Patrick McQuillan

Penn State Hershey Medical Center and Penn State College of Medicine, هرشي، بنسيلفانيا, Pennsylvania, United States

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Publications (27)63.03 Total impact

  • Keith Reid · Patrick McQuillan · Zakiyah Kadry · Piotr Janicki · Dmitri Bezinover ·
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    ABSTRACT: Good right ventricular function and responsiveness to vasodilator therapy are the most important prerequisites for successful liver transplant in patients with portopulmonary hypertension. A patient with portopulmonary hypertension and good right ventricular function presented for deceased-donor liver transplant. Pulmonary arterial pressure was controlled with epoprostenol and sildenafil preoperatively. After anesthesia induction, pulmonary arterial pressure increased significantly and the procedure was aborted. Additional medical treatment included aggressive vasodilator therapy and the transplant was successfully performed 1 month later. During the procedure, elevations in pulmonary arterial pressure responded to a combination of inhaled nitric oxide, intravenous milrinone and nitroglycerin, and optimization of mechanical ventilation.
    06/2015; DOI:10.6002/ect.2014.0250
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    ABSTRACT: A reliable screening test for Coronary Artery Disease (CAD) in liver transplant (LT) candidates with end stage liver disease is essential because a high percentage of perioperative mortality and morbidity is CAD-related. In this study the effectiveness of Myocardial Perfusion Imaging (MPI) for identification of significant CAD in LT candidates was evaluated. Records of 244 patients meeting criteria for MPI were evaluated: 74 met inclusion criteria; 40 had a positive MPI and cardiology follow-up; 27 had a negative MPI and underwent LT; and 7 had a negative MPI and then had coronary angiography or a significant cardiac event. A selective MPI interpretation strategy was established where MPI-positive patients were divided into high, intermediate, and low CAD-risk groups. The overall incidence of CAD in this study population was 5.1% and our strategy resulted in PPV 20%, NPV 94%, sensitivity 80%, and specificity 50% for categorizing CAD risk. When applied only to the subset of patients categorized as high CAD-risk, the strategy was more effective, with PPV 67%, NPV 97%, sensitivity 80%, and specificity 94%. We determined that renal dysfunction was an independent predictive factor for CAD (p<0.0001, Odds Ratio=8.1), and grades of coronary occlusion correlated significantly with chronic renal dysfunction (p=0.0079).This article is protected by copyright. All rights reserved.
    Clinical Transplantation 01/2015; 29(4). DOI:10.1111/ctr.12517 · 1.52 Impact Factor
  • J.A. Anson · S. Vaida · D M Giampetro · P M McQuillan ·
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    ABSTRACT: The anesthetic management of labor and delivery in patients with elevated intracranial pressure is complex. This review discusses the etiologies of diffuse and focal pathologies which lead to elevated intracranial pressure in pregnancy. The role of neuraxial and general anesthesia in the management of labor and delivery is also examined. Finally, a comprehensive review of strategies to minimize increases in intracranial pressure during general anesthesia for cesarean delivery is presented. Copyright © 2015 Elsevier Ltd. All rights reserved.
