22 results on '"Sessler, Daniel I"'
Search Results
2. Effect of personalized perioperative blood pressure management on postoperative complications and mortality in high-risk patients having major abdominal surgery: protocol for a multicenter randomized trial (IMPROVE-multi)
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Bergholz, Alina, Meidert, Agnes S., Flick, Moritz, Krause, Linda, Vettorazzi, Eik, Zapf, Antonia, Brunkhorst, Frank M., Meybohm, Patrick, Zacharowski, Kai, Zarbock, Alexander, Sessler, Daniel I., Kouz, Karim, and Saugel, Bernd
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- 2022
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3. Impact of dexmedetomidine supplemented analgesia on delirium in patients recovering from orthopedic surgery: A randomized controlled trial
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Hong, Hong, Zhang, Da-Zhi, Li, Mo, Wang, Geng, Zhu, Sai-Nan, Zhang, Yue, Wang, Dong-Xin, and Sessler, Daniel I.
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- 2021
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4. Tranexamic acid and rosuvastatin in patients at risk of cardiovascular events after noncardiac surgery: a pilot of the POISE-3 randomized controlled trial
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Marcucci, Maura, Duceppe, Emmanuelle, Le Manach, Yannick, Kearon, Clive, Eikelboom, John W., Pohl, Kayla, Vincent, Jessica, Darvish-Kazem, Saeed, Srinathan, Sadeesh K., Neary, John D. D., Parlow, Joel L., Kurz, Andrea, Gross, Peter L., Mrkobrada, Marko, Balasubramanian, Kumar, Sessler, Daniel I., and Devereaux, P. J.
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- 2020
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5. Severe hypoglycemia reduces the shivering threshold in rabbits
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Wada, Keiichi, Masamune, Taishi, Ino, Hirofumi, Ueda, Kenta, Ishiyama, Tadahiko, Sessler, Daniel I., and Matsukawa, Takashi
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- 2019
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6. Hypotension Prediction Index software for management of hypotension during moderate- to high-risk noncardiac surgery: protocol for a randomized trial
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Maheshwari, Kamal, Shimada, Tetsuya, Fang, Jonathan, Ince, Ilker, Mascha, Edward J., Turan, Alparslan, Kurz, Andrea, and Sessler, Daniel I.
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- 2019
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7. Optimal site for ultrasound-guided venous catheterisation in paediatric patients: an observational study to investigate predictors for catheterisation success and a randomised controlled study to determine the most successful site
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Takeshita, Jun, Nakayama, Yoshinobu, Nakajima, Yasufumi, Sessler, Daniel I, Ogawa, Satoru, Sawa, Teiji, and Mizobe, Toshiki
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- 2015
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8. Reversal of fibrosis in patients with nonalcoholic steatohepatosis after gastric bypass surgery.
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Parker, Brian M., Jiang Wu, Jing You, Barnes, David S., Yerian, Lisa, Kirwan, John P., Schauer, Philip R., and Sessler, Daniel I.
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FIBROSIS ,GASTRIC bypass ,FATTY liver - Abstract
Background: Roux-en-Y gastric bypass (RYGB) improves the pathophysiology that contributes to obesity-related nonalcoholic steatohepatitis (NASH). Whether obesity-related fibrosis improves is unclear. We hypothesized that RYGB reverses NASH and fibrosis, and indocyanine green (ICG) clearance provides a sensitive measure for detecting asymptomatic fatty liver disease. Methods: One hundred six obese adults scheduled for RYGB had preoperative liver function assessed using standard tests and ICG clearance and core liver biopsies obtained during RYGB. Once patients lost 60% of their preoperative weight or weight loss plateaued, liver function was reassessed. Repeat liver biopsies were obtained on patients with NASH at the time of RYGB. Results: RYGB improved steatosis, lobular inflammation, hepatocyte ballooning and fibrosis. Serum albumin, AST, and ALT decreased the most in patients with NASH and NASH plus fibrosis. Twenty seven (26%) patients had normal baseline liver histology and 45 (43%) had NASH or NASH plus fibrosis. Nine of 13 patients with substantial fatty liver had normalized histology after weight loss, while severity of disease in the rest had stabilized or was reduced. Mean ICG clearance in patients with normal/mild fatty liver disease and those with histological fatty livers did not differ significantly. Conclusions: RYGB surgery reverses NASH and liver fibrosis. Underlying mechanisms that facilitate improvement remain unclear. [ABSTRACT FROM AUTHOR]
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- 2017
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9. Volatile organic compounds in ventilated critical care patients: a systematic evaluation of cofactors.
