Robert Feneck | Kings College London (original) (raw)

Papers by Robert Feneck

Research paper thumbnail of Recommendations

transoesophageal echo studies

Research paper thumbnail of P. Wouters12, and J. Zamorano13 on behalf of the European Association of Cardiothoracic Anaesthesiologists (EACTA) and the European Association of

Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal ... more Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal report may be given at the time of the study. Important findings must be included in the written report. Where the perioperative TEE findings are new, or have led to a change in operative surgery, postoperative care or in prognosis, it is essential that this information should be reported in writing and available as soon as possible after surgery. The ultrasound technology and methodology used to assess valve pathology, ventricular performance and any other derived information should be included to support any conclusions. This is particularly important in the case of new or unexpected findings. Particular attention should be attached to the echo findings following the completion of surgery. Every written report should include a

Research paper thumbnail of Recommendations for reporting perioperative transoesophageal echo studies

European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2010

Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal ... more Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal report may be given at the time of the study. Important findings must be included in the written report. Where the perioperative TEE findings are new, or have led to a change in operative surgery, postoperative care or in prognosis, it is essential that this information should be reported in writing and available as soon as possible after surgery. The ultrasound technology and methodology used to assess valve pathology, ventricular performance and any other derived information should be included to support any conclusions. This is particularly important in the case of new or unexpected findings. Particular attention should be attached to the echo findings following the completion of surgery. Every written report should include a written conclusion, which should be comprehensible to physicians who are not experts in echocardiography.

Research paper thumbnail of Transesophageal echocardiography reporting

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Core Topics in Transesophageal Echocardiography

Research paper thumbnail of in patients undergoing coronary artery bypass surgery Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib

Research paper thumbnail of Time-course of free radical activity during coronary artery operations with cardiopulmonary bypass

The Journal of thoracic and cardiovascular surgery, 1993

Myocardial and pulmonary impairment after cardiopulmonary bypass may be caused by oxygen free rad... more Myocardial and pulmonary impairment after cardiopulmonary bypass may be caused by oxygen free radicals produced by reperfusion and by activated neutrophils. Free radical activity was assessed by assays for lipid peroxidation (thiobarbituric acid-reactive material) and phospholipid-esterified diene conjugation (18:2[9,11]/18:2[9,12] molar ratio) in 25 patients during coronary artery operations. Arterial blood samples were obtained before, during the ischemic period, and for 24 hours thereafter. There were no significant changes in free radical indices during the ischemic periods, but after cessation of bypass they increased significantly. Ten minutes after bypass thiobarbituric acid-reactive material rose from 96 (median; range 65 to 145) nmol/gm albumin to 138 (85 to 200) nmol/gm albumin (p < 0.001), and molar ratio rose from 2.23% (0.45% to 7.70%) to 2.51% (0.39% to 7.93%) (p < 0.02). Values of thiobarbituric acid-reactive material subsequently decreased, but molar ratio reac...

Research paper thumbnail of 8 Pre-anaesthetic preparation of the emergency patient

Baillière's Clinical Anaesthesiology, 1998

Pre-anaesthetic preparation is a vital component of safe anaesthesia. The emergency patient is at... more Pre-anaesthetic preparation is a vital component of safe anaesthesia. The emergency patient is at higher risk in almost all surgical circumstances, not least because adequate preparation is more difficult. A variety of factors, including the nature of the emergency, cardiovascular disturbance, fluid shifts and the presence of a full stomach will render the patient more at risk. Furthermore, the presence of pre-existing disease, often poorly controlled, may further hazard the delivery of safe anaesthesia. This chapter explores these aspects in greater detail.

