J C Horrow

The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

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Publications (41)298.58 Total impact

  • Anesthesiology 09/2000; 93(Supplement):A-84. DOI:10.1097/00000542-200009001-00084 · 5.88 Impact Factor
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    ABSTRACT: To determine the effect of the addition of disodium edetate (EDTA) to propofol on haemodynamics, ionised calcium and magnesium serum concentrations, and adverse events during cardiac surgery. Double-blind, randomised, multicenter trial. Operating room and intensive care unit of 5 academic health centres. A total of 102 evaluable patients, aged 34 to 85 years, undergoing first-time, elective coronary artery bypass graft surgery. Comparison of propofol with EDTA and propofol without EDTA, each in conjunction with the opioid sufentanil, for intraoperative anaesthesia and postoperative sedation. There were no significant differences at any time between the two formulations in any clinical chemistry measurements, including ionised calcium, ionised magnesium, total calcium, parathyroid hormone, blood urea nitrogen, creatinine, sodium, potassium, and phosphate. During bypass, the mean concentration of ionised calcium decreased to below the normal range, but the decrease was similar in both groups (propofol with EDTA, 0.98 +/- 0.07 mmol/L [N = 51]; propofol, 0.99 +/- 0.10 mmol/ L [N = 51]; p = NS). Calcium concentration returned to normal after rewarming. Mean ionised magnesium concentrations remained within normal limits in both groups. Similarly, there were no clinically meaningful differences between treatments with respect to haemodynamic variables, efficacy variables, or incidence of adverse events. The inclusion of EDTA in the current formulation of propofol appears to have no significant effects on calcium and magnesium profiles, renal function, haemodynamic variables, or other indicators of safety and efficacy during intraoperative anaesthesia and postoperative sedation in patients undergoing cardiac surgery.
    Intensive Care Medicine 02/2000; 26 Suppl 4(S3):S443-51. DOI:10.1007/PL00003788 · 7.21 Impact Factor
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    ABSTRACT: The right atrium and the right ventricle of fifty-five patients were imaged with transesophageal echocardiography during fifty-nine total knee arthroplasties performed with cement and the use of general anesthesia. The patients ranged in age from thirty-two to eighty-three years (mean, 65.5 years). Cardiopulmonary parameters were measured with use of hemodynamic monitoring systems, such as pulse oximeters, pulmonary artery catheters, and radial artery catheters. In addition, a femoral vein catheter was inserted on the side of the operation in ten of the fifty-five patients. Showers of echogenic material traversing the right atrium, the right ventricle, and the pulmonary artery after the tourniquet was deflated were observed to various degrees in all patients and lasted three to fifteen minutes. The mean peak intensity occurred within thirty seconds (range, twenty-four to forty-five seconds) after the tourniquet was released. The mean mixed venous oxygen saturation (and standard error of the mean) decreased (from 83+/-0.9 to 72+/-1.5 per cent) and the mean pulmonary arterial pressure increased (from 20+/-1.0 to 27+/-1.0 millimeters of mercury [2.67+/-0.13 to 3.60+/-0.13 kilopascals]), compared with the values before the tourniquet was released, in all patients. The pulmonary vascular resistance index increased after release of the tourniquet (to a maximum of 328+/-29 dyne.s.cm(-5).m2; p = 0.00002) only in the patients who had echogenic material that was at least 0.5 centimeter in diameter. Clinical pulmonary embolism developed postoperatively in three patients; all three had had echogenic particles that were more than 0.5 centimeter in maximum diameter on imaging. Blood aspirated from one of the pulmonary artery catheters and from five of the ten femoral vein catheters demonstrated fresh venous thrombus. Histological evaluation of the aspirates failed to demonstrate fat, marrow, or particles of polymethylmethacrylate. Surgeons should consider acute pulmonary embolism as a diagnosis when evaluating a patient who has hemodynamic collapse during total knee arthroplasty performed with cement.
    The Journal of Bone and Joint Surgery 03/1998; 80(3):389-96. · 5.28 Impact Factor
  • G. S. Okum · M. M. Keykhah · J. C. Horrow · R. J. Storella ·