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Hüppe, Tobias, Lorenz, Dominik, Wachowiak, Mario, Maurer, Felix, Meiser, Andreas, Groesdonk, Heinrich, Fink, Tobias, Sessler, Daniel I., and Kreuer, Sascha
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VOLATILE organic compounds ,CRITICALLY ill ,COFACTORS (Biochemistry) ,PATIENTS ,INTENSIVE care units ,HOSPITAL gastroenterology services ,MEDICAL care - Abstract
Background: Expired gas (exhalome) analysis of ventilated critical ill patients can be used for drug monitoring and biomarker diagnostics. However, it remains unclear to what extent volatile organic compounds are present in gases from intensive care ventilators, gas cylinders, central hospital gas supplies, and ambient air. We therefore systematically evaluated background volatiles in inspired gas and their influence on the exhalome.Methods: We used multi-capillary column ion-mobility spectrometry (MCC-IMS) breath analysis in five mechanically ventilated critical care patients, each over a period of 12 h. We also evaluated volatile organic compounds in inspired gas provided by intensive care ventilators, in compressed air and oxygen from the central gas supply and cylinders, and in the ambient air of an intensive care unit. Volatiles detectable in both inspired and exhaled gas with patient-to-inspired gas ratios < 5 were defined as contaminating compounds.Results: A total of 76 unique MCC-IMS signals were detected, with 39 being identified volatile compounds: 73 signals were from the exhalome, 12 were identified in inspired gas from critical care ventilators, and 34 were from ambient air. Five volatile compounds were identified from the central gas supply, four from compressed air, and 17 from compressed oxygen. We observed seven contaminating volatiles with patient-to-inspired gas ratios < 5, thus representing exogenous signals of sufficient magnitude that might potentially be mistaken for exhaled biomarkers.Conclusions: Volatile organic compounds can be present in gas from central hospital supplies, compressed gas tanks, and ventilators. Accurate assessment of the exhalome in critical care patients thus requires frequent profiling of inspired gases and appropriate normalisation of the expired signals. [ABSTRACT FROM AUTHOR]- Published
- 2017
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10. The effects of Y-27632 on pial microvessels during global brain ischemia and reperfusion in rabbits.