Research paper thumbnail of Cardiac masses and pericardial disease

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Infective endocarditis

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Addendum to Chapter 1: updated indications for perioperative TEE

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Standards of monitoring

Journal of Cardiothoracic and Vascular Anesthesia, 1994

Research paper thumbnail of Intravenous milrinone following cardiac surgery: I. effects of bolus infusion followed by variable dose maintenance infusion

Journal of Cardiothoracic and Vascular Anesthesia, 1992

The hemodynamic and adverse effects of intravenous milrinone were studied in 99 adult patients (6... more The hemodynamic and adverse effects of intravenous milrinone were studied in 99 adult patients (66 men) following elective myocardial revascularization, mitral and/or aortic valve surgery. All patients had a low cardiac output (cardiac index [Cl] mean 1.93, range, 1.11 to 2.5 L/min/mZ) despite adequate cardiac filling pressure (mean pulmonary capillary wedge pressure [PCWP] ll.5 mmHg, range, 8 to 20 mmHg). Following a period of baseline stability (mean 17.8 minutes, range, 10 to 50 minutes), patients received a bolus infusion of 50 pg/kg over 10 minutes. A continuous maintenance infusion of 0.375 (low), 0.5 (mid) or 0.75 (high) pg/ kg/min was administered for a minimum of 12 hours. Patients were allocated to each dosage group sequentially, not randomly. Hemodynamic measurements were made before the start of milrinone and 15 minutes after the bolus infusion. Further measurements were made at 30,45, and 60 minutes, and at 3, 6, and 12 hours after the start of treatment. Measurements were also made at 2 and 4 hours after treatment was stopped. The bolus infusion caused significant increases in Cl, heart rate (HR), and stroke index (SI), (P < 0.001). and significant falls in PCWP, right atrial pressure (RAP), mean pulmonary artery pressure (mPAP), pulmonary vascular resistante (PVR), mean arterial pressure (MAP), and systemic vascular resistance (SVR) (P c 0.001). These effects were maintained to a significant degree by each of the three maintenance infusion regimens, although the pulmonary vasodilator effects appeared less predictable and more dose dependent. Eighteen patients (19%) had arrhythmias; 16 of these were judged not to be serious events. Two were deemed serious; these were both episodes of fast atrial fibrillation (AF). Recovery in these patients was otherwise uncomplicated. There were no other arrhythmias seen, and there were no other serious adverse effects related to the study drug. It is concluded that intravenous milrinone may be effective and safe treatment for low cardiac output states following cardiac surgery in this patient population.

Research paper thumbnail of How silent is perioperative myocardial ischemia? a hemodynamic, electrocardiographic, and biochemical study in patients undergoing coronary artery bypass graft surgery

Journal of Cardiothoracic and Vascular Anesthesia, 2000

Research paper thumbnail of Milrinone and postoperative pulmonary hypertension

Journal of Cardiothoracic and Vascular Anesthesia, 1993

Research paper thumbnail of Comparison of isradipine with nitroprusside for control of blood pressure following myocardial revascularization: Effects on hemodynamics, cardiac metabolism, and coronary blood flow

Journal of Cardiothoracic and Vascular Anesthesia, 1991

The effects of isradipine (ISR) on cardiac performance, myocardial metabolism, and coronary blood... more The effects of isradipine (ISR) on cardiac performance, myocardial metabolism, and coronary blood flow were compared with those of sodium nitroprusside (SNP) when used to control blood pressure following myocardial revascularization. Twenty patients were randomized to receive either intravenous ISR or SNP if arterial blood pressure increased above 130 mm Hg systolic. Hemodynamic and metabolic parameters were studied using radial, pulmonary arterial, and coronary sinus catheters. Cardiac output and coronary blood flows were measured by thermodilution and blood was taken for calculation of myocardial oxygen consumption and lactate extraction. Electrocardiographic changes were recorded by Holter monitoring throughout the study. ISR and SNP both produced a satisfactory reduction in blood pressure accompanied by a decreased systemic vascular resistance (P < 0.001). ISR infusion was associated with increases in cardiac output and stroke index (P < 0.01). which were not apparent in the SNP group. Tachycardia occurred with SNP (P < 0.01) but not with ISR therapy. Right and left ventricular stroke work indices and myocardial oxygen con-From The London Chest Hospital, London, England.

Research paper thumbnail of Perioperative blood pressure control: A prospective survey of patient management in cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia, 2000

Objective: To conduct a survey of current cardiac anesthetic practice in Europe and the United St... more Objective: To conduct a survey of current cardiac anesthetic practice in Europe and the United States, as a first step toward establishing guidelines for the management of perioperative hypertension.