    Anesthesiology 09/1997; 87(3). DOI:10.1097/00000542-199709001-00845 · 5.88 Impact Factor

  • Anesthesiology 09/1997; 87(3). DOI:10.1097/00000542-199709001-00095 · 5.88 Impact Factor
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    J T Abrams · J C Horrow · JA Bennett · D F Van Riper · R J Storella ·
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    ABSTRACT: Large-dose opioid induction of anesthesia can lead to difficult ventilation via a mask. Poor ventilatory compliance (VC) may be secondary to "rigid" chest and abdominal wall musculature, glottic closure, or upper airway obstruction. This double-blind study assessed the contribution of the upper airway to poor VC by inducing sufentanil anesthesia in patients undergoing cardiac surgery who are ventilated via a mask (Group M) or endotracheal tube fiberoptically inserted (Group E). After induction of anesthesia with sufentanil 3 microgram/kg from time (T) = 0 min to T = 2 in Group M (n = 17) or Group E(n = 23), VC and adductor pollicis (AP) twitch tension was measured continuously. Immediately prior to muscle relaxant (pipecuronium or doxacurium) administration at T = 3, Group E demonstrated significantly better VC (46 mL/cm H2O [39-55 interquartile range (IQR)]) than Group M (19 mL/cm H2O [7-24 IQR]). The effect of muscle relaxant administration on VC preceded its effect at the AP. After complete relaxation of the AP at T = 9, both groups had similar VC. Difficult ventilation during sufentanil induction of anesthesia lies at the level of the glottis or above. Bypassing these structures with an endotracheal tube overcomes the usual decreased VC.
    Anesthesia & Analgesia 10/1996; 83(3):629-32. DOI:10.1097/00000539-199609000-00034 · 3.47 Impact Factor
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    ABSTRACT: Aprotinin is a serine protease inhibitor that reduces blood loss and transfusion requirements when administered prophylactically to cardiac surgical patients. To examine the safety and dose-related efficacy of aprotinin, a prospective, multicenter, placebo-controlled trial was conducted in patients undergoing repeat coronary artery bypass graft (CABG) surgery. Two hundred eighty-seven patients were randomly assigned to receive either high-dose aprotinin, low-dose aprotinin, pump-prime-only aprotinin, or placebo. Drug efficacy was determined by the reduction in donor-blood transfusion up to postoperative day 12 and in postoperative thoracic-drainage volume. The percentage of patients requiring donor-red-blood-cell (RBC) transfusions in the high- and low-dose aprotinin groups was reduced compared with the pump-prime-only and placebo groups (high-dose aprotinin, 54%; low-dose aprotinin, 46%; pump-prime only, 72%; and placebo, 75%; overall P = .001). The number of units of donor RBCs transfused was significantly lower in the aprotinin-treated patients compared with placebo (high-dose aprotinin, 1.6 +/- 0.2 U; low-dose aprotinin, 1.6 +/- 0.3 U; pump-prime-only, 2.5 +/- 0.3 U; and placebo, 3.4 +/- 0.5 U; P = .0001). There was also a significant difference in total blood-product exposures among treatment groups (high-dose aprotinin, 2.2 +/- 0.4 U; low-dose aprotinin, 3.4 +/- 0.9 U; pump-prime-only, 5.1 +/- 0.9 U; placebo, 10.3 +/- 1.4 U). There were no differences among treatment groups for the incidence of perioperative myocardial infarction (MI). This study demonstrates that high- and low-dose aprotinin significantly reduces the requirement for donor-blood transfusion in repeat CABG patients without increasing the risk for perioperative MI.
    Circulation 11/1995; 92(8):2236-44. DOI:10.1161/01.CIR.92.8.2236 · 14.43 Impact Factor
  • S. Metz · J. C. Horrow · C. Bellwoar · I. P. Goel · M. R. Kuretu ·