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Noriyuki Shintani, Tadahiko Ishiyama, Masakazu Kotoda, Nobumasa Asano, Sessler, Daniel I., and Takashi Matsukawa
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ANIMAL experimentation ,BLOOD sugar ,VASODILATION ,CEREBRAL circulation ,CEREBRAL ischemia ,PHOSPHOTRANSFERASES ,RABBITS ,REPERFUSION ,CUTANEOUS therapeutics ,VASOCONSTRICTION ,PROPOFOL ,DESCRIPTIVE statistics - Abstract
Background: Global brain ischemia-reperfusion during propofol anesthesia provokes persistent cerebral pial constriction. Constriction is likely mediated by Rho-kinase. Cerebral vasoconstriction possibly exacerbates ischemic brain injury. Because Y-27632 is a potent Rho-kinase inhibitor, it should be necessary to evaluate its effects on cerebral pial vessels during ischemia--reperfusion period. We therefore tested the hypotheses that Y-27632 dilates cerebral pial arterioles after the ischemia-reperfusion injury, and evaluated the time-course of cerebral pial arteriolar status after the ischemia-reperfusion. Methods: Japanese white rabbits were anesthetized with propofol, and a closed cranial window inserted over the left hemisphere. Global brain ischemia was produced by clamping the brachiocephalic, left common carotid, and left subclavian arteries for 15 min. Rabbits were assigned to cranial window perfusion with: (1) artificial cerebrospinal fluid (Control group, n = 7); (2) topical infusion of Y-27632 10
-6 mol ⋅ L-1 for 30 min before the initiation of global brain ischemia (Pre group, n = 7); (3) topical infusion of Y-27632 10-6 mol ⋅ L-1 starting 30 min before ischemia and continuing throughout the study period (Continuous group, n = 7); and, (4) topical infusion of Y-27632 10-6 mol ⋅ L-1 starting 10 min after the ischemia and continuing until the end of the study (Post group, n = 7). Cerebral pial arterial and venule diameters were recorded 30 min before ischemia, just before arterial clamping, 10 min after clamping, and 5, 10, 20, 40, 60, 80, 100, and 120 min after unclamping. Results: Mean arterial blood pressure and blood glucose concentration increased significantly after global brain ischemia except in the Continuous group. In the Pre and Continuous groups, topical application of Y-27632 produced dilation of large (mean 18-19%) and small (mean; 25-29%) pial arteries, without apparent effect on venules. Compared with the Control and Pre groups, arterioles were significantly dilated during the reperfusion period in the Continuous and Post groups (mean at 120 min: 5-8% in large arterioles and 11-12% in small arterioles). Conclusions: Y-27632 dilated cerebral pial arterioles during reperfusion. Y-27632 may enhance recovery from ischemia by preventing arteriolar vasoconstriction during reperfusion. [ABSTRACT FROM AUTHOR]- Published
- 2017
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11. The effects of topical and intravenous JM-1232(-) on cerebral pial microvessels of rabbits.
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Kodai Ikemoto, Tadahiko Ishiyama, Noriyuki Shintani, Nobumasa Asano, Sessler, Daniel I., and Takashi Matsukawa
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BRAIN anatomy ,ANESTHESIOLOGY ,ANESTHETICS ,ANIMAL experimentation ,BLOOD pressure measurement ,BLOOD vessels ,BODY weight ,CEREBRAL circulation ,DIFFUSION of innovations ,INTRAVENOUS therapy ,RABBITS ,CUTANEOUS therapeutics ,SEVOFLURANE ,INVESTIGATIONAL drugs - Abstract
Background: JM-1232(-) is a novel anesthetic agent which acts through gamma-aminobutyric acid receptors. Cerebral pial vascular effects of JM-1232(-) are unknown. We thus evaluated topical and intravenous effects of JM-1232(-) on cerebral pial microvessels in rabbits, and the extent to which carbon dioxide (CO2) reactivity is preserved. Methods: Closed cranial windows were used to visualize cerebral pial circulation in 29 Japanese white rabbits. In the first experiment, the cranial window was superfused with increasing concentrations of JM-1232(-): 10-11, 10-9, 10-7, 10-5 mol/L, n = 8 per concentration. In the second experiment, we examined the effects of an intravenous bolus of 1 mg/kg bolus of JM-1232(-), followed by the continuous infusion at 0.3 mg/kg/minute on cerebral pial vascular alteration (n = 9). In the third, we examined CO2 reactivity of cerebral pial vessels under JM-1232(-) (n = 6) or sevoflurane anesthesia (n = 6). Results: Topical application of JM-1232(-) did not change pial venular diameter, and constricted arterials only at the highest concentration. Intravenous administration of JM-1232(-) produced cerebral pial constriction which gradually diminished over time. Under intravenous administration of JM-1232(-) and inhaled sevoflurane, diameters of vessels increased in parallel with CO2 partial pressure. Slopes of linear regression and correlation coefficients in arterioles and venules were comparable for JM-1232(-) anesthesia and sevoflurane anesthesia. Conclusions: Topical application of JM-1232(-) had little effect on cerebral pial vessels. Intravenous administration produced vasoconstriction of cerebral pial arterioles and venules, however those changes were clinically unimportant. In addition, JM-1232(-) did not impair CO2 responsiveness. At least from the perspective of vascular reactivity, JM-1232(-) thus appears safe for neurosurgical patients. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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- View/download PDF
12. Optimal site for ultrasound-guided venous catheterisation in paediatric patients: an observational study to investigate predictors for catheterisation success and a randomised controlled study to determine the most successful site.
