Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1992
Perioperative evaluation of a new mixed venous oxygen saturation catheter in cardiac surgical patients.
Fiberoptic pulmonary artery flotation catheters have gained clinical acceptance for continuous monitoring of mixed venous oxygen saturation (SvO2), especially in the management of hemodynamically unstable patients. Therefore, the performance of the oximetry system used is extremely important. The accuracy and stability of a new two-wavelength oximetry pulmonary artery catheter and SAT-2 oximeter were assessed in adult patients during and following cardiac surgery. ⋯ A total of 604 paired data points from 52 patients were analyzed, 572 (94.7%) of which were within the 95% confidence interval. Overall bias was -1.7% +/- 3.5% (SD). The results suggest that over the time course of the study, in vivo SvO2 values obtained with the two-wavelength catheter and the SAT-2 oximeter closely approximated SvO2 measured with a reference oximeter from mixed venous blood samples (r = 0.917; SEE 3.5%) in cardiac surgical patients in whom marked physiological changes occur.
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J. Cardiothorac. Vasc. Anesth. · Jun 1992
Randomized Controlled Trial Comparative Study Clinical TrialReduction in blood loss and blood use after cardiopulmonary bypass with high-dose aprotinin versus autologous fresh whole blood transfusion.
Ninety patients undergoing cardiac surgery were randomly divided into three groups of 30 patients to compare the effects on bleeding and transfusion requirements of either intraoperative infusion of high-dose aprotinin (GpI) or reinfusion of autologous fresh whole blood (GpII) versus a control group (GpIII). Standardized anesthetic, perfusion, and surgical techniques were used. Platelet counts, hemoglobin concentration, hematocrit, fibrinogen, and Ivy-Nelson bleeding times determined at fixed times perioperatively did not differ among the three groups. ⋯ No GpI patient required transfusion of platelets or fresh frozen plasma. Fresh whole autologous blood transfusions had no significant hemostatic effect and failed to reduce the homologous blood requirement. Conversely, high-dose aprotinin reduced blood loss and transfusion requirements.
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J. Cardiothorac. Vasc. Anesth. · Jun 1992
Pharmacokinetics of alfentanil before and after cardiopulmonary bypass in pediatric patients undergoing cardiac surgery: Part I.
Changes induced by cardiopulmonary bypass (CPB) may markedly affect the pharmacokinetics of drugs. Therefore, the pharmacokinetics of alfentanil before and after CPB were compared in infants and children undergoing cardiac surgery, who had been anesthetized with nitrous oxide in oxygen and low inspiratory concentrations of halothane. Six infants and six children were investigated. ⋯ The initial volume of distribution before CPB was smaller (68 +/- 37 mL/kg in infants and 80 +/- 32 mL/kg in children) than after CPB (235 +/- 58 mL/kg in infants and 179 +/- 99 mL/kg in children; P less than 0.001). The normalized area under the plasma concentration-time curve from 0 to 45 minutes was larger before CPB (17.9 +/- 2.9 mg.min/L in infants and 18.3 +/- 5.4 mg.min/L in children) than after CPB (11.1 +/- 2.9 mg.min/L in infants and 12.9 +/- 3.4 mg.min/L in children; P less than 0.001). Despite intravenous administration of atropine, arterial blood pressure and heart rate decreased significantly after alfentanil was given.