    International Journal of Obstetric Anesthesia 01/2015; 24(2). DOI:10.1016/j.ijoa.2015.01.004 · 1.60 Impact Factor
  • Lili Xu · Zhiyong Hu · Jianjun Shen · Patrick M. McQuillan ·
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    ABSTRACT: Cerebral injury caused by hypoperfusion during the perioperative period is one of the main causes of disability and death in patients after major surgery. No effective protective or preventative strategies have been identified. This study was designed to evaluate the effects of Ginkgo biloba extract on cerebral oxygen and glucose metabolism in elderly patients with known, pre-existing cerebral ischemia. Sixty ASA (American Society of Anesthesiologists) II-III patients, diagnosed with vertebral artery ischemia by transcranial Doppler ultrasonography (TCD), and scheduled for elective total hip replacement surgery, were enrolled in the study. They were randomly allocated to receive either 1mg/kg Ginkgo biloba extract (G group n=30) or normal saline (D group n=30) after induction of anesthesia. Blood samples were collected from radial artery and jugular venous bulb catheters for blood gas analysis and determination of glucose and lactate concentrations preoperatively, before surgical incision, at the end of surgery, and on post-op day 1. Arterial O2 content (CaO2), jugular venous O2 content (CjvO2), arteriovenous O2 content difference (Da-jvO2), cerebral oxygen extraction rate (CEO2), and arteriovenous glucose and lactate content differences (Da-jvGlu and Da-jvLac) were calculated. There were no significant differences in CaO2 or Da-jvGlu during surgery between groups (p>0.05). However, the Ginkgo group had higher CjvO2, internal jugular venous oxygen saturation (SjvO2) and lower CEO2, Da-jvO2 and Da-jvLac at the end of surgery (T2) and on post-op day 1 (T3) than those in the control group (p<0.05). Ginkgo biloba extract can improve cerebral oxygen supply, decrease cerebral oxygen extraction rate and consumption, and help maintain the balance between cerebral oxygen supply and consumption. It has no effect, however, on cerebral glucose metabolism in elderly patients with known, pre-existing cerebral ischemia. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Complementary Therapies in Medicine 01/2015; 23(2). DOI:10.1016/j.ctim.2014.12.009 · 1.55 Impact Factor
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    ABSTRACT: In this report, we describe a case of posterior reversible encephalopathy syndrome in a female patient after deceased donor liver transplantation. She developed posterior reversible encephalopathy syndrome on postoperative day 3 and did not improve despite adjustments in immunosuppressive therapy. The patient had symptoms of severe brain edema requiring maximal therapy, which included cooling, mannitol, 3% saline, and a pentobarbital infusion. Attempts to lighten the level of sedation failed because of recurring intractable seizure activity. Reductions in therapeutic support were ultimately successful after 62 days of continuous pentobarbital therapy. The patient awoke neurologically intact and was discharged to a rehabilitation center in good condition.
    12/2014; 3(11):149-52. DOI:10.1213/XAA.0000000000000093
  • Lili Xu · Zhiyong Hu · Jianjun Shen · Patrick M. McQuillan ·
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    ABSTRACT: This study was designed to determine the effects of dexmedetomidine on perioperative myocardial injury by observing peripheral circulatory changes in response to tracheal intubation and extubation, myocardial enzyme levels, myocardial ischemia improvements, cardiovascular adverse events and cytokines in patients with coronary heart disease (CHD) undergoing non-cardiac surgery. This study was a prospective, randomized, double-blind trial. Eighty patients having CHD were scheduled for elective hip replacement surgery and randomly allocated to receive a loading dose of 1μg/kg dexmedetomidine followed with a 0.2 μg/kg/h infusion (Dex group n = 40) or normal saline (Control group n = 40). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), rate pressure product (RPP) and changes of ST-T segment in ECG were recorded every 5 minutes during surgery. Serum creatine kinase-MB(CK-MB), cardiac troponin I(cTnI), glycogen phosphorylase BB(GP-BB), interleukin-6(IL-6) and tumor necrosis factor(TNF-α) protein levels were determined preoperatively, at the end of surgery, 12h post-surgery and 24h post-surgery. The improvement rate of myocardial ischemia (87.5% vs 32.5%, p<0.05) was higher in the dexmedetomidine group than in the control group. The dexmedetomidine group had lower serum CK-MB, IL-6, cTnI and GP-BB concentrations than those in the control group (p<0.05). There was no significance difference in TNF-α between the two groups (p>0.05). Dexmedetomidine can reduce myocardial injury and cytokines levels in patients with CHD undergoing non-cardiac surgery.This article is protected by copyright. All rights reserved.
    Clinical and Experimental Pharmacology and Physiology 08/2014; 41(11). DOI:10.1111/1440-1681.12296 · 2.37 Impact Factor
  • Julie T Vuong · Patrick M McQuillan · Evangelos Messaris · Sanjib Das Adhikary ·
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    ABSTRACT: Elderly patients undergoing emergency intra-abdominal surgery are at high risk for morbidity and mortality. The risks and side-effects associated with intubation and mechanical ventilation or neuraxial anesthesia must be balanced against the need to maintain hemodynamic stability while maximizing pain control. Providing anesthesia and analgesia without either of these techniques can be a difficult prospect. We present three cases of ultrasound guided transversus abdominis plane (TAP) block as the primary anesthetic for laparotomy in elderly patients with multiple comorbidities. We have demonstrated the efficacy of and recommend the use of TAP blocks as the primary surgical anesthetic in a selected group of patients undergoing laparotomy.