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Jun Takeshita, Yoshinobu Nakayama, Yasufumi Nakajima, Sessler, Daniel I., Satoru Ogawa, Teiji Sawa, and Toshiki Mizobe
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- 2015
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13. Optimal doses of sevoflurane and propofol in rabbits.
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Yoshihide Terada, Tadahiko Ishiyama, Nobumasa Asano, Masakazu Kotoda, Kodai Ikemoto, Sessler, Daniel I., and Takashi Matsukawa
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SEVOFLURANE ,PROPOFOL ,ANESTHETICS ,HYPNOTICS ,LABORATORY rabbits - Abstract
Background Although sevoflurane and propofol are commonly used anesthetics in rabbits, optimal doses of remain unclear. We thus assessed the optimal hypnotic doses of sevoflurane and propofol, and evaluated the influence of dexmedetomidine on sevoflurane and propofol requirements. Methods Twenty-eight Japanese white rabbits were randomly assigned to one of four groups (n =7 each). Rabbits were given either sevoflurane, propofol, sevoflurane + dexmedetomidine, or propofol + dexmedetomidine (injected 30 μg.kg
-1 .hr-1 for 10 min followed by an infusion of 3.5 μg.kg-1 .hr-1 ). Hypnotic level was evaluated with Bispectral Index (BIS), a well-validated electroenchalographic measure, with values between 40 and 60 representing optimal hypnosis. BIS measurements were made 10 minutes after the adjustment of target end-tidal sevoflurane concentration in the sevoflurane group and sevoflurane + dexmedetomidine group, and at 10 min after the change of infusion rate in the propofol group and propofol + dexmedetomidine group. Results BIS values were linearly related to sevoflurane concentration and propofol infusion rate, with or without dexmedetomidine. Sevoflurane concentration at BIS =50 was 3.9 ± 0.2% in the sevoflurane group and 2.6 ± 0.3% in the sevoflurane + dexmedetomidine group. The propofol infusion rate to make BIS =50 was 102 ± 5 mg.kg-1 .hr-1 in the propofol group, and 90 ± 10 mg.kg-1 .hr-1 in the propofol + dexmedetomidine group. Conclusions The optimal end-tidal concentration of sevoflurane alone was thus 3.9%, and optimal infusion rate for propofol alone was 102 mg.kg-1 .hr-1 . Dexmedetomidine reduced sevoflurane requirement by 33% and propofol requirement by 11%. [ABSTRACT FROM AUTHOR]- Published
- 2014
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14. Design and Organization of the Dexamethasone,Light Anesthesia and Tight Glucose Control (DeLiT)Trial: a factorial trial evaluating the effects ofcorticosteroids, glucose control, anddepth-of-anesthesia on perioperativeinflammation and morbidity from majornon-cardiac surgery
- Author
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Abdelmalak, Basem, Maheshwari, Ankit, Mascha, Edward, Srivastava, Sunita, Marks, Theodore, Tang, WH Wilson, Kurz, Andrea, and Sessler, Daniel I.
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INFLAMMATORY mediators ,DISEASES ,MORTALITY ,PLACEBOS ,CLINICAL trials - Abstract
Background: The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia. Methods/Design: The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major noncardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS) monitoring (Aspect medical, Newton, MA). The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment. Discussion: The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three. Trial registration: This trial is registered at Clinicaltrials.gov #: NTC00433251 [ABSTRACT FROM AUTHOR]
- Published
- 2010
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15. Nitrous oxide may not increase the risk of cancer recurrence after colorectal surgery: a follow-up of a randomized controlled trial.
