學變化的方法，它可以系統地定量測定臂叢阻滯麻醉後上肢的局部血流動力學變化，確定這些變化在上肢不同部位的差異，以及確定不同臂叢阻滯麻醉技術後局部血流動力學變化的差異。以下的部分列舉了本博士課題中開展的壹系列研究來證實我的假設。 / 第壹，我們在12個健康年輕誌願者中（年齡21-34歲）用脈沖多普勒超聲在上肢肱動脈和指掌側總動脈進行血流動力學測量，評估其在觀察者內和觀察者間的差異性。兩個觀察者獨立進行了測量。測量的指標包括收縮期峰值血流速度（厘米/秒），舒張末期血流速度（厘米/秒），收縮期峰值血流速度和舒張末期血流速度比值，平均速度（厘米/秒），時均速度（厘米/秒），阻力指數，搏動指數，動脈直徑（厘米），和血流量（毫升/分鐘）。結果顯示脈沖多普勒超聲是壹種可靠的方法，可用來重復測量上肢的局部血流動力學參數（組內相關系數>0.9）. / 第二，我們在8個病人中（年齡24-70歲）系統地評估了超聲波引導下的腋路臂叢神經阻滯後同側肱動脈的局部血流動力學變化。結果表明臂叢神經阻滯後最早的變化是脈沖多普勒頻譜波形的變化，其波形由三相變為單相，舒張期血流曲線擡升。隨著時間推移，收縮期峰值血流速度，舒張末期血流速度，平均速度，時均速度，動脈直徑，和血流量均顯著增加，收縮期峰值血流速度和舒張末期血流速度比值，阻力指數，搏動指數顯著降低。大部分變化發生在神經阻滯後5分鐘。在所有的局部血流動力學指標中，舒張末期血流速度表現出最顯著的變化（3.7倍），其增加超過收縮期峰值血流速度（1.5倍）和平均速度（2.8倍）。 / 第三，利用15個病人（年齡23-70歲），我們評估了超聲波引導下的鎖骨上臂叢神經阻滯後上肢近端動脈（肱動脈）和遠端動脈（指掌側總動脈）血流動力學變化的差異。臂叢神經阻滯之後，在能量多普勒圖像上，指掌側總動脈表現出更明顯的血管擴張。在脈沖多普勒頻譜波形中，兩個動脈均出現舒張早期的反流消失以及舒張期曲線擡升。另外，收縮期峰值血流速度，舒張末期血流速度，平均速度，時均速度，動脈直徑，和血流量增加，收縮期峰值血流速度和舒張末期血流速度比值，阻力指數，搏動指數顯著降低。這些指標的相對變化在指掌側總動脈比肱動脈更顯著。此研究中，4個病人出現對側手部溫度的增加，以此推測局部麻醉藥的雙側擴散。 / 第四，我們開展了壹項前瞻性隨機對照研究來比較腋路和鎖骨上臂叢神經阻滯引起的局部血流動力學變化的不同。兩組病人人口統計學資料類似。兩種臂叢神經阻滯技術均引起肱動脈和指掌側總動脈收縮期峰值血流速度，舒張末期血流速度，平均速度，時均速度，動脈直徑，和血流量的顯著增加，收縮期峰值血流速度和舒張末期血流速度比值，阻力指數，搏動指數顯著降低。跟腋窩方法相比，鎖骨上技術能夠引起肱動脈時均速度和血流量更顯著的增加。然而，在感覺神經阻滯起效方面，腋窩方法比鎖骨上方法更快。 / 總之，脈沖多普勒超聲可重復地測量肱動脈和指掌側總動脈的血流動力學參數及其變化。臂叢阻滯麻醉引起肱動脈和指掌側總動脈脈沖多普勒頻譜形態的變化，血流速度的增加和血流量的增加。這些局部血流動力學變化在指掌側總動脈中比肱動脈更顯著。鎖骨上臂叢神經阻滯比腋窩方法引起更顯著的局部血流動力學變化。臨床醫生可以利用上肢遠端動脈的局部血流動力學變化來評價臂叢阻滯麻醉的交感神經阻滯效應。麻醉醫師還可以根據這些發現為術後需要較好血流灌註的上肢血管手術選取臂叢神經阻滯方法。 / Brachial plexus block (BPB), which produces sensory and motor blockade of the ipsilateral median, ulnar, radial and musculocutaneous nerves, is frequently used for anesthesia and/or analgesia during surgical procedures of the upper extremity. BPB also produces ipsilateral sympathetic nerve blockade that is characterized by vasodilatation (venous and arterial), and an increase in blood flow to the ipsilateral upper extremity. Pulsed wave Doppler (PWD) ultrasound (US) has been used to evaluate these regional hemodynamic changes. A review of the literature shows that most published reports to date have only partially evaluated the regional hemodynamic changes in the upper extremity after a BPB. There are also limited data demonstrating that PWD US is a reliable or reproducible method of quantifying the regional hemodynamic changes in the upper extremity. Moreover, it is also not known whether the regional hemodynamic changes vary with the site of measurement or the technique of BPB used. / I hypothesized that PWD US is a reliable method for measuring regional hemodynamic parameters in the upper extremity. It can be used to comprehensively quantify the regional hemodynamic changes after a BPB and to determine the extent of these changes at different sites in the upper extremity and after different techniques for BPB. The following section outlines a series of studies that I undertook during this PhD project to corroborate my hypothesis. / Firstly, we sought to assess the intra-observer and inter-observer variability of measuring regional hemodynamic parameters, in the brachial and common palmar digital arteries of the upper extremity, using PWD US in 12 healthy young volunteers aged 21-34 yrs. The measurements were performed independently by two observers. Measured hemodynamic parameters included peak systolic velocity (PSV, cm/s), end diastolic velocity (EDV, cm/s), ratio of PSV and EDV (S/D), mean