Journal of cardiothoracic and vascular anesthesia
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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.
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J. Cardiothorac. Vasc. Anesth. · Aug 1999
Do anticoagulation with heparin and protamine reversal alter thrombogenicity of coated and noncoated pulmonary artery catheters?
To clarify the role of anticoagulation with heparin and protamine reversal on the effectiveness of heparin bonding or coating of pulmonary artery catheters in preventing thrombus formation in the Rhesus monkey. ⋯ Anticoagulation of primates with heparin before catheter insertion imparts some protection to non-coated catheters, and protamine reversal of anticoagulation with heparin may partially negate the protective effect seen with heparin-coated pulmonary artery catheters.
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J. Cardiothorac. Vasc. Anesth. · Jun 1999
Randomized Controlled Trial Clinical TrialThoracic epidural anesthesia as an adjunct to general anesthesia for cardiac surgery: effects on ventilation-perfusion relationships.
To determine the effects of thoracic epidural anesthesia (TEA) on ventilation-perfusion (VA/Q) relationships, atelectasis, and oxygenation before and after coronary artery bypass graft surgery (CABG). ⋯ TEA can reduce respirator time and the need for morphine analgesics after CABG without negative effects on VA/Q matching, oxygenation, or atelectasis formation.
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J. Cardiothorac. Vasc. Anesth. · Jun 1999
Efficacy of epsilon-aminocaproic acid in children undergoing cardiac surgery.
To compare coagulation test results, blood loss, and blood product transfusions between patients receiving prophylactic epsilon-aminocaproic acid (EACA) and a control group matched for age, resternotomy, and surgery in children undergoing cardiac surgery. ⋯ EACA reduced intraoperative blood loss but did not significantly decrease blood product transfusions. Lack of efficacy may be related to relative underdosing and should be further studied.
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J. Cardiothorac. Vasc. Anesth. · Jun 1999
Randomized Controlled Trial Clinical TrialMarkