Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Use of monitoring devices during anesthesia for cardiac surgery: a survey of practices at public hospitals within the United Kingdom and Ireland.
A questionnaire was sent to all 42 public hospitals, within the United Kingdom (UK) and Ireland, known to conduct elective cardiac surgery. Information was sought with regard to the availability of intraoperative monitoring equipment. ⋯ Similarly, continuous monitoring of arterial oxygen tension and oxygen fraction in the gas flow to the bypass machine was not conducted in 28 and 32 hospitals, respectively. This survey revealed that essential anesthetic monitoring devices, as defined by the United Kingdom Association of Anesthetists, are not in routine usage during the pre-bypass and post-bypass phases of anesthesia for cardiac surgery within the British Isles.
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Transesophageal pulsed-Doppler echocardiographic evaluation of transmitral and pulmonary venous flow during ventilation with positive end-expiratory pressure.
During mechanical ventilation with high levels of positive end-expiratory pressure (PEEP) several hemodynamic changes occur, the mechanism of which has been the subject of various previous studies. The effects of increasing levels of PEEP during mechanical ventilation were measured on left atrial and left ventricular filling dynamics, as assessed by pulmonary venous and transmitral flow velocities, respectively. Using transesophageal echocardiography in 12 patients, Doppler flow velocities of pulmonary venous and transmitral flow were studied at baseline (0 cmH2O PEEP) and at 5, 10, 15, and 20 cm H2O with 10-minute intervals, and once more after removal of PEEP. ⋯ In contrast, early and late diastolic velocities and velocity time integrals did not change. In regard to transmitral flow, both early and late diastolic velocities significantly decreased from 51 +/- 7 cm/s and 50 +/- 9 cm/s at baseline to 38 +/- 7 cm/s at 20 cmH2O PEEP, respectively (P < 0.01). Early and late diastolic velocity time integrals decreased from 6.1 +/- 1.8 cm and 4.7 +/- 1.0 cm to 4.5 +/- 1.0 cm (NS) and 3.4 +/- 0.7 cm (P < 0.05), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Effects of atrial natriuretic peptide on renal function after cardiac surgery and in cyclosporine-treated heart transplant recipients.
The study investigated the effects of intravenous infusion of atrial natriuretic peptide (human ANP 99-126) on renal function and central hemodynamics after coronary artery bypass grafting (CABG), and the ability of ANP to reverse the acute nephrotoxic effects of cyclosporine after heart transplantation. Ten patients with an EF > 0.5 and normal renal function were studied 2 to 4 hours after CABG surgery. Furthermore, six heart transplant recipients receiving cyclosporine for immunosuppression who developed renal dysfunction 2 to 4 days after transplantation were studied. ⋯ In the heart transplant recipients, baseline GFR was markedly reduced compared to pretransplantation values (-65%). UF, GFR, and RBF increased 240%, 69%, and 53%, respectively, while renal vascular resistance decreased 45% during the highest dose of ANP infused. At this ANP dose level, circulating ANP concentrations were sixfold to eightfold higher than the preinfusion control level.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Randomized Controlled Trial Clinical TrialAn amrinone bolus prior to weaning from cardiopulmonary bypass improves cardiac function in mitral valve surgery patients.
This double-blind, randomized study was performed to assess the effectiveness of a single bolus dose of 2 mg/kg of amrinone given during cardiopulmonary bypass (CPB) to patients undergoing mitral valve surgery. Outcome variables were hemodynamic function and the number and amount of vasopressors or inotropes required to wean from CPB. In amrinone-treated patients, cardiac index (CI) increased significantly by 48 +/- 14% following CPB (T3) versus 10 +/- 10% for placebo-treated patients (P = 0.029). ⋯ While on CPB, mean arterial pressure at 5 minutes following administration of the study drug was decreased in amrinone patients by 20 +/- 4% versus 4 +/- 3% in placebo patients (P = 0.005), but was no different at 10 and 15 minutes. There were no statistically significant differences in the number of patients who required supplemental inotropes or vasopressors either during CPB, following separation from CPB, or upon arrival in the ICU. Thus, amrinone improved CI without changing pulmonary vascular resistance or the requirement for supplemental inotropes or vasopressors in patients undergoing elective mitral valve surgery.