Journal of cardiothoracic and vascular anesthesia
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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.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Assessment of ventricular function in critically ill patients: limitations of pulmonary artery catheterization. Institutions of the McSPI Research Group.
To determine the accuracy of conventional hemodynamic assessment using pulmonary artery catheter-derived data in critically ill patients. ⋯ Evaluable data included 130 of 150 (87%) observations of simultaneously collected CA and TEE data, averaging 5.6+/-4.4 observations per patient. The overall predictive probability for conventional clinical assessment of normal ventricular function was 98% (118/121), whereas for abnormal ventricular function it was 0% (0/9). For CA of volume, the overall predictive probabilities for hypovolemia, normovolemia, and hypervolemia were 50% (3/6), 60% (69/115), and 22% (2/9). Although conventional clinical assessment of normal LV function in the intensive care unit correlates well with echocardiographic assessment, both LV dysfunction and extremes of preload (hypovolemia or hypervolemia) are assessed poorly by clinicians using conventional clinical monitoring with pulmonary artery catheterization.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Computed tomography-based tracheobronchial image reconstruction allows selection of the individually appropriate double-lumen tube size.
To determine whether individualized selection of double-lumen tubes or alternatives based on three-dimensional reconstruction of the tracheobronchial image from routine preoperative computed tomography (CT) scans leads to clinically appropriate choices. ⋯ Individualized selection of double-lumen tube size using CT-based reconstructions of tracheobronchial anatomy leads to clinically appropriate choices. Risks resulting from variations in tracheobronchial morphology are recognized in advance.