Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
The association between preoperative patient characteristics and both clinical and economic outcomes after abdominal aortic surgery.
To evaluate the association between patient characteristics and both clinical and economic outcomes in patients having abdominal aortic surgery in Maryland between 1994 and 1996. ⋯ In patients having aortic surgery, several patient characteristics such as mild liver disease and chronic renal failure, were associated with increased in-hospital mortality and length of stay. The practice of admitting patients to the hospital 1 to 2 days before surgery should be reevaluated because this was not associated with reduced in-hospital mortality but was associated with increased hospital and ICU stay.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Randomized Controlled Trial Comparative Study Clinical TrialRocuronium versus vecuronium during fentanyl induction in patients undergoing coronary artery surgery.
To evaluate the neuromuscular, ventilatory, and cardiovascular effects of rocuronium and vecuronium. ⋯ During narcotic induction of anesthesia, rocuronium was associated with lower requirement for vasopressors, faster onset of neuromuscular blockade, and better conditions for mask ventilation and tracheal intubation compared with vecuronium.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Randomized Controlled Trial Clinical TrialIntrathecal morphine for coronary artery bypass graft procedure and early extubation revisited.
To determine the dose of intrathecal (IT) morphine (along with the intraoperative baseline anesthetic) that provides significant analgesia yet does not delay extubation in the immediate postoperative period in patients undergoing cardiac surgery and early extubation. ⋯ Even when used in conjunction with an intraoperative baseline anesthetic that allows early extubation, IT morphine (10 microg/kg) was unable to provide substantial postoperative analgesia. The risks of using IT morphine in patients undergoing cardiac surgery and early extubation may outweigh the potential benefits.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
ReviewNeurophysiologic monitoring and outcomes in cardiovascular surgery.
The first step to make in improving neurologic outcome is to recognize and accept neurologic injury occurs in all patient groups undergoing CPB. Fortunately, that stage has now been passed. Accurate detection and documentation of the incidence of brain injury is the next progression. ⋯ A strategy that confers absolute myocardial protection would be ideal, but at what cost to the protection of the kidneys, intestines, and brain? A neuroprotective strategy would ideally eliminate brain injury and be beneficial for all organs. The only way to continue to make progress is by the scientific evaluation of new techniques. The use of appropriate monitoring and outcome measures is fundamental to this process.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Randomized Controlled Trial Clinical TrialThe safety and effectiveness of esmolol in the perioperative period in patients undergoing abdominal aortic surgery.
To determine (1) if perioperative use of esmolol in major vascular surgery patients provides strict heart rate (HR) control, (2) what doses of esmolol are required to do this, and (3) does this control influence myocardial ischemia or result in adverse consequences. ⋯ Using esmolol for HR control in the intraoperative period for abdominal vascular surgery patients is effective and safe. HR control was much less effective in the postoperative period, but esmolol is safe when used at recommended doses. Further study with a larger number of patients is necessary to determine whether strict HR control with esmolol affects the incidence of myocardial ischemia or infarction in this patient population.