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Fleischmann, Edith, Marschalek, Corinna, Schlemitz, Katja, Dalton, Jarrod E., Gruenberger, Thomas, Herbst, Friedrich, Kurz, Andrea, and Sessler, Daniel I.
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ONCOLOGIC surgery ,NITROUS oxide ,CANCER relapse ,COLON cancer ,KILLER cells ,RANDOMIZED controlled trials - Abstract
Background: Even the best cancer surgery is usually associated with minimal residual disease. Whether these remaining malignant cells develop into clinical recurrence is at least partially determined by adequacy of host defense, especially natural killer cell function. Anesthetics impair immune defenses to varying degrees, but nitrous oxide appears to be especially problematic. We therefore tested the hypothesis that colorectal-cancer recurrence risk is augmented by nitrous oxide administration during colorectal surgery. Methods: We conducted a 4- to 8-year follow-up of 204 patients with colorectal cancer who were randomly assigned to 65% nitrous oxide (n = 97) or nitrogen (n = 107), balanced with isoflurane and remifentanil. The primary outcome was the time to cancer recurrence. Our primary analysis was a multivariable Cox-proportional-hazards regression model that included relevant baseline variables. In addition to treatment group, the model considered patient age, tumor grade, dissemination, adjacent organ invasion, vessel invasion, and the number of nodes involved. The study had 80% power to detect a 56% or greater reduction in recurrence rates (i.e., hazard ratio of 0.44 or less) at the 0.05 significance level. Results: After adjusting for significant baseline covariables, risk of recurrence did not differ significantly for nitrous oxide and nitrogen, with a hazard ratio estimate (95% CI) of 1.10 (0.66, 1.83), P = 0.72. No two-way interactions with the treatment were statistically significant. Conclusion: Colorectal-cancer recurrence risks were not greatly different in patients who were randomly assigned to 65% nitrous oxide or nitrogen during surgery. Our results may not support avoiding nitrous oxide use to prevent recurrence of colorectal cancer. Implications Statement: The risk of colorectal cancer recurrence was similar in patients who were randomly assigned to 65% nitrous oxide or nitrogen during colorectal surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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16. Differential effects of antibiotics in combination with G-CSF on survival and polymorphonuclear granulocyte cell functions in septic rats.
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Bauhofer, Artur, Huttel, Markus, Lorenz, Wilfried, Sessler, Daniel I., and Torossian, Alexander
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PHYSIOLOGICAL effects of antibiotics ,GRANULOCYTE-colony stimulating factor ,CELL physiology ,SEPSIS ,LABORATORY rats ,RANDOMIZED controlled trials - Abstract
Background: In addition to their antimicrobial activity, antibiotics modulate cellular host defence. Granulocyte-colony stimulating factor (G-CSF) is also a well known immunomodulator; however little is known about the interactions of G-CSF with antibiotics. We investigated in septic rats the effects of two antibiotic combinations with G-CSF. Methods: In two clinic modelling randomised trials (CMRTs), male Wistar rats were anesthetized, given antibiotic prophylaxis, had a laparotomy with peritoneal contamination and infection (PCI), and were randomly assigned (n = 18 rats/group) to: 1) PCI only; 2) PCI+antibiotic; and, 3) PCI+antibiotic+G-CSF prophylaxis (20 µg/kg, three times). This sequence was conducted first with 10 mg/kg coamoxiclav, and then with ceftriaxone/metronidazole (Cef/met, 10/3 mg/kg). In additional animals, the blood cell count, migration and superoxide production of PMNs, systemic TNF-α and liver cytokine mRNA expression levels were determined. Results: Only the combination coamoxiclav plus G-CSF improved the survival rate (82 vs. 44%, p < 0.001). Improved survival with this combination was accompanied by normalised antimicrobial PMN migratory activity and superoxide production, along with normalised systemic TNF-α levels and a reduced expression of TNF-α and IL-1 in the liver. Conclusion: There are substantial differences in the interaction of antibiotics with G-CSF. Therefore, the selection of the antibiotic for combination with G-CSF in sepsis treatment should be guided not only by the bacteria to be eliminated, but also by the effects on antimicrobial functions of PMNs and the cytokine response. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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17. The effects of Y-27632 on pial microvessels during global brain ischemia and reperfusion in rabbits.
