Journal of cardiothoracic and vascular anesthesia
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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
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
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.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
ReviewSafety issues in heparin and protamine administration for extracorporeal circulation.
This article reviews past approaches to heparin and protamine dosing and summarizes current practice. The author elucidates his experience with the Celite activated coagulation time (ACT), with attention to his adoption of a value of 400 seconds for this time; the adoption of an ACT of 480 seconds by Bull et al (J Thorac Cardiovasc Surg 69:674-684, 1975) and Young et al (Ann Thorac Surg 26:231-240, 1978); the proposed use of heparin response curves by Bull et al; the author's experience with a unitized dosing system to individualize dosing of heparin; and the use for this purpose by Despotis et al (J Thorac Cardiovasc Surg 110:46-54, 1995) of a system based on protamine titration. In more than 270 adult cardiac surgery patients, the unitized dosing system identified patients with high sensitivity or resistance to heparin and facilitated exact individualized doses to be given to produce the desired effect. ⋯ Aprotinin is not a procoagulant during cardiopulmonary bypass. Emerging studies suggest that graft patency is not affected by aprotinin use. The Celite ACT should not be used to monitor heparin effect and safety when using aprotinin; the kaolin ACT should be used instead.