Research paper thumbnail of Effects of the inotrope DPI 201-106 on cardiac performance following cardiac surgery

International Journal of Cardiology, 1990

Davis ME, Feneck RO, Jones CJH, Lunnon MW, Walesby RK. Effects of the inotrope DPI 201-106 on car... more Davis ME, Feneck RO, Jones CJH, Lunnon MW, Walesby RK. Effects of the inotrope DPI 201-106 on cardiac performance following cardiac surgery. Int J Cardiol 1990;29:229-237.

Research paper thumbnail of Failure of diazepam to prevent the suxamethonium-induced rise in intra-ocular pressure

Anaesthesia, 1983

Failure of diazepam to prevent the sw amethonium-induced rise in intra-ocular pressure R. 0 . FEN... more Failure of diazepam to prevent the sw amethonium-induced rise in intra-ocular pressure R. 0 . FENECK AND J . H. COOK

Research paper thumbnail of Use of isradipine in hypertension following coronary artery bypass surgery

The American Journal of Medicine, 1989

A dose-finding pilot study including six patients concluded that isradipine at an initial rate of... more A dose-finding pilot study including six patients concluded that isradipine at an initial rate of 0.6 microgram/kg/minute, decreasing to 0.3 microgram/kg/minute with further adjustments as necessary, was safe for the treatment of post-aortocoronary bypass graft hypertension. A comparative study followed, comprising 20 patients randomly assigned to receive isradipine (starting at 0.6 microgram/kg/minute) or nitroprusside (initially 1 microgram/kg/minute) for the treatment of post-aortocoronary bypass graft hypertension. Both drugs produced a satisfactory reduction in arterial blood pressure accompanied by a decrease in systemic vascular resistance. Central venous pressure and mean pulmonary artery pressure decreased with nitroprusside, but both increased with isradipine. Pulmonary capillary wedge pressure was reduced, heart rate increased, and cardiac output was minimally changed with nitroprusside. However, wedge pressure was maintained with isradipine and there was no tachycardia. An increase in cardiac output was seen, associated with an increase in stroke index. Isradipine is a more specific treatment for post-aortocoronary bypass graft hypertension than nitroprusside because its systemic arterial dilating effect is associated with a minimum of other circulatory changes.

Research paper thumbnail of Recommendations

transoesophageal echo studies

Research paper thumbnail of P. Wouters12, and J. Zamorano13 on behalf of the European Association of Cardiothoracic Anaesthesiologists (EACTA) and the European Association of

Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal ... more Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal report may be given at the time of the study. Important findings must be included in the written report. Where the perioperative TEE findings are new, or have led to a change in operative surgery, postoperative care or in prognosis, it is essential that this information should be reported in writing and available as soon as possible after surgery. The ultrasound technology and methodology used to assess valve pathology, ventricular performance and any other derived information should be included to support any conclusions. This is particularly important in the case of new or unexpected findings. Particular attention should be attached to the echo findings following the completion of surgery. Every written report should include a

Research paper thumbnail of Recommendations for reporting perioperative transoesophageal echo studies

European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2010

Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal ... more Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal report may be given at the time of the study. Important findings must be included in the written report. Where the perioperative TEE findings are new, or have led to a change in operative surgery, postoperative care or in prognosis, it is essential that this information should be reported in writing and available as soon as possible after surgery. The ultrasound technology and methodology used to assess valve pathology, ventricular performance and any other derived information should be included to support any conclusions. This is particularly important in the case of new or unexpected findings. Particular attention should be attached to the echo findings following the completion of surgery. Every written report should include a written conclusion, which should be comprehensible to physicians who are not experts in echocardiography.

Research paper thumbnail of Transesophageal echocardiography reporting

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Core Topics in Transesophageal Echocardiography

Research paper thumbnail of in patients undergoing coronary artery bypass surgery Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib

Research paper thumbnail of Time-course of free radical activity during coronary artery operations with cardiopulmonary bypass