- Author
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Shintani N, Ishiyama T, Kotoda M, Asano N, Sessler DI, and Matsukawa T
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- Animals, Blood Glucose drug effects, Blood Pressure drug effects, Brain Ischemia complications, Propofol adverse effects, Rabbits, Reperfusion Injury complications, Amides pharmacology, Brain Ischemia blood, Microvessels drug effects, Pia Mater blood supply, Pyridines pharmacology, Reperfusion Injury prevention & control, Vasoconstriction drug effects
- Abstract
Background: Global brain ischemia-reperfusion during propofol anesthesia provokes persistent cerebral pial constriction. Constriction is likely mediated by Rho-kinase. Cerebral vasoconstriction possibly exacerbates ischemic brain injury. Because Y-27632 is a potent Rho-kinase inhibitor, it should be necessary to evaluate its effects on cerebral pial vessels during ischemia-reperfusion period. We therefore tested the hypotheses that Y-27632 dilates cerebral pial arterioles after the ischemia-reperfusion injury, and evaluated the time-course of cerebral pial arteriolar status after the ischemia-reperfusion., Methods: Japanese white rabbits were anesthetized with propofol, and a closed cranial window inserted over the left hemisphere. Global brain ischemia was produced by clamping the brachiocephalic, left common carotid, and left subclavian arteries for 15 min. Rabbits were assigned to cranial window perfusion with: (1) artificial cerebrospinal fluid (Control group, n = 7); (2) topical infusion of Y-27632 10
-6 mol · L-1 for 30 min before the initiation of global brain ischemia (Pre group, n = 7); (3) topical infusion of Y-27632 10-6 mol · L-1 starting 30 min before ischemia and continuing throughout the study period (Continuous group, n = 7); and, (4) topical infusion of Y-27632 10-6 mol · L-1 starting 10 min after the ischemia and continuing until the end of the study (Post group, n = 7). Cerebral pial arterial and venule diameters were recorded 30 min before ischemia, just before arterial clamping, 10 min after clamping, and 5, 10, 20, 40, 60, 80, 100, and 120 min after unclamping., Results: Mean arterial blood pressure and blood glucose concentration increased significantly after global brain ischemia except in the Continuous group. In the Pre and Continuous groups, topical application of Y-27632 produced dilation of large (mean 18-19%) and small (mean; 25-29%) pial arteries, without apparent effect on venules. Compared with the Control and Pre groups, arterioles were significantly dilated during the reperfusion period in the Continuous and Post groups (mean at 120 min: 5-8% in large arterioles and 11-12% in small arterioles)., Conclusions: Y-27632 dilated cerebral pial arterioles during reperfusion. Y-27632 may enhance recovery from ischemia by preventing arteriolar vasoconstriction during reperfusion.- Published