velocity (Vmean, cm/s), time-averaged mean velocity (TAVM, cm/s), resistance index (RI), pulsatility index (PI), the arterial diameter (d, cm), and blood flow (mL/min). The results showed that PWD US is a reliable and reproducible method of measuring regional hemodynamic parameters in the upper extremity (ICC>0.9). / Secondly, we comprehensively evaluated the regional hemodynamic changes in the ipsilateral brachial artery after an ultrasound guided (USG) axillary BPB in eight adult patients aged 24-70 yrs. Our results suggested that the earliest change after the BPB was a change in the morphology of the PWD spectral waveform from a triphasic to a monophasic waveform and an elevation in the diastolic blood flow velocity. Over time, there was also a significant increase in PSV, EDV, Vmean, TAVM, d, and blood flow, and a decrease in S/D ratio, RI, and PI. Most of these changes were seen as early as 5 minutes after the block. The increase in EDV (3.7-fold) was the most notable change, and it was significantly greater than the increase in PSV (1.5-fold) and Vmean (2.8-fold). / Thirdly, the regional hemodynamic changes in the proximal (brachial artery) and distal (common palmar digital artery) artery of the upper extremity after an USG supraclavicular BPB was investigated in 15 adult patients aged 23-70 yrs. After the block, the common palmar digital artery showed more obvious vasodilatation on the power Doppler US scan. In the PWD spectral waveform, and in both arteries studied, the protodiastolic blood flow disappeared and there was an elevation of the diastolic curve. Also there was a significant increase in PSV, EDV, Vmean, TAVM, d, and blood flow, and a significant reduction in S/D ratio, PI and RI in both arteries. Relative changes of these parameters were greater in the common palmar digital artery than in the brachial artery. In this study, bilateral spread of local anesthetic was observed in 4 patients, as evidenced by an increase of skin temperature on the contralateral hand. / Fourthly, a prospective and randomized study was conducted to compare the regional hemodynamic changes in the upper extremity after an axillary and supraclavicular BPB. The two study groups were similar with respect to demographic data. Both axillary and supraclavicular BPB caused a significant increase in PSV, EDV, Vmean, TAVM, d, and blood flow, and a significant reduction in S/D ratio, PI and RI in both the brachial and common palmar digital arteries. Compared with the axillary approach, the supraclavicular approach produced significantly greater increases in TAVM and blood flow in the brachial artery. However, the onset of sensory blockade was faster after the axillary BPB than with the supraclavicular BPB. / In conclusion, PWD US is a reliable and reproducible method for quantifying the regional hemodynamic parameters in both the brachial and common palmar digital arteries. BPB produces a change in the morphology of the PWD spectral waveform, arterial vasodilatation, an increase in blood flow velocity, and an increase in blood flow in both the ipsilateral brachial and common palmar digital arteries. These changes in regional hemodynamic parameters were more profound in the common palmar digital artery than in the brachial artery. Also these changes were more significant after a supraclavicular BPB than after an axillary BPB. These findings will allow clinicians to evaluate the sympathetic effect of a BPB using regional hemodynamic changes in the distal arteries of the upper extremity. These findings will also allow anesthesiologists to make an evidence-based choice on the techniques of BPB for vascular surgery of the upper extremity when good tissue perfusion is desirable postoperatively. