Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Clinical TrialAnesthetic myocardial protection with sevoflurane.
To examine the role of sevoflurane in myocardial protection in patients undergoing coronary artery bypass graft (CABG) surgery. ⋯ Sevoflurane decreases the inflammatory response after CPB, as measured by the release of IL-6, CD11b/CD18, and TNF-alpha. Myocardial function after CPB, as assessed by RWMA and LVSWI, was also improved with sevoflurane. The role of sevoflurane in myocardial protection and the inflammatory response to myocardial reperfusion should be considered.
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia after thoracotomy: epidural fentanyl/bupivacaine compared with intercostal nerve block plus intravenous morphine.
Intercostal nerve blockade plus intravenous (IV) patient-controlled analgesia (PCA) could be an easier and safer alternative to epidural analgesia for postthoracotomy pain, but information about the efficacy of this technique is scarce. The objective of this randomized study was to compare the quality of analgesia and lung function in 2 groups of patients undergoing pulmonary surgery through a posterolateral thoracotomy. ⋯ The fact that the difference in pain scores is probably not clinically significant shows that an intercostal block with bupivacaine plus IV morphine PCA is a good alternative for postthoracotomy pain management.
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialStress response to tracheal intubation in patients undergoing coronary artery surgery: direct laryngoscopy versus an intubating laryngeal mask airway.
Stress response caused by endotracheal intubation may be harmful for the coronary or cerebral circulation of high-risk patients. This study evaluated the hypothesis that tracheal intubation via an intubating laryngeal mask airway is associated with less cardiovascular and endocrine stress response than the conventional technique using direct laryngoscopy. ⋯ Reduction of cardiovascular and endocrine stress response associated with endotracheal intubation is more pronounced when performed via the intubating laryngeal mask. Thus, this technique can be helpful in high-risk cardiac patients.
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Clinical TrialMagnesium in addition to sotalol does not influence the incidence of postoperative atrial tachyarrhythmias after coronary artery bypass surgery.
Postoperative atrial tachyarrhythmias (POATs) after coronary artery bypass grafting (CABG) are reported in 11% to 40% of patients. Several etiologic factors are mentioned. Prophylactic intervention with sotalol is reported to reduce the incidence of POAT. The authors studied the effect of magnesium chloride (MgCl2) in addition to sotalol in the prevention of POAT. ⋯ These results show that MgCl(2), in addition to sotalol, is not more effective than sotalol alone in the prevention of tachyarrhythmias after CABG. The data showed that this combination may also induce serious bradyarrhythmias.
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J. Cardiothorac. Vasc. Anesth. · Jun 2004
Randomized Controlled Trial Clinical TrialPostoperative analgesia in video-assisted thoracoscopy: the role of intercostal blockade.
This study examined (1) the opioid and nonopioid requirement of patients undergoing video-assisted thoracoscopy (VATS) as a measure of postoperative pain and (2) whether percutaneous intercostal blockade might reduce morphine requirements and improve analgesia in VATS procedures. ⋯ Postoperative morphine requirements after VATS surgery are considerable, with pleurectomy being the most painful procedure. Intercostal blockade with bupivacaine provided effective pain relief and a dramatic reduction in morphine requirements. This technique is recommended for VATS surgery, especially if day-case procedures are being contemplated.