- 2017
- Full Text
- View/download PDF
18. The effects of topical and intravenous JM-1232(-) on cerebral pial microvessels of rabbits.
- Author
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Ikemoto K, Ishiyama T, Shintani N, Asano N, Sessler DI, and Matsukawa T
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- Administration, Intravenous, Administration, Topical, Animals, Arterioles physiology, Dose-Response Relationship, Drug, Hypercapnia physiopathology, Hypocapnia physiopathology, Rabbits, Venules physiology, Arterioles drug effects, Isoindoles administration & dosage, Isoindoles pharmacology, Pia Mater blood supply, Pia Mater drug effects, Piperazines administration & dosage, Piperazines pharmacology, Venules drug effects
- Abstract
Background: JM-1232(-) is a novel anesthetic agent which acts through gamma-aminobutyric acid receptors. Cerebral pial vascular effects of JM-1232(-) are unknown. We thus evaluated topical and intravenous effects of JM-1232(-) on cerebral pial microvessels in rabbits, and the extent to which carbon dioxide (CO2) reactivity is preserved., Methods: Closed cranial windows were used to visualize cerebral pial circulation in 29 Japanese white rabbits. In the first experiment, the cranial window was superfused with increasing concentrations of JM-1232(-): 10(-11), 10(-9), 10(-7), 10(-5) mol/L, n = 8 per concentration. In the second experiment, we examined the effects of an intravenous bolus of 1 mg/kg bolus of JM-1232(-), followed by the continuous infusion at 0.3 mg/kg/minute on cerebral pial vascular alteration (n = 9). In the third, we examined CO2 reactivity of cerebral pial vessels under JM-1232(-) (n = 6) or sevoflurane anesthesia (n = 6)., Results: Topical application of JM-1232(-) did not change pial venular diameter, and constricted arterials only at the highest concentration. Intravenous administration of JM-1232(-) produced cerebral pial constriction which gradually diminished over time. Under intravenous administration of JM-1232(-) and inhaled sevoflurane, diameters of vessels increased in parallel with CO2 partial pressure. Slopes of linear regression and correlation coefficients in arterioles and venules were comparable for JM-1232(-) anesthesia and sevoflurane anesthesia., Conclusions: Topical application of JM-1232(-) had little effect on cerebral pial vessels. Intravenous administration produced vasoconstriction of cerebral pial arterioles and venules, however those changes were clinically unimportant. In addition, JM-1232(-) did not impair CO2 responsiveness. At least from the perspective of vascular reactivity, JM-1232(-) thus appears safe for neurosurgical patients.
- Published
- 2015
- Full Text
- View/download PDF
19. Optimal doses of sevoflurane and propofol in rabbits.
- Author
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Terada Y, Ishiyama T, Asano N, Kotoda M, Ikemoto K, Shintani N, Sessler DI, and Matsukawa T
- Subjects
- Anesthesia, Animals, Blood Pressure drug effects, Body Temperature drug effects, Consciousness Monitors, Dexmedetomidine administration & dosage, Dexmedetomidine pharmacology, Dose-Response Relationship, Drug, Heart Rate drug effects, Linear Models, Rabbits, Sevoflurane, Systole drug effects, Methyl Ethers administration & dosage, Methyl Ethers pharmacology, Propofol administration & dosage, Propofol pharmacology
- Abstract
Background: Although sevoflurane and propofol are commonly used anesthetics in rabbits, optimal doses of remain unclear. We thus assessed the optimal hypnotic doses of sevoflurane and propofol, and evaluated the influence of dexmedetomidine on sevoflurane and propofol requirements., Methods: Twenty-eight Japanese white rabbits were randomly assigned to one of four groups (n=7 each). Rabbits were given either sevoflurane, propofol, sevoflurane+dexmedetomidine, or propofol+dexmedetomidine (injected 30 μg∙kg(-1)∙hr(-1) for 10 min followed by an infusion of 3.5 μg∙kg(-1)∙hr(-1)). Hypnotic level was evaluated with Bispectral Index (BIS), a well-validated electroenchalographic measure, with values between 40 and 60 representing optimal hypnosis. BIS measurements were made 10 minutes after the adjustment of target end-tidal sevoflurane concentration in the sevoflurane group and sevoflurane+dexmedetomidine group, and at 10 min after the change of infusion rate in the propofol group and propofol+dexmedetomidine group., Results: BIS values were linearly related to sevoflurane concentration and propofol infusion rate, with or without dexmedetomidine. Sevoflurane concentration at BIS=50 was 3.9±0.2% in the sevoflurane group and 2.6±0.3% in the sevoflurane+dexmedetomidine group. The propofol infusion rate to make BIS=50 was 102±5 mg∙kg(-1)∙hr(-1) in the propofol group, and 90±10 mg∙kg(-1)∙hr(-1) in the propofol+dexmedetomidine group., Conclusions: The optimal end-tidal concentration of sevoflurane alone was thus 3.9%, and optimal infusion rate for propofol alone was 102 mg∙kg(-1)∙hr(-1). Dexmedetomidine reduced sevoflurane requirement by 33% and propofol requirement by 11%.
