Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Comparative StudyRespiratory outcomes with early extubation after coronary artery bypass surgery.
Aortocoronary bypass surgery has undergone recent changes, promoting the concept of "fast tracking," in which patients are extubated and discharged postoperatively at an accelerated pace compared with previous historic patterns. Postoperative respiratory function and complications have not been previously studied in patients selected for "fast tracking." ⋯ Differences in chest radiographs in the late extubation group at the time of extubation may be related to greater use of fluids or increased airway obstruction. The rationale of early extubation is based on cost minimization to decrease hospital duration. This article suggests that respiratory physiological outcomes are not worsened in patients who are extubated and discharged early after elective aortocoronary bypass surgery.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Comparative StudyContinuous intraoperative noninvasive cardiac output monitoring using a new thoracic bioimpedance device.
To compare a new noninvasive bioimpedance device with the standard thermodilution method during the intraoperative period in high-risk patients undergoing oncological surgery. ⋯ This new impedance device is a safe, reliable, clinically acceptable alternative to the invasive thermodilution method in the operating room environment.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Comparative StudyEvaluation of the accuracy and response time of STAT-mode continuous cardiac output.
This study was conducted to compare continuous cardiac output (CCO) with bolus thermodilution cardiac output (BTD) at steady state, and to compare the response time of STAT CCO with that of trend CCO, mean arterial pressure, and mixed venous oxygen saturation [SvO2] during an acute hemodynamic change. ⋯ STAT and trend CCO are accurate and precise and show close agreement with BTD cardiac output at steady state. The faster algorithm of STAT CCO offers some advantage over trend CCO during an acute hemodynamic change. However, because of the averaging process for determining CCO, the response time of STAT CCO is slower than that of mean arterial pressure and SvO2.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Acetylcholine reactivity in the pulmonary artery during cardiac surgery in patients with ischemic or valvular heart disease.
During cardiopulmonary bypass, there is almost no blood flow through the pulmonary artery. Ischemia and reperfusion are known to attenuate the reaction to acetylcholine. An attenuated reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass was previously shown in children. The current study in adult patients was designed to analyze the change over time of acetylcholine reactivity after cardiac surgery. ⋯ These results confirm the finding of altered reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass. In view of the often prolonged tendency toward pulmonary hypertension observed in children, the recovery at 8 hours after surgery was unexpectedly rapid. The attenuated response to acetylcholine is most likely explained by relative ischemia in the pulmonary circulation during cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
The effects of pulsatile cardiopulmonary bypass on cerebral and renal blood flow in dogs.
The purpose of this study was to determine the effects of pulsatility on cerebral blood flow, cerebral metabolism, and renal blood flow over a range of cardiopulmonary bypass temperature and flow conditions. ⋯ Pulsatility has no significant effect on cerebral or renal perfusion over a broad range of cardiopulmonary bypass temperature and flow conditions. Cerebral blood flow and metabolism were functions of temperature but not pulsatility or flow rate. Renal blood flow was affected by both temperature and cardiopulmonary bypass flow rate but not by pulsatility. Finally, central nervous system perfusion may be preserved under low-flow cardiopulmonary bypass conditions by shunting of perfusion from splanchnic vascular beds.