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Jiawei. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 182-192). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / TABLE OF CONTENTS / ABSTRACT / 中文摘要 / STATEMENT OF WORK / ACKNOWLEDGMENTS / PUBLICATIONS AND PRESENTATIONS / LIST OF ABBREVIATIONS / LIST OF TABLES / LIST OF FIGURES / Chapter CHAPTER 1 --- Introduction / Chapter 1.1 --- Introduction / Chapter 1.2 --- Aims of the project / Chapter 1.3 --- Outline of the thesis / Chapter CHAPTER 2 --- Literature Review / Chapter 2.1 --- Introduction / Chapter 2.2 --- Why regional hemodynamic changes occur after a BPB / Chapter 2.2.1 --- Anatomy of the sympathetic nervous system in the upper extremity / Chapter 2.2.2 --- The anatomic relationship between the sympathetic nerves and the brachial plexus / Chapter 2.2.3 --- Sympathetic efferents to blood vessels in the upper extremity / Chapter 2.3 --- Methods used to measure regional hemodynamic changes / Chapter 2.3.1 --- Skin and muscle blood flow / Chapter 2.3.2 --- Regional hemodynamic measurements using PWD US / Chapter 2.3.2.1 --- Basics of Doppler ultrasound / Chapter 2.3.2.2 --- Principles of blood flow / Chapter 2.3.2.3 --- Spectral analysis of blood flow using PWD US / Chapter 2.4 --- Published data on regional hemodynamic changes after BPB / Chapter 2.4.1 --- Skin temperature / Chapter 2.4.2 --- Cutaneous and muscular blood flow / Chapter 2.4.3 --- Regional hemodynamic measurements on major arterial branches of the upper extremity / Chapter 2.5 --- Introduction of BPB / Chapter 2.5.1 --- Anatomy of the brachial plexus / Chapter 2.5.2 --- Techniques for performing BPB / Chapter 2.5.3 --- USG BPB / Chapter 2.5.3.1 --- History / Chapter 2.5.3.2 --- Advantages of ultrasound guidance for peripheral nerve blockade / Chapter CHAPTER 3 --- Methodology / Chapter 3.1 --- Introduction / Chapter 3.2 --- Patient preparations / Chapter 3.3 --- Regional hemodynamic measurement / Chapter 3.3.1 --- Ultrasound equipment / Chapter 3.3.2 --- Patient position / Chapter 3.3.3 --- Regional hemodynamic measurements using PWD US / Chapter 3.3.3.1 --- Optimizing settings for B-Mode US / Chapter 3.3.3.2 --- Optimizing settings for PWD US / Chapter 3.3.3.3 --- Measurement of regional hemodynamic parameters / Chapter 3.3.4 --- Measurement of diameter (d) and blood flow (Q) / Chapter 3.4 --- USG BPB / Chapter 3.4.1 --- USG axillary BPB / Chapter 3.4.1.1 --- Scout scan / Chapter 3.4.1.2 --- Aseptic precautions / Chapter 3.4.1.3 --- USG axillary BPB / Chapter 3.4.2 --- USG supraclavicular BPB / Chapter 3.4.2.1 --- Scout scan / Chapter 3.4.2.2 --- Aseptic precautions / Chapter 3.4.2.3 --- USG supraclavicular BPB / Chapter 3.5 --- Outcome data after the BPB / Chapter CHAPTER 4 --- Measurement of Regional Hemodynamic Parameters in the Upper Extremity Using Pulsed Wave Doppler Ultrasound: A Reliability Study / Chapter 4.1 --- Introduction / Chapter 4.2 --- Methods / Chapter 4.2.1 --- Subjects / Chapter 4.2.2 --- Study design / Chapter 4.2.3 --- Data acquisition / Chapter 4.2.4 --- Statistical analysis / Chapter 4.3 --- Results / Chapter 4.4 --- Discussion / Chapter 4.4.1 --- Summary of main findings / Chapter 4.4.2 --- Compared with previous studies / Chapter 4.4.3 --- Sources of measurement variability / Chapter 4.4.4 --- Explanation for the variation in the changes in various regional hemodynamic parameters / Chapter 4.5 --- Conclusion / Chapter CHAPTER 5 --- Regional Hemodynamic Changes after an Axillary BPB: A Pulsed Wave Doppler Ultrasound Study / Chapter 5.1 --- Introduction / Chapter 5.2 --- Methods / Chapter 5.2.1 --- Patient enrollment / Chapter 5.2.2 --- Patient preparation / Chapter 5.2.3 --- Measurement of baseline regional hemodynamic parameters / Chapter 5.2.4 --- USG axillary BPB / Chapter 5.2.5 --- Outcome data after the BPB / Chapter 5.2.6 --- Sensory and motor assessments after the BPB / Chapter 5.2.7 --- Statistical Analysis / Chapter 5.3 --- Results / Chapter 5.4 --- Discussion / Chapter 5.4.1 --- Summary of main findings / Chapter 5.4.2 --- Limitations / Chapter 5.4.3 --- Changes in PWD spectral waveform / Chapter 5.4.4 --- Changes in regional hemodynamic parameters / Chapter 5.4.5 --- Increase in skin temperature / Chapter 5.4.6 --- Effects of local anesthetic / Chapter 5.5 --- Conclusion / Chapter CHAPTER 6 --- Does a Supraclavicular Brachial Plexus Block Induce Comparable Hemodynamic Changes in the Proximal and Distal Arteries of the Upper Extremity? / Chapter 6.1 --- Introduction / Chapter 6.2 --- Methods / Chapter 6.2.1 --- Patient recruitment / Chapter 6.2.2 --- Patient preparation / Chapter 6.2.3 --- Measurement of baseline regional hemodynamic parameters, arterial diameter and blood flow / Chapter 6.2.4 --- USG supraclavicular BPB / Chapter 6.2.5 --- Outcome measurements after the BPB / Chapter 6.2.6 --- Statistical analysis / Chapter 6.3 --- Results / Chapter 6.4 --- Discussion / Chapter 6.4.1 --- Summary of the main findings / Chapter 6.4.2 --- Limitations / Chapter 6.4.3 --- Changes in the PWD spectral waveform / Chapter 6.4.4 --- Explanation of the differences in regional hemodynamic changes in the distal and proximal arteries after BPB / Chapter 6.4.5 --- Increase in skin temperature and its relation to blood flow / Chapter 6.4.6 --- Bilateral sympathetic effect after supraclavicular BPB / Chapter 6.4.7 --- Other findings of this study / Chapter 6.5 --- Conclusion / Chapter CHAPTER 7 --- Does a Supraclavicular Brachial Plexus Block Induce Greater Changes in Regional Hemodynamics than an Axillary Brachial Plexus Block? / Chapter 7.1 --- Introduction / Chapter 7.2 --- Methods / Chapter 7.2.1 --- Sample size estimation / Chapter 7.2.2 --- Exclusion criteria / Chapter 7.2.3 --- Randomized allocation / Chapter 7.2.4 --- Preparations before the ultrasound scan / Chapter 7.2.5 --- Measurement of baseline regional hemodynamic parameters, diameter and blood / Chapter 7.2.6 --- USG axillary and supraclavicular BPB / Chapter 7.2.7 --- Outcome measurements after the BPB / Chapter 7.2.8 --- Statistical analysis / Chapter 7.3 --- Results / Chapter 7.4 --- Discussion / Chapter 7.4.1 --- Summary of the main findings / Chapter 7.4.2 --- Limitations / Chapter 7.4.3 --- Change in the PWD spectral waveform / Chapter 7.4.4 --- Differences in regional hemodynamic changes between the 2 study groups / Chapter 7.4.5 --- Differences in sensory and motor blockade between the 2 study groups / Chapter 7.4.6 --- Changes in skin temperature / Chapter 7.5 --- Conclusion / Chapter CHAPTER 8 --- Summary and Conclusions / APPENDIX / REFERENCES

