Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2008
Accuracy of core temperature measurement in deep hypothermic circulatory arrest.
Deep hypothermia is an effective technique for neuroprotection in cardiac surgery. However, standard body temperature measurement may deviate from actual brain temperature. Therefore, we simultaneously measured brain and core temperatures during neurosurgical interventions in hypothermic circulatory arrest to determine its accuracy. ⋯ Mean deviations from brain temperature were +0.2+/-2.7 degrees C at the tympanum, -0.8+/-2.6 degrees C in the bladder, -0.7+/-2.6 degrees C in the pulmonary artery and -1.8+/-4.4 degrees C in the rectum. In conclusion, temperature monitoring in the bladder and tympanum reliably reflects brain temperature. Temperature measurements in the pulmonary artery and rectum are less optimal.
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Interact Cardiovasc Thorac Surg · Oct 2008
Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective.
Previous reports have described penetrating cardiac injuries as the anatomic injury with the greatest opportunity for emergency department thoracotomy (EDT) survival. We hypothesize that actual survival rates are lower than that initially reported. A retrospective review of our EDT experience was performed. ⋯ Survival rates were 5% for GSW and 33% for SW. Mechanism of injury (SW), prehospital transportation by police, higher GCS, sinus tachycardia, and measurable ED vital signs were associated with improved survival. In urban trauma centers where firearm injuries are much more common than stabbings, the presence of a penetrating cardiac injury may no longer be considered a predictor of survival after EDT.
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Interact Cardiovasc Thorac Surg · Oct 2008
The effect of sivelestat sodium on post-cardiopulmonary bypass acute lung injury in a neonatal piglet model.
Cardiopulmonary bypass may cause acute lung injury and can seriously affect postoperative outcome, especially in younger patients. A synthesized neutrophil elastase inhibitor, sivelestat sodium, may be most effective when used during cardiopulmonary bypass. After anesthesia induction, sivelestat (2 mg/kg/h) was given to the SS group (n=7), and 0.9% saline solution to the placebo group (n=7). ⋯ Interleukin-8 level in the epithelial lining fluid was above the lowest standard in 6 out of 7 (4.5, 12.9, 24.6, 27.7, 37.7, and 159.8; mean=44.5+/-57.6 g/l) in the placebo group, and in 2 out of 7 (36.1 and 67.8 g/l) in the SS group (P<0.05). The median histological score of acute lung injury in the harvested lung was 3 (2-5) in the placebo group and 1 (1-5) in the SS group (P<0.05). Intraoperative administration of sivelestat effectively reduced neutrophil induction and activation in the lung and improved oxygenation after cardiopulmonary bypass in a piglet model.