Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Randomized Controlled Trial Comparative StudyThe response of the vascular beds to sodium bicarbonate in patients during normothermic bypass.
Cardiopulmonary bypass (CPB) provides a unique circumstance to study the effects of drugs on the systemic vasculature. Thus, this study was designed to evaluate the effects of sodium bicarbonate on the systemic circulation during CPB in humans. ⋯ This study found a biphasic response to SB on the systemic circulation during CPB. Early dilation of venous capacitance vessels occurred followed by arteriolar constriction over the 20-minute study interval.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Randomized Controlled Trial Comparative StudyA preliminary study of a new tranexamic acid dosing schedule for cardiac surgery.
The authors have developed an alternative dosing schedule for tranexamic acid that incorporates the effects of renal function on tranexamic acid concentrations. The objectives of this study were to determine if this new dosing schedule can achieve the desired plasma concentration of tranexamic acid and reduce intra- and interpatient variability in tranexamic acid plasma concentrations relative to the current dosing schedule. ⋯ The new dosing protocol for tranexamic acid resulted in more consistent blood concentrations of tranexamic acid, but not stable tranexamic acid levels >20 microg/mL on cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Randomized Controlled Trial Comparative StudyRemifentanil infusion does not induce opioid tolerance after cardiac surgery.
Remifentanil is being used increasingly during fast-track cardiac surgery. Postoperative hyperalgesia and opioid tolerance have been reported in volunteer studies and in patients after major abdominal surgery with remifentanil infusion. In the present study, the authors evaluated whether high-dose remifentanil infusion induces opioid tolerance in 90 patients undergoing coronary artery bypass surgery with sternotomy. ⋯ Three-hour remifentanil infusion did not increase postoperative pain or opioid consumption in cardiac surgery patients. The present results suggest that high-dose remifentanil does not elicit opioid tolerance when given during cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative Study Clinical TrialAssessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter.
To verify the reliability of different markers of fluid-responsiveness during off-pump cardiac surgery (OPCAB). ⋯ Dynamic parameters of fluid responsiveness by LiDCO are highly sensitive for assessment of intravascular volume status during OPCAB surgery. In contrast, even if static parameters by TEE reflect changes in ventricular diastolic volume, they are poor indicators of fluid responsiveness. Surprisingly, no significant correlation between DeltaVAo (TEE) and DeltaCI% was found.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative StudyChronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery.
Chronic angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) therapy has been reported to result in intraoperative hypotension in patients undergoing general anesthesia. This study evaluated the association between ACE-I/ARB therapy and the hemodynamics of patients undergoing noncardiac surgery using a large patient dataset. ⋯ Chronic diuretic therapy is associated with more frequent hypotension in ACE-I/ARB-treated patients undergoing noncardiac surgery.