    Journal of Anaesthesiology Clinical Pharmacology 07/2014; 30(3):419-21. DOI:10.4103/0970-9185.137284
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    ABSTRACT: Cardiac ischemia and angina pectoris are commonly experienced during exertion in a cold environment. In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic beta-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (-15 to -30° C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate (HR), blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were measured continuously. Rate pressure product (RPP) was calculated and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2441 ± 376) and control conditions (3159 ± 626); CBV responses were also not different between treatments. With propranolol, the HR (8 ± 1 versus 14 ± 3 bpm) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller ΔCBV (1.4 ± 0.8 versus 5.3 ± 1.4 cm/sec, P=0.035) such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43 ± 0.37 versus 2.1 ± 0.63 au). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, beta-adrenergic vasodilation may play a significant role in coronary regulation during exercise.
    AJP Heart and Circulatory Physiology 05/2014; 307(2). DOI:10.1152/ajpheart.00174.2014 · 3.84 Impact Factor
  • Jonathan A Anson · Patrick M McQuillan ·
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    ABSTRACT: A healthy 21-year-old primigravida presented for elective cesarean section. At 45 min after intrathecal (IT) injection of bupivacaine, morphine and fentanyl she developed dysphagia, right sided facial droop, ptosis and ulnar nerve weakness. This constellation of signs and symptoms resolved 2 h later. Based on the time course and laterality of her symptoms, as well as the pharmacologic properties of spinal opioids, we believe her symptoms can be attributed to the IT administration of fentanyl.
    Journal of Anaesthesiology Clinical Pharmacology 04/2014; 30(2):273-5. DOI:10.4103/0970-9185.130073
  • S D Adhikary · A Hadzic · P M McQuillan ·

    BJA British Journal of Anaesthesia 11/2013; 111(5):844-845. DOI:10.1093/bja/aet364 · 4.85 Impact Factor
  • Zhi-Rui Zhu · Zhi-Yong Hu · Yi-Lei Jiang · Li-Li Xu · Patrick M McQuillan ·
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    ABSTRACT: To evaluate the efficacy and safety of a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a double-lumen central venous catheter (DLCVC) in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis. Thirty-six pediatric patients with laryngeal papillomatosis undergoing suspension laryngoscopic surgery were anesthetized with oxygen and volatile anesthetic insufflation while spontaneously breathing. Anesthesia was induced by inhalation of 8% sevoflurane in oxygen by mask. Atropine, dexamethasone, lidocaine, and midazolam were administered intravenously. The tip of a 7Fr DLCVC was inserted below the glottis after placement of the laryngoscope and establishing suspension. Anesthesia was maintained with insufflation of 4-6% sevoflurane and oxygen with a total fresh gas flow of 6 l·min(-1) through the 14G (larger lumen) of the DLCVC. Endtidal carbon dioxide tension (PetCO2 ) was monitored using the other lumen of the DLCVC, which was connected to the CO2 sampling line. Duration of the procedure as well as total anesthesia time was recorded. Electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2 ), and PetCO2 were also monitored. Arterial blood was sampled for blood gas analysis including pH, PaO2 , PaCO2 , and actual base excess (ABE). Complications, including intraoperative patient movement, hypoxemia (SpO2 < 95% during oxygen insufflation), nausea, vomiting, bronchospasm, and arrhythmias, were recorded. There was a significant increase in PetCO2 and PaCO2 (P values <0.05) as well as a decrease in ABE, pH, and PaO2 (P values <0.05) in samples collected before and after surgery. MAP, HR, and SpO2 after surgery were not significantly different from after induction values (P values >0.05). During surgery, SpO2 < 95% in three cases and body movements in three cases were observed. No patient had any other of the complications previously described. Furthermore, no postsurgical endotracheal intubation was needed in any patient. After establishing an adequate depth of anesthesia, a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a DLCVC is feasible in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis.