The Journal of thoracic and cardiovascular surgery, 1993

Myocardial and pulmonary impairment after cardiopulmonary bypass may be caused by oxygen free rad... more Myocardial and pulmonary impairment after cardiopulmonary bypass may be caused by oxygen free radicals produced by reperfusion and by activated neutrophils. Free radical activity was assessed by assays for lipid peroxidation (thiobarbituric acid-reactive material) and phospholipid-esterified diene conjugation (18:2[9,11]/18:2[9,12] molar ratio) in 25 patients during coronary artery operations. Arterial blood samples were obtained before, during the ischemic period, and for 24 hours thereafter. There were no significant changes in free radical indices during the ischemic periods, but after cessation of bypass they increased significantly. Ten minutes after bypass thiobarbituric acid-reactive material rose from 96 (median; range 65 to 145) nmol/gm albumin to 138 (85 to 200) nmol/gm albumin (p < 0.001), and molar ratio rose from 2.23% (0.45% to 7.70%) to 2.51% (0.39% to 7.93%) (p < 0.02). Values of thiobarbituric acid-reactive material subsequently decreased, but molar ratio reac...

Research paper thumbnail of 8 Pre-anaesthetic preparation of the emergency patient

Baillière's Clinical Anaesthesiology, 1998

Pre-anaesthetic preparation is a vital component of safe anaesthesia. The emergency patient is at... more Pre-anaesthetic preparation is a vital component of safe anaesthesia. The emergency patient is at higher risk in almost all surgical circumstances, not least because adequate preparation is more difficult. A variety of factors, including the nature of the emergency, cardiovascular disturbance, fluid shifts and the presence of a full stomach will render the patient more at risk. Furthermore, the presence of pre-existing disease, often poorly controlled, may further hazard the delivery of safe anaesthesia. This chapter explores these aspects in greater detail.

Research paper thumbnail of Cardiac masses and pericardial disease

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Infective endocarditis

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Addendum to Chapter 1: updated indications for perioperative TEE

Core Topics in Transesophageal Echocardiography, 2010

Research paper thumbnail of Standards of monitoring

Journal of Cardiothoracic and Vascular Anesthesia, 1994

Research paper thumbnail of Intravenous milrinone following cardiac surgery: I. effects of bolus infusion followed by variable dose maintenance infusion

Journal of Cardiothoracic and Vascular Anesthesia, 1992

The hemodynamic and adverse effects of intravenous milrinone were studied in 99 adult patients (6... more The hemodynamic and adverse effects of intravenous milrinone were studied in 99 adult patients (66 men) following elective myocardial revascularization, mitral and/or aortic valve surgery. All patients had a low cardiac output (cardiac index [Cl] mean 1.93, range, 1.11 to 2.5 L/min/mZ) despite adequate cardiac filling pressure (mean pulmonary capillary wedge pressure [PCWP] ll.5 mmHg, range, 8 to 20 mmHg). Following a period of baseline stability (mean 17.8 minutes, range, 10 to 50 minutes), patients received a bolus infusion of 50 pg/kg over 10 minutes. A continuous maintenance infusion of 0.375 (low), 0.5 (mid) or 0.75 (high) pg/ kg/min was administered for a minimum of 12 hours. Patients were allocated to each dosage group sequentially, not randomly. Hemodynamic measurements were made before the start of milrinone and 15 minutes after the bolus infusion. Further measurements were made at 30,45, and 60 minutes, and at 3, 6, and 12 hours after the start of treatment. Measurements were also made at 2 and 4 hours after treatment was stopped. The bolus infusion caused significant increases in Cl, heart rate (HR), and stroke index (SI), (P < 0.001). and significant falls in PCWP, right atrial pressure (RAP), mean pulmonary artery pressure (mPAP), pulmonary vascular resistante (PVR), mean arterial pressure (MAP), and systemic vascular resistance (SVR) (P c 0.001). These effects were maintained to a significant degree by each of the three maintenance infusion regimens, although the pulmonary vasodilator effects appeared less predictable and more dose dependent. Eighteen patients (19%) had arrhythmias; 16 of these were judged not to be serious events. Two were deemed serious; these were both episodes of fast atrial fibrillation (AF). Recovery in these patients was otherwise uncomplicated. There were no other arrhythmias seen, and there were no other serious adverse effects related to the study drug. It is concluded that intravenous milrinone may be effective and safe treatment for low cardiac output states following cardiac surgery in this patient population.