Since the advent of functional magnetic resonance imaging (fMRI) and the rise in popularity of its use for resting state functional connectivity mapping (rs-FCM) to non-invasively detect correlated networks of brain activity in human and animal models, many resting state FCM studies have reported differences in these networks under pathologies such as Alzheimer’s or schizophrenia, highlighting the potential for the method’s diagnostic relevance. A common underlying assumption of this analysis, however, is that the blood oxygen level dependent (BOLD) signal of fMRI is a direct measurement of local neural activity. The BOLD signal is in fact a measurement of the local changes in concentration of deoxy-hemoglobin (HbR). Thus, it is imperative that neurovascular coupling—the relationship between neuronal activity and subsequent hemodynamic activity—be better characterized to enable accurate interpretation of resting state fMRI in the context of clinical usage. This dissertation first describes the development and utility of WFOM paradigm for the robust and easily adaptable imaging of simultaneous neuronal and hemodynamic activity in awake mouse models of health or disease in strains with genetically encoded fluorescent calcium reporters. Subsequent exploration of resting state WFOM data collected in Thy1-GCaMP3 and Thy1-GCaMP6f mouse strains is then presented, namely the characterization of spatiotemporal patterns of neuronal and hemodynamic activity and different modulatory depths of neuronal activity via a toolbox of unsupervised blind source separation (e.g. k-means clustering) and supervised (e.g. non-negative least squares, Pearson correlation) analysis tools. The presence of these different modulatory depths of neuronal activity were then confirmed in another Thy1-jRGECO1a mouse strain using the same imaging scheme. Finally, the dissertation documents the application of the WFOM paradigm and select analysis tools to a novel mouse model of diffusely infiltrating glioma, through which neuronal and hemodynamic activity changes during diffusely infiltrating glioma development which impact temporal coherence of the tumor region activity relative to non-tumor regions activity were recorded and analyzed. The paradigm also allowed for recording of numerous spontaneous occurrences of interictal neuronal activity during which neurovascular coupling is modified in the tumor, as well as occurrences of non-convulsive generalized seizure activity (during which neurovascular is non-linear and cortex eventually suffers hypoxia). The detection of spatiotemporal patterns and different modulatory depths of activity in the awake mouse cortex, as well as observation of changes in functional activity in the context of diffusely infiltrating glioma, provide us with new insights into the possible mechanisms underlying variations in resting state connectivity networks found in resting state fMRI studies comparing health and disease states.

Thesis (M.S.)--James Madison University, 2009. / Includes bibliographical references.