    Pediatric Anesthesia 08/2013; 24(2). DOI:10.1111/pan.12253 · 1.85 Impact Factor
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    ABSTRACT: Tactile stimulation of the oropharynx (TSO) elicits the gag reflex and increases heart rate (HR) and mean arterial pressure (MAP) in anesthetized patients. However, the interaction between upper airway defense reflexes and the sympathetic nervous system has not been investigated in conscious humans. In Experiment 1, beat-by-beat measurements of HR, MAP, muscle sympathetic nerve activity (MSNA) and renal vascular resistance (RVR) were measured during TSO and tactile stimulation of the hard palate (Sham) in the supine posture. In Experiment 2, TSO was performed before and after inhalation of 4% lidocaine via nebulizer. Rate pressure product (RPP) was determined. Compared to Sham, TSO elicited the gag reflex and increased RPP (Δ36 ± 6 vs. 17 ± 5%), MSNA (Δ122 ± 39 vs 19 ± 19%) and RVR (Δ55 ± 11 vs. 4 ± 4%). This effect occurred within 1-2 cardiac cycles of TSO. The ΔMAP (12 ± 3 vs. 6 ± 1 mmHg) and the ΔHR (10 ± 3 vs. 3 ± 3 bpm) were also greater following TSO compared to Sham. Lidocaine inhalation blocked the gag reflex and attenuated increases in MAP (Δpre: 16 ± 2; Δpost: 5 ± 2 mmHg) and HR (Δpre: 12 ± 3; Δpost: 2 ± 2 bpm) in response to TSO. When mechanically stimulated, afferents in the oropharynx not only serve to protect the airway but also cause reflex increases in MSNA, RVR, MAP, and HR. An augmented sympathoexcitatory response during intubation and laryngoscopy may contribute to perioperative cardiovascular morbidity and mortality.
    Journal of Applied Physiology 04/2013; 115(1). DOI:10.1152/japplphysiol.00197.2013 · 3.06 Impact Factor
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    ABSTRACT: Background: Controversy exists regarding the increased safety profile when ultrasound is used for central venous catheters inserted in the subclavian or axillary vein. The critically ill neurosurgical patient presents unique considerations for the optimal central line approach. Methods: This report is a retrospective chart review of 6 neurosurgical intensive care patients in whom an ultrasound-guided, transpectoral, axillary vein catheterization was attempted. A sterile technique was observed. The anatomy was confirmed using combined transverse, longitudinal, and Doppler flow images. The needle tip was advanced into the axillary vein under real-time ultrasound using an in-plane technique. The central venous catheter was inserted using the Seldinger technique. A chest radiograph was obtained after each line. Results: Five of the 6 central lines were inserted easily, without complications. The sixth central line was inserted without complications but more proximally because of difficulty in visualizing the axillary vein on account of the patient's morbid obesity and severe hypovolemia. Conclusions: This series illustrates new and useful aspects of ultrasound use in transpectoral axillary vein catheterization: it requires minimal additional training; it combines the real time, in-plane technique with transverse, longitudinal, and Doppler color flow images; and it is used safely in the critically ill neurosurgical patient. The data on infraclavicular central venous catheters indicate decreased line sepsis, arterial punctures, and venous thrombosis while improving nursing care and patient comfort. This technique's potential for decreasing the risk of pneumothorax may make it a reasonable option for many critically ill patients in whom other central venous catheter approaches may not be ideal.
    Journal of neurosurgical anesthesiology 08/2012; 25(1). DOI:10.1097/ANA.0b013e318264542e · 2.99 Impact Factor
  • Jian Cui · Patrick M McQuillan · Cheryl Blaha · Allen R Kunselman · Lawrence I Sinoway ·
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    ABSTRACT: We have recently shown that a saline infusion in the veins of an arterially occluded human forearm evokes a systemic response with increases in muscle sympathetic nerve activity (MSNA) and blood pressure. In this report, we examined whether this response was a reflex that was due to venous distension. Blood pressure (Finometer), heart rate, and MSNA (microneurography) were assessed in 14 young healthy subjects. In the saline trial (n = 14), 5% forearm volume normal saline was infused in an arterially occluded arm. To block afferents in the limb, 90 mg of lidocaine were added to the same volume of saline in six subjects during a separate visit. To examine whether interstitial perfusion of normal saline alone induced the responses, the same volume of albumin solution (5% concentration) was infused in 11 subjects in separate studies. Lidocaine abolished the MSNA and blood pressure responses seen with saline infusion. Moreover, compared with the saline infusion, an albumin infusion induced a larger (MSNA: Δ14.3 ± 2.7 vs. Δ8.5 ± 1.3 bursts/min, P < 0.01) and more sustained MSNA and blood pressure responses. These data suggest that venous distension activates afferent nerves and evokes a powerful systemic sympathoexcitatory reflex. We posit that the venous distension plays an important role in evoking the autonomic adjustments seen with postural stress in human subjects.
