Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1999
Support of mean arterial pressure during tepid cardiopulmonary bypass: effects of phenylephrine and pump flow on systemic oxygen supply and demand.
To examine the effects of phenylephrine infusion and increases in pump flow on systemic oxygen supply and demand when they are used to support mean arterial pressure (MAP) during cardiopulmonary bypass (CPB). ⋯ During CPB with conventional flow rates, DO2 is decreased. Supporting MAP with increases in pump flow better maintains DO2 than the administration of an alpha-agonist.
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J. Cardiothorac. Vasc. Anesth. · Aug 1999
Comparative Study Clinical Trial Controlled Clinical TrialComparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting.
To investigate the precision and accuracy of continuous pulse contour cardiac output (PCCO) compared with intermittent transcardiopulmonary (TCPCO) and pulmonary artery thermodilution (TDCO) measurements in patients undergoing minimally invasive coronary bypass surgery (MIDCAB). ⋯ The results of the present study show that compared with thermodilution CO, pulse contour analysis enables accurate measurement of continuous CO in patients undergoing MIDCAB.
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J. Cardiothorac. Vasc. Anesth. · Aug 1999
Influence of fast-track anesthetic technique on cardiovascular infusions and weight gain.
To evaluate whether cardiac surgical patients receiving conventional versus fast-track anesthetic management are statistically significantly different with regard to cardiovascular drug infusions, weight gain, cardiac and pulmonary morbidity, length of intubation, and length of stay. ⋯ Fast-track anesthetic management may be associated with decreased need for inotropic and antiarrhythmic drug infusions and decreased weight gain.
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J. Cardiothorac. Vasc. Anesth. · Aug 1999
Coagulation tests during cardiopulmonary bypass correlate with blood loss in children undergoing cardiac surgery.
To examine whether coagulation tests, sampled before and during cardiopulmonary bypass (CPB), are related to blood loss and blood product transfusion requirements, and to determine what test value(s) provide the best sensitivity and specificity for prediction of excessive hemorrhage. ⋯ During cardiac surgery, coagulation tests (including thromboelastography) drawn pre-CPB and during CPB are useful to identify children at risk for excessive bleeding. Platelet count during CPB was the variable most significantly associated with blood loss.
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J. Cardiothorac. Vasc. Anesth. · Aug 1999
Etiology and incidence of brain dysfunction after cardiac surgery.
The frequency and severity of central nervous system complications in patients undergoing cardiopulmonary bypass (CPB) may be greater than previously thought, particularly in the older population. The risks of embolic neurologic complications and stroke in the population older than 70 years from a severely atherosclerotic ascending aorta are well documented. Moreover, while the majority of CPB patients do not experience perioperative stroke, a high incidence of more subtle central nervous system dysfunction has been demonstrated to persist for up to 1 year after surgery. ⋯ Aprotinin, a serine protease inhibitor, has been found in two separate, randomized, placebo-controlled trials to significantly lower incidences of perioperative stroke. Further study to develop therapeutic and preemptive strategies for prevention of brain injury is required, especially in the elderly. Aprotinin and other modalities aimed at suppressing the inflammatory response to CPB may offer hope because they act to suppress injury-provoking enzymes and leukocyte activation that are, in part, responsible for organ system dysfunction following CPB.