Orientador: Newton Nunes / Banca: Valéria Nobre Leal de Souza Oliva / Banca: Roberta Carareto / Banca: Paulo Sérgio Patto dos Santos / Banca: José Antonio Marques / Resumo: Avaliaram-se os efeitos da infusão contínua de propofol ou tiopental sobre os parâmetros respiratórios, hemodinâmicos, hemogasométricos e do índice biespectral em cães portadores de hipertensão pulmonar (HP) induzida pela serotonina (5-HT). Utilizaram-se 20 cães adultos SRD, machos ou fêmeas, distribuídos em dois grupos de dez animais denominados grupo propofol (GP, n= 10) e grupo tiopental (GT, n = 10). O peso médio dos cães no GP foi 11,8 ± 1,8 kg e no GT 10,6 ± 2,7 kg. O propofol foi empregado na indução (8 ± 0,03 mg/kg) e manutenção da anestesia (0,8 mg/kg/min) no GP, e o tiopental foi utilizado para indução (22 ± 2,92 mg/kg) seguido por infusão contínua (0,5 mg/kg/min) no GT. Em seguida, a ventilação mecânica ciclada a tempo foi iniciada. A HP foi induzida pela administração de 5-HT em bolus (10 μg/kg) seguido por infusão contínua (1 mg/kg/h) na artéria pulmonar. As mensurações dos parâmetros tiveram início antes da aplicação (M0) e após 30 minutos da administração da 5-HT (M30), seguida de intervalos de 15 minutos (M45, M60, M75 e M90). As variáveis foram submetidas à Análise de Perfil (p<0,05). O coeficiente de Pearson foi calculado em ambos os grupos para determinar a correlação entre mistura arteriovenosa (Qs/Qt) e diferença de tensão entre o oxigênio alveolar e o arterial (AaDO2), entre Qs/Qt e o índice respiratório (IR), entre Qs/Qt e a relação artérioalveolar (a/A) e entre Qs/Qt e o índice de oxigenção (IO). Os resultados mostraram que a indução da HP alterou as variáveis hemogasométricas, respiratórias, a frequência cardíaca (FC), sendo registradas diferenças significativas entre os grupos ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The effects of continuous infusion of propofol or thiopental on respiratory, hemodynamic, blood-gas parameters and on bispectral index, in dogs induced to pulmonary hypertension (PH) by serononin (5-HT), were evaluated. Twenty adult mongrel dogs, male or female, were randomly assigned into two groups composed by ten animals: propofol group (PG, n = 10) and thiopental group (TG, n= 10). In PG, dogs weighing 11.8 ± 1.8 kg and in TG, 10.6 ± 2.7 kg. Propofol was used for induction (8 ± 0.03 mg/kg) and maintenance of anesthesia (0.8 mg/kg/minute) in PG. Thiopental was used for induction (22 ± 2.92 mg/kg) followed by continuous infusion (0.5 mg/kg/minute) in TG. Mechanical ventilation using time cycled was started. PH was induced by administration of a serotonin (5-HT) bolus (10 μg/kg) followed by continuous infusion (1 mg/kg/hour) in the pulmonary artery. The parameters were measured before administration of 5-HT (T0), after 30 minutes (T30) and, then, at 15-minute intervals (T45, T60, T75 and T90). Numeric data were submitted to Profile analysis (P<0.05). Pearson's coefficient was calculated in both groups to determine the correlation between venous admixture (Qs/Qt) and alveolar-arterial oxygen tension difference (AaDO2), between Qs/Qt and respiratory index (RI), between Qs/Qt and alveolo-arterial ratio (a/A) and between Qs/Qt and oxygenation index (IO) ... (Complete abstract click electronic access below) / Doutor

Orientador: Gilberto de Nucci / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T10:02:10Z (GMT). No. of bitstreams: 1 AbibJunior_Eduardo_D.pdf: 639040 bytes, checksum: e96fa4a810e2980947816b23f3c078a1 (MD5) Previous issue date: 2005 / Resumo: Objetivo: Esta tese tem por objetivos: avaliar a agregação plaquetária e o comportamento da pressão arterial em três momentos (sem alho; alho dose única (3,5 g) e alho dose diária (3,5 g) duas vezes ao dia por 4 dias) em voluntários sadios; Analisar a resposta de agregação plaquetária in vitro adicionando extrato de alho diluído em PRP e por ultimo correlacionar os dados obtidos da analise da agregação com os parâmetros TxB2, GMPc entre in vivo e in vivo. Para Analise em in vivo foram selecionados dezoito (18) voluntários do sexo masculino, entre 18 a 45 anos, saudáveis, para