    AJP Heart and Circulatory Physiology 06/2012; 303(4):H457-63. DOI:10.1152/ajpheart.00236.2012 · 3.84 Impact Factor
  • R Kapoor · S D Adhikary · C Siefring · P M McQuillan ·
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    ABSTRACT: Recently, ultrasound-guided saphenous nerve blocks within and distal to the adductor canal have shown success. However, a potential side effect is an unintentional block of branches of the nerve to the vastus medialis resulting in undesired motor weakness. We dissected 40 embalmed cadaver thighs to determine the course and relation of the saphenous nerve to the nerve to the vastus medialis. Measurements were taken between various landmarks, and descriptive statistics were used to present the collected data. In 72.5% of specimens, the most distal visible branch of the nerve to the vastus medialis pierced the muscle proximal to the site where the saphenous nerve crosses the anterior surface of the superficial femoral artery to become medial to the vessel. Knowledge of this anatomy may help establish a safe region in preventing motor blockade when performing saphenous nerve blocks.
    Acta Anaesthesiologica Scandinavica 03/2012; 56(3):365-7. DOI:10.1111/j.1399-6576.2011.02645.x · 2.32 Impact Factor
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    ABSTRACT: Cold storage in any of the commonly used preservation solutions is not always adequate for donation after cardiac death (DCD) liver grafts due to prolonged warm ischemic time. In this study, we used a third-generation perfluorocarbon (PFC), Oxycyte, for DCD liver graft preservation in a rat model. Twenty-eight rats (14 in each group) were used. Thirty minutes after cardiopulmonary arrest, livers were harvested and flushed with a cold and pre-oxygenated solution of either University of Wisconsin (UW) or UW + 20% PFC. After 8 h of cold preservation in either of the investigated solutions, liver graft specimens were analyzed for evidence of ischemic injury. Hemotoxylin and eosin staining (H and E), as well as immunohistochemical analysis with anti-cleaved caspase 3 antibody, was performed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the preservation solution were analyzed at 1 and 8 h during preservation. In the PFC group, the degree of cell congestion, vacuolization and necrosis were all significantly less than in the UW group (P = 0.002-0.004). The number of cells with a positive cleaved caspase 3 antibody reaction was reduced by about 50% in comparison with the UW group (P < 0.006). The AST level in the PFC group was significantly less than in the UW group after 8 h of preservation (P < 0.048). The addition of PFC to UW solution significantly decreases the degree of histologic damage in rat DCD liver grafts. This preservation strategy can be potentially helpful for organ preservation after prolonged warm ischemia.
    Journal of Surgical Research 04/2011; 175(1):131-7. DOI:10.1016/j.jss.2011.02.046 · 1.94 Impact Factor
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    ABSTRACT: The objectives of this prospective, observational study were (1) to determine whether a transplanted liver graft releases proinflammatory cytokines into the systemic circulation upon reperfusion and (2) to determine whether they contribute to any subsequent hemodynamic instability observed after graft reperfusion (if this release occurs). Blood samples from 17 consecutive patients undergoing liver transplantation were analyzed for cytokines, including tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-2, IL-6, and IL-8. Blood samples were obtained from the radial artery, portal vein, and flush blood (a sample taken from a catheter placed above the infrahepatic inferior vena cava clamp). The amount of catecholamines necessary to maintain a mean arterial pressure between 65 and 75 mm Hg during graft reperfusion was compared with the level of cytokines. A statistical analysis was performed with the least squares method, Kendall's tau-b test, and regression analysis. We demonstrated that flush blood from the liver grafts contained a significant amount and variety of cytokines. Most of these were removed by graft irrigation. The concentration of TNF-α in samples obtained from flush blood at the end of liver irrigation was significantly higher than the concentration in samples obtained from the radial artery (P = 0.0067) or portal vein (P = 0.0003) before reperfusion. This correlated directly with the amount of catecholamines used to treat hemodynamic instability. Although there were increased levels of IL-1β, IL-2, and IL-8 in the flush blood, there was no statistically significant correlation between the levels of these cytokines and the amount of catecholamines used.
