Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Randomized Controlled Trial Comparative Study Clinical TrialA comparative evaluation of intrapleural and thoracic epidural analgesia for postoperative pain relief after minimally invasive direct coronary artery bypass surgery.
To compare the efficacy of thoracic epidural analgesia (TEA) and intrapleural analgesia (IPA) after minimally invasive direct coronary artery bypass (MIDCAB) surgery with regard to quality of analgesia and complications. ⋯ IPA is a safe and effective technique for postoperative analgesia after MIDCAB surgery and has a low complication rate compared with TEA. Careful positioning, chest tube clamping, and anchoring of the catheter are mandatory for IPA to be effective.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Randomized Controlled Trial Comparative Study Clinical TrialPleural bupivacaine placement for optimal postthoracotomy pulmonary function: a prospective, randomized study.
To determine dependent chest tube losses of bupivacaine with paravertebral versus interpleural administration, thereby helping to explain the significant differences in pulmonary function that exist between these two techniques. ⋯ Local anesthetic on the diaphragm might actively impair respiratory function through diaphragmatic and abdominal muscle weakness, while failing to contribute to pain relief.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Comparative StudyFlow resistances of disposable double-lumen, single-lumen, and Univent tubes.
To compare the airflow resistances of modern double-lumen, single-lumen, and Univent (Fuji Systems Corp; Tokyo, Japan) tubes. ⋯ Flow resistances of modern disposable double-lumen tubes are lower than commonly perceived. In most clinical situations, there will be no decrease in flow resistance when a Rusch or Sheridan double-lumen tube is replaced by a single-lumen tube.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Airway compression in children due to congenital heart disease: value of flexible fiberoptic bronchoscopic assessment.
To evaluate the frequency and severity of airway compression due to congenital heart disease in children and validate the use of the fiberoptic bronchoscope to assess them. ⋯ Endoscopy in an awake patient is the only way to evaluate the functional component of a compression due to malacia; the resulting collapse of the airway can cause trapping of air and secretions. Furthermore, fiberoptic bronchoscopy offers a complete examination of the airways and can help detect airway abnormalities that are potential causes of complications. Fiberoptic bronchoscopy is a suitable and well-tolerated examination that is easy to perform at the bedside of the child. This technique optimizes the preoperative assessment of children with congenital heart disease.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
ReviewResolved: A pulmonary artery catheter should be used in the management of the critically ill patient. Pro.
Selected studies showing both positive and negative outcomes with the use of pulmonary artery catheters (PACs) are reviewed. Indications for use of a PAC are controversial, although clearly the "red cap syndrome" is an indication for its insertion. There are sufficient data as well as personal experience to suggest that PACs do make a difference in the management of critically ill patients. ⋯ Studies are reviewed that addressed physician level of expertise related to PAC insertion, complications, data and waveform interpretation, and management. User knowledge clearly is suboptimal. Before attempting to draw conclusions from outcome studies, criteria for appropriate use need to be developed and clinician knowledge needs to be significantly improved.