estudo não randomizado, aberto e divididos em tres grupos (Grupo Sem alho; Grupo Com Alho Único e Grupo Alho Diário). Amostras de sangue dos voluntários foram coletadas de acordo com horários pré-estabelecidos. Após execução da agregação plaquetária, Pressão arterial através da MAPA e quantificação dos níveis de TXB2, foram realizadas análises estatisticas. Para analise in vitro foram selecionados 5 voluntários sadios, de ambos os sexos, isentos de qualquer medicação uma semana antes coleta. O sangue foi coletado e o PRP foi separado e adicionado extrato de alho em volume determinado. Após execução da agregação plaquetária e quantificação dos níveis de TXB2, foram tb realizadas análises estatisticas. Tendo estes dados tanto in vivo quanto in vivo procedeu-se a analise comparativa entre eles. Resultados : Na analise in vivo, tanto a agregação plaquetária quanto a inibição da formação de TxB2 não se observou diferença entre os outros grupos independente do agonista utilizado. Na analise in vitro, os resultados sugeriram que o extrato de alho, em quantidades pequenas, inibi a agregação plaquetária Os resultados se confirmaram com o TXB2, pois quantidades de extrato que foram capazes de inibir a agregação plaquetária induzida por todos agonistas, inclusive àquela induzida por AA, não causou diminuição significativa da síntese de TXA2 induzida por AA. Houve variação significativa da PA sistólica e FC com administração diária de alho fresco comparada ao sem alho e alho único. Conclusão: Concluímos que outros mecanismos podem estar envolvidos na inibição da agregação plaquetária que não da inibição da ciclooxigenase plaquetária quando utilizado o extrato de alho. Não há uma inibição da agregação plaquetária através da ação sobre a ciclooxigenase quando observado em voluntários que ingeriram alho fresco. A administração de alho in natura, pequenas quantidades (3,5g de dente de alho = 16 mg alicina/g de alho) pode contribuir para promover alterações no comportamento hemodinâmico como observado através da MAPA em voluntários sadios / Abstract: Objective: This thesis has as objectives: to evaluate the platelet aggregation and the behavior of blood pressure in three moments (control; garlic single dose (3,5 g) and garlic daily dose (3,5 g) twice a day for 4 days) in healthy volunteers; To analyze the in vitro platelet aggregation answer adding garlic extract diluted in PRP and the last to correlate the obtained data from the aggregation analysis with the TxB2, GMPc parameters between in vivo and in vivo. For the in vivo Analysis eighteen (18) healthy volunteers of the masculine gender between 18 and 45 years old were selected, for an open, non-randomized study and divided into three groups (Control; Group With Single Garlic and Group Daily Garlic). Samples of the volunteers' blood were collected according to the pre-established schedules. After execution of the platelet aggregation, blood Pressure through AMBP and quantification of TXB2 levels , statistical analyses were accomplished. For in vitro analysis 5 healthy volunteers of both genders were selected, free of any medication one week before collection. The blood was collected and the PRP was separated and added garlic extract in determined volume. After execution of the platelet aggregation and quantification of TXB2 levels, statistical analyses were also accomplished. Having these in vivo data as well in in vivo the comparative analysis between them was preceeded. Results: There was significant variation of the systolic BP and HR with daily administration of fresh garlic compared to control and single garlic. Regarding the platelet aggregation it was observed difference between the daily garlic group and the other two groups (P <0.005) when used agonist arachidonic acid. In the in vitro analysis, the results suggested that the garlic extract, in small amounts, can inhibit the platelet aggregation without affecting in a significant way the activity of ciclooxygenase. The results were confirmed with the TXB2, for amounts of extract that were capable to inhibit the platelet aggregation