- Published
- 2014
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20. Choice of anesthetic technique on plasma concentrations of interleukins and cell adhesion molecules.
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Ionescu DC, Margarit SC, Hadade AN, Mocan TN, Miron NA, and Sessler DI
- Abstract
Background: Whether inflammatory responses to surgery are comparably activated during total intravenous anesthesia (TIVA) and during volatile anesthesia remains unclear. We thus compared the perioperative effects of TIVA and isoflurane anesthesia on plasma concentrations of proinflammatory and anti-inflammatory interleukins and cell adhesion molecules., Methods: Patients having laparoscopic cholecystectomies were randomly allocated to two groups: 44 were assigned to TIVA and 44 to isoflurane anesthesia. IL-1β, IL-6, IL-8, IL-10, IL-13, and the cellular adhesion molecules intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 were determined preoperatively, before incision, and at 2 and 24 hours postoperatively. Our primary outcomes were area-under-the-curve cytokine and adhesion molecule concentrations over 24 postoperative hours., Results: The only statistically significant difference in area-under-the-curve concentrations was for IL-6, which was greater in patients given isoflurane:78 (95% confidence interval (CI): 52 to 109) pg/ml versus 33 (22 to 50) pg/ml, P= 0.006. Two hours after surgery, IL-6 was significantly greater than baseline in patients assigned to isoflurane: 47 (95% CI: 4 to 216, P<0.001) pg/ml versus 18 (95%CI: 4 to 374, P<0.001) pg/ml in the TIVA group. In contrast, IL-10 was significantly greater in patients assigned to TIVA: 20 (95% CI: 2 to 140, P<0.001) pg/ml versus 12 (95% CI: 3 to 126, P<0.001) pg/ml. By 24 hours after surgery, concentrations were generally similar between study groups and similar to baseline values., Conclusion: The only biomarker whose postoperative area-under-the-curve concentrations differed significantly as a function of anesthetic management was IL-6. Two hours after surgery, IL-6 concentrations were significantly greater in patients given isoflurane than TIVA. However, the differences were modest and seem unlikely to prove clinically important. Further studies are needed.
- Published
- 2013
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21. Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT) Trial: a factorial trial evaluating the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery.
- Author
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Abdelmalak B, Maheshwari A, Mascha E, Srivastava S, Marks T, Tang WW, Kurz A, and Sessler DI
- Abstract
Background: The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia., Methods/design: The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major non-cardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS) monitoring (Aspect medical, Newton, MA). The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment., Discussion: The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three., Trial Registration: This trial is registered at Clinicaltrials.gov #: NTC00433251.
- Published
- 2010
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22. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure.
- Author
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Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J, and Wadhwa A
- Abstract
BACKGROUND: Cuff pressure in endotracheal (ET) tubes should be in the range of 20-30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. METHODS: With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to study purpose. Cuff pressure in tube sizes 7.0 to 8.5 mm was evaluated 60 min after induction of general anesthesia using a manometer connected to the cuff pilot balloon. Nitrous oxide was disallowed. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. RESULTS: Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 +/- 21.6 cmH2O). Only 27% of pressures were within 20-30 cmH2O; 27% exceeded 40 cmH2O. Although it varied considerably, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size. CONCLUSION: We recommend that ET cuff pressure be set and monitored with a manometer.
- Published
- 2004
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