cefamandole and Ischemia

Acute massive intestinal ischemia is an abdominal catastrophe. Prompt diagnosis and restoration of blood flow is essential; otherwise, massive intestinal resection occurs, leading to death or, in the survivors, intestinal cripples. In this study, the time of warm reversible ischemia in the canine intestine was explored. After this time was established, fluids and antibiotics were administered to note change in survival times. Massive intestinal ischemia (superior mesenteric artery was clamped) was tolerated without death for five hours (20 dogs in each group). With six hours of ischemia, a 10 per cent mortality rate occurred; with seven hours of ischemia, a 90 per cent mortality rate occurred. These dogs had a maintenance of 75 milliliters of fluid administered per hour. Using this group of dogs as the control (that is, the group with seven hour clamping time of the superior mesenteric artery with maintenance intravenously administered replacement), fluids were given to dogs in the experimental group to keep the pulmonary artery wedge pressure at a normal value (average of 300 milliliters per hour). This group of dogs had an increased survival rate of 40 per cent (ten dogs). Antibiotics were given to the dogs in the experimental group both before and after clamping, increasing the over-all survival rate to more than 80 per cent (46 dogs). Aggressive fluid replacement and antibiotic coverage may lengthen the so-called golden period in which intestinal ischemia may be reversed by revascularization.

Topics: Animals; Anti-Bacterial Agents; Cefamandole; Dogs; Fluid Therapy; Intestines; Ischemia; Pulmonary Wedge Pressure

Cefamandole levels were measured in peripheral blood, and in skeletal muscle and subcutaneous fat samples taken from 20 patients during amputation of the leg for severe ischemia. Tissue samples were taken from both proximal and distal levels in the amputated limb. Cefamandole was administered as either a 2 g intravenous bolus given with induction of anaesthesia, or a combination of 1 g intramuscularly with the premedication plus 1 g intravenously with anaesthetic induction. Levels of cefamandole in serum and proximal muscle and fat samples were well above the minimum inhibitory concentrations required for most Gram-positive and Gram-negative organisms. Cefamandole levels in more distal samples were somewhat lower but still achieved therapeutic levels in most cases. Higher tissue levels of cefamandole were achieved when 2 g were given intravenously as a bolus.

Topics: Adipose Tissue; Adult; Aged; Cefamandole; Cephalosporins; Female; Humans; Ischemia; Leg; Male; Middle Aged; Muscles; Time Factors