induced by all agonists, including that one induced by AA, didn't cause significant decrease of TXA2 synthesis induced by AA. Conclusion: We concluded that other mechanisms can be involved in the inhibition of the platelet aggregation other than the inhibition of the platelet ciclooxygenase when used the garlic extract. There is not an inhibition of the platelet aggregation through the action on the ciclooxygenase when observed in volunteers that ingested fresh garlic. The administration of garlic in natura, small quantities (3,5g garlic glove = 16 mg allicim/g garlic) can contribute to promote alterations in the hemodynamic behavior as observed through the AMBP in healthy volunteers / Doutorado / Clinica Medica / Doutor em Clínica Médica

L'utilité de toute technique de monitorage hémodynamique en réanimation est de procurer des informations fiables et reproductibles sur l'état cardio-circulatoire d'un patient présentant un état de choc. Les valeurs recueillies vont permettre au réanimateur de comprendre l'état dans lequel se trouve le patient et de prendre des décisions thérapeutiques plus éclairées dans le but d'optimiser l'état hémodynamique du patient et d'améliorer son pronostic. La surveillance hémodynamique est nécessaire pour évaluer la perfusion tissulaire globale et régionale. La correction de l'instabilité hémodynamique et de l'hypoperfusion tissulaire est essentielle pour prévenir la survenue d'une défaillance multiviscérale. La pratique de la réanimation est caractérisée par une relation temporelle très étroite entre la surveillance, la prise de décision et le traitement. Pour ce faire, le médecin réanimateur dispose d'un arsenal d'appareils de monitorage. Mais avant d'utiliser un dispositif, il est impératif que le clinicien ait de solides connaissances de la physiopathologie des états de choc afin de savoir quelles sont les paramètres qu'il souhaite monitorer. Dans la première partie de ce travail de thèse, nous nous sommes d'abord appliqués à rappeler quels sont les paramètres de monitorage hémodynamique disponibles pour le clinicien et le rationnel physiopathologique. Dans la deuxième partie de ce travail, nous avons présenté une revue des travaux originaux, les revues et les commentaires réalisés par l'auteur au cours de ces 4 dernières années sur plusieurs techniques de monitorage hémodynamique. Enfin, dans la troisième partie de ce travail, nous avons détaillé deux études expérimentales animales sur un modèle porcin en choc hémorragique : la première étudiant l'influence de l'hypovolémie sur le shunt intrapulmonaire d'animaux soumis à un syndrome de détresse respiratoire aigu par acide oléique et la seconde étude concernant l'impact des amines vasopressives sur les indices dynamiques de la réponse au remplissage vasculaire. Ces deux travaux expérimentaux mettent en évidence la complexité d'interprétation du monitorage hémodynamique dans des situations complexes comme le choc hémorragique / The usefulness of any technique hemodynamic monitoring in the ICU is to provide reliable and reproducible information on the cardio-circulatory status of a patient with shock. The collected values will allow the intensivist to understand the condition in which the patient is located and to take more informed treatment decisions in order to optimize the hemodynamic status and improve patient prognosis. Hemodynamic monitoring is needed to assess global and regional tissue perfusion. The correction of hemodynamic instability and tissue hypoperfusion is essential for prevent the occurrence of multiple organ failure. The practice of resuscitation is characterized by a very close temporal relationship between the monitoring, decision making and processing. To do this, numbers of monitoring devices are available. But before using a device, it is imperative for the clinician to have the knowledge of the pathophysiology of states shock to find out which parameters he wishes to monitor. In the first part of this thesis, we first recalled which hemodynamic monitoring parameters are available for the clinician and there pathophysiological rationals