Research paper thumbnail of How silent is perioperative myocardial ischemia? a hemodynamic, electrocardiographic, and biochemical study in patients undergoing coronary artery bypass graft surgery

Journal of Cardiothoracic and Vascular Anesthesia, 2000

Research paper thumbnail of Milrinone and postoperative pulmonary hypertension

Journal of Cardiothoracic and Vascular Anesthesia, 1993

Research paper thumbnail of Comparison of isradipine with nitroprusside for control of blood pressure following myocardial revascularization: Effects on hemodynamics, cardiac metabolism, and coronary blood flow

Journal of Cardiothoracic and Vascular Anesthesia, 1991

The effects of isradipine (ISR) on cardiac performance, myocardial metabolism, and coronary blood... more The effects of isradipine (ISR) on cardiac performance, myocardial metabolism, and coronary blood flow were compared with those of sodium nitroprusside (SNP) when used to control blood pressure following myocardial revascularization. Twenty patients were randomized to receive either intravenous ISR or SNP if arterial blood pressure increased above 130 mm Hg systolic. Hemodynamic and metabolic parameters were studied using radial, pulmonary arterial, and coronary sinus catheters. Cardiac output and coronary blood flows were measured by thermodilution and blood was taken for calculation of myocardial oxygen consumption and lactate extraction. Electrocardiographic changes were recorded by Holter monitoring throughout the study. ISR and SNP both produced a satisfactory reduction in blood pressure accompanied by a decreased systemic vascular resistance (P < 0.001). ISR infusion was associated with increases in cardiac output and stroke index (P < 0.01). which were not apparent in the SNP group. Tachycardia occurred with SNP (P < 0.01) but not with ISR therapy. Right and left ventricular stroke work indices and myocardial oxygen con-From The London Chest Hospital, London, England.

Research paper thumbnail of Perioperative blood pressure control: A prospective survey of patient management in cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia, 2000

Objective: To conduct a survey of current cardiac anesthetic practice in Europe and the United St... more Objective: To conduct a survey of current cardiac anesthetic practice in Europe and the United States, as a first step toward establishing guidelines for the management of perioperative hypertension.

Research paper thumbnail of Effects of the inotrope DPI 201-106 on cardiac performance following cardiac surgery

International Journal of Cardiology, 1990

Davis ME, Feneck RO, Jones CJH, Lunnon MW, Walesby RK. Effects of the inotrope DPI 201-106 on car... more Davis ME, Feneck RO, Jones CJH, Lunnon MW, Walesby RK. Effects of the inotrope DPI 201-106 on cardiac performance following cardiac surgery. Int J Cardiol 1990;29:229-237.

Research paper thumbnail of Failure of diazepam to prevent the suxamethonium-induced rise in intra-ocular pressure

Anaesthesia, 1983

Failure of diazepam to prevent the sw amethonium-induced rise in intra-ocular pressure R. 0 . FEN... more Failure of diazepam to prevent the sw amethonium-induced rise in intra-ocular pressure R. 0 . FENECK AND J . H. COOK

Research paper thumbnail of Use of isradipine in hypertension following coronary artery bypass surgery

The American Journal of Medicine, 1989

A dose-finding pilot study including six patients concluded that isradipine at an initial rate of... more A dose-finding pilot study including six patients concluded that isradipine at an initial rate of 0.6 microgram/kg/minute, decreasing to 0.3 microgram/kg/minute with further adjustments as necessary, was safe for the treatment of post-aortocoronary bypass graft hypertension. A comparative study followed, comprising 20 patients randomly assigned to receive isradipine (starting at 0.6 microgram/kg/minute) or nitroprusside (initially 1 microgram/kg/minute) for the treatment of post-aortocoronary bypass graft hypertension. Both drugs produced a satisfactory reduction in arterial blood pressure accompanied by a decrease in systemic vascular resistance. Central venous pressure and mean pulmonary artery pressure decreased with nitroprusside, but both increased with isradipine. Pulmonary capillary wedge pressure was reduced, heart rate increased, and cardiac output was minimally changed with nitroprusside. However, wedge pressure was maintained with isradipine and there was no tachycardia. An increase in cardiac output was seen, associated with an increase in stroke index. Isradipine is a more specific treatment for post-aortocoronary bypass graft hypertension than nitroprusside because its systemic arterial dilating effect is associated with a minimum of other circulatory changes.