    Anesthesiology 09/1994; 81(3A). DOI:10.1097/00000542-199409001-00191 · 5.88 Impact Factor
  • J. Abrams · J. C. Horrow · J. Bennett · D. Van Riper · C. Bellwoar · P. Katta · R. Storella ·

    Anesthesiology 09/1994; 81(3A). DOI:10.1097/00000542-199409001-00190 · 5.88 Impact Factor
  • J. C. Horrow · H. Rosenberg ·

    Anesthesiology 09/1994; 81(SUPPLEMENT). DOI:10.1097/00000542-199409001-01308 · 5.88 Impact Factor
  • J C Horrow · Daniel F. Van Riper ·

    The American Journal of Cardiology 06/1994; 73(12):933. DOI:10.1016/0002-9149(94)90835-4 · 3.28 Impact Factor
  • J Horrow · M D Strong · D F Van Riper ·

    Journal of Thoracic and Cardiovascular Surgery 06/1994; 107(5):1375-7. · 4.17 Impact Factor
  • J L Parmet · J Horrow · H Rosenberg ·

    New England Journal of Medicine 04/1994; 330(9):642-3. · 55.87 Impact Factor
  • G H Pharo · J Horrow · D F Van Riper · J H Levy ·

    Anesthesia & Analgesia 02/1994; 78(1):181-4. · 3.47 Impact Factor
  • J N Siler · J C Horrow · H Rosenberg ·
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    ABSTRACT: This study compared the effects of propofol anesthesia and nonpropofol general anesthetics on duration of stay in the postanesthesia care unit (PACU) for prolonged drowsiness or nausea and vomiting following various surgical procedures. A group of 512 patients undergoing general anesthesia for a variety of outpatient surgical procedures over a 6-month period received general anesthesia with nitrous oxide, with or without propofol. Data collected from PACU records included type of surgical procedure and duration in the PACU of more than 2 hours owing to drowsiness or nausea and vomiting. Overall, patients who received propofol with nitrous oxide experienced less frequent drowsiness, nausea, or vomiting compared with patients who received nonpropofol anesthetic agents (drowsiness 12% vs 31%; nausea/vomiting 3% vs 25%). For patients undergoing gynecologic surgery, propofol anesthesia yielded an 8% incidence of prolonged PACU stay, compared with 41% for nonpropofol techniques. Similar results occurred for orthopedic surgery (15% vs 35%); for ear, nose, or throat procedures (30% vs 75%); and for ophthalmic surgery (18% vs 71%), but not for oral surgery (44% vs 64%). Most same-day surgery patients benefit from administration of propofol for induction and maintenance of anesthesia. Advantages include a decreased likelihood of a prolonged stay in the PACU as a result of drowsiness or nausea and vomiting.
    Anesthesiology review 01/1994; 21(4):129-32.
  • J L Parmet · A T Berman · J C Horrow · Harding SP · H Rosenberg ·
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    ABSTRACT: Despite prophylactic therapy, pulmonary embolism remains the leading cause of perioperative mortality in patients undergoing total knee arthroplasty (TKA). We used transoesophageal echocardiography to monitor 29 consecutive patients during TKA. Showers of substantial amounts of echogenic material, lasting for 3-15 min, were visible in the right atrium and ventricle within 10-15 s of tourniquet deflation in all patients. A 3 x 6 mm fresh thrombus was aspirated from the central circulation of one patient. Another patient, who had had a Greenfield filter placed for previous thromboembolism, showed very little echogenic material after tourniquet deflation. The composition and importance of these echogenic emboli remain uncertain.
    The Lancet 05/1993; 341(8852):1057-8. DOI:10.1016/0140-6736(93)92414-O · 45.22 Impact Factor
  • J C Horrow · J Bennett · D Van Riper · R J Storella ·

