Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Clinical TrialDoes aprotinin influence endothelial-associated coagulation in cardiac surgery?
Aprotinin has been reported to reduce bleeding in cardiac surgery patients. Its mechanisms of action on coagulation have not been fully elucidated. In a prospectively randomized study of 40 patients undergoing elective aortocoronary bypass grafting, the influence of high-dose aprotinin (2 million IU of aprotinin before CPB, 500,000 IU/h until the end of operation, 2 million IU added to the prime) (N = 20) on endothelial-related coagulation was compared to a nontreated control group (N = 20). ⋯ During CPB, TM plasma concentrations decreased similarly in both groups (aprotinin: 18 +/- 6 ng/mL, control: 17 +/- 7 ng/mL) followed by a comparable increase in the postbypass period until the first postoperative day (aprotinin: 60 +/- 10 ng/mL, control: 53 +/- 11 ng/mL). Protein C and (free) protein S plasma levels also showed no differences between the two groups. On the first postoperative day, baseline values for protein C and protein S had not yet been reached.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Early extubation after cardiac surgery using combined intrathecal sufentanil and morphine.
The records of 10 patients who had well-preserved respiratory and ventricular function and had received 50 micrograms of sufentanil and 0.5 mg of morphine intrathecally before induction of anesthesia for cardiopulmonary bypass surgery were reviewed. Anesthesia was maintained with isoflurane and no patient received intravenous narcotics intraoperatively. ⋯ No patient required naloxone, reintubation, or treatment for respiratory depression. Combined intrathecal sufentanil and morphine provided conditions that allowed successful early extubation in 8 of 10 of these selected cardiac surgery patients.
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Comparative StudyPerioperative management and outcome of patients having cardiac surgery combined with abdominal aortic aneurysm resection.
Patients with abdominal aortic aneurysms (AAA) have a high incidence of associated cardiac disease. If a patient presents with both severe coronary artery disease and a large AAA, a staged procedure of cardiac surgery (CS) followed by AAA resection may present too great a risk of aneurysm rupture and death. A combined procedure may be recommended in this circumstance; however, the literature contains only individual successful case reports of such a procedure. ⋯ The staged procedure of first performing CS and then the AAA resection has a combined operative mortality of 4%. When the nature of both lesions is severe and a combined procedure is necessary, there is an associated in-hospital mortality of approximately 30% at this institution. The S group patients had an unremarkable postoperative course with a relatively short hospital stay when compared to the staged procedure.
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Biography Historical ArticleKenneth K. Keown, MD: pioneer of cardiac anesthesiology.
In 1948, just 2 years out of his anesthesiology residency at Hahnemann Medical College and Hospital, Kenneth K. Keown, MD, was chosen as the anesthesiologist for the procedure that launched the era of intracardiac surgery--a mitral valves commissurotomy. Although surgery on stenotic mitral valves had met with some success as early as the 1920s, its application had lain dormant for some 25 years. ⋯ He also maintained a vigorous resident recruitment service. Keown held leadership positions in many medical organizations and, during a sabbatical from Missouri, served on the hospital ship Hope in Tunisia. He was Professor and Chief, and later Chairman, Section of Anesthesiology, at the University of Missouri Medical Center, and from 1969 until his death in 1985, he also served as the Center's Medical Director.
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialHemodynamic and pharmacodynamic comparison of doxacurium and high-dose vecuronium during coronary artery bypass surgery: a cost-benefit study.
Doxacurium (DOX), a new nondepolarizing neuromuscular blocking drug (NMBD), was compared in a randomized, double-blind fashion to high-dose vecuronium (VEC) in 60 coronary artery bypass grafting (CABG) patients. A third group of 15 patients older than 70 years of age (DOX-70) was added to compare the effects of DOX to VEC in the older population. Endpoints of the study were hemodynamic stability, ease of ventilation and intubation, anesthesiologist's satisfaction, drug interventions to correct hemodynamic instability, and total cost of the drug. ⋯ The durations of the induction and maintenance doses of DOX were similar in the younger and older patients. Although the intubating dose of VEC had a faster onset of action, this had no effect on the ease of ventilation, conditions for tracheal intubation, and overall anesthesiologist satisfaction. The total cost for each NMBD was not different.(ABSTRACT TRUNCATED AT 250 WORDS)