    Liver Transplantation 03/2011; 17(3):324-30. DOI:10.1002/lt.22227 · 4.24 Impact Factor
  • Jian Cui · Patrick McQuillan · Lawrence I Sinoway ·

    CIRCULATION; 01/2011
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    ABSTRACT: Refractory hypotension is a frequent event during reperfusion of a liver graft. Measures that help maintain hemodynamic stability include correction of electrolytes and acid-base abnormalities as well as administration of fluid and/or catecholamines. Vasoplegic syndrome represents the most severe form of hemodynamic instability. Management of this condition is very difficult due primarily to the inadequate response to even very high doses of catecholamines. A 60-year-old patient presented for liver transplantation due to end stage liver disease. After an initially uneventful hepatic phase, the patient developed excessive tachycardia and refractory hypotension during cross-clamping of the vena cava. The situation rapidly deteriorated despite administration of fluid and extremely high doses of norepinephrine and vasopressin. A transesophageal echocardiogram (TEE) performed at that time failed to demonstrate any cardiac dysfunction or signs of pulmonary emboli. Subsequent blood cultures and imaging studies did not confirm any signs of sepsis. Further investigation revealed an increased preoperative level of cyclic guanosine monophosphate (cGMP). cGMP is the second messenger for nitric oxide, and is responsible for relaxation of vascular smooth muscle with subsequent vasodilatation. This finding suggests a release of nitric oxide in the systemic circulation which could have been a potential cause for vasoplegic shock. Release of nitric oxide in the systemic circulation can be a potential cause of vasoplegic syndrome. Future investigation will demonstrate whether a patient's preoperative cGMP plasma level can be a potential predictor of intraoperative hemodynamic instability.
    Medical science monitor: international medical journal of experimental and clinical research 09/2010; 16(9):CS114-7. · 1.43 Impact Factor
  • D Bezinover · L Douthitt · P.M. McQuillan · A Khan · P Dalal · J Stene · T Uemura · Z Kadry · P.K. Janicki ·
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    ABSTRACT: We present a case of severe hyperammonemia with subsequent brain herniation in an adult man after renal transplantation. After successful surgery and an initially uneventful postoperative course, the patient developed significant mental status changes associated with seizure activity. His condition rapidly deteriorated, requiring mechanical ventilation and cardiovascular support. Laboratory studies at that time demonstrated an increased serum ammonia level without evidence of liver or kidney dysfunction. Further investigation revealed an increased orotic acid level in the urine, suggesting a urea cycle disorder (UCD). Despite aggressive therapy, the patient's condition continued to deteriorate. Magnetic resonance imaging demonstrated severe brain edema with no cerebral perfusion; after consultation with the family, care was withdrawn. The combination of hyperammonemia and elevated urine orotic acid with normal liver and kidney function suggested a UCD. It is important to note that patients with a UCD may be free of symptoms for many years. Several factors are able to trigger the disease in adulthood, leading to encephalopathy and death. In this case, the patient's seizures were initially assumed to be a side effect of immunosuppressive therapy. Further diagnostic measures were only performed late in the course of the disease, which delayed the diagnosis of UCD.
    Transplantation Proceedings 06/2010; 42(5):1982-5. DOI:10.1016/j.transproceed.2010.03.142 · 0.98 Impact Factor

Publication Stats

122 Citations
63.03 Total Impact Points


  • 2007-2015
    • Penn State Hershey Medical Center and Penn State College of Medicine
      • • Anesthesiology
      • • Department of Anesthesia
      هرشي، بنسيلفانيا, Pennsylvania, United States
  • 2012
    • William Penn University
      Hershey, Pennsylvania, United States
  • 2006-2011
    • Philadelphia ZOO
      Filadelfia, Pennsylvania, United States
  • 2008
    • Pennsylvania State University
      • Department of Anesthesiology
      University Park, Maryland, United States