    Anesthesiology 09/1992; 77(Supplement). DOI:10.1097/00000542-199209001-00940 · 5.88 Impact Factor
  • J L Parmet · G Pharo · D Kuralis · J C Horrow ·

    Anesthesiology 09/1992; 77(Supplement). DOI:10.1097/00000542-199209001-00095 · 5.88 Impact Factor
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    J C Horrow · D F Van Riper · M D Strong · I Brodsky · J L Parmet ·
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    ABSTRACT: Desmopressin-induced release of tissue plasminogen activator from endothelial cells may explain the absence of its hemostatic effect in patients undergoing cardiac surgery. Prior administration of the antifibrinolytic drug tranexamic acid might unmask such an effect, and combination therapy might thereby improve postoperative hemostasis. A double-blinded design randomly allocated 163 adult patients undergoing coronary revascularization, valve replacement, both procedures, or repair of atrial septal defect to four treatment groups: placebo, tranexamic acid given as 10 mg/kg over 30 minutes followed by 1 mg.kg-1.hr-1 for 12 hours initiated before skin incision, desmopressin given as 0.3 micrograms/kg over 20 minutes after protamine infusion, and both drugs. One surgeon performed all operations. Blood loss consisted of mediastinal tube drainage over 12 hours. Follow-up visits sought evidence of myocardial infarction and stroke. Desmopressin decreased neither the 12-hour blood loss nor the amount of homologous red cells transfused. Tranexamic acid alone significantly reduced 12-hour blood loss, by 30% (mean, 318 versus 453 ml; p less than 0.0001), without enhancement by desmopressin. Tranexamic acid also decreased the proportion of patients receiving homologous blood within 12 hours of operation (8% versus 21%, p = 0.024) and within 5 days of operation (22% versus 41%, p = 0.011). Desmopressin exerts no hemostatic effect, with or without prior administration of antifibrinolytic drug. Prophylactic tranexamic acid alone appears economical and safe in decreasing blood loss and transfusion requirement after cardiac surgery.
    Circulation 12/1991; 84(5):2063-70. DOI:10.1161/01.CIR.84.5.2063 · 14.43 Impact Factor
  • Gerald Soslau · Jan Horrow · Isadore Brodsky ·
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    ABSTRACT: Seventeen adults received the antifibrinolytic drug tranexamic acid during cardiac surgery utilizing extracorporeal circulation (ECC). In 8 patients, drug administration began prior to skin incision (pre-ECC); infusions commenced after ECC and protamine administration in another 9 patients (post-ECC). Compared with the post-ECC group, the pre-ECC group exhibited less bleeding via mediastinal drains (420 vs. 655 mL/12 h median, P = 0.024), decreased frequency of the presence (≥10 γg/mL) of fibrin split products (P < 0.05), and greater platelet dense granule content of adenosine diphosphate after surgery (15.47 vs. 4.05 nmoles/mg protein median, P = 0.021). Follow-up in vitro study of tranexamic acid inhibition of plasmin-induced platelet activation utilizing normal human platelet rich plasma and porcine plasmin revealed a 13-fold lower concentration of tranexamic acid for 50% inhibition when plasmin was preincubated with the drug (1.2 γg/mL, 95% CI = 1.13 – 1.60 γg/mL) compared to when platelet rich plasma was preincubated with the drug (16 γg/mL, 95% CI = 7.3 – 99. γg/mL). Plasmin inactivated with tranexamic acid retained its ability to inhibit thrombininduced platelet activation, thus suggesting that tranexamic acid inhibits plasmin's catalytic activity and not its binding to platelets. Both clot lysis and platelet dysfunction may contribute to bleeding after ECC. Tranexamic acid blocks plasmin-induced partial platelet activation during ECC, thus preserving platelet function and promoting hemostasis after ECC.
    American Journal of Hematology 10/1991; 38(2):113-9. DOI:10.1002/ajh.2830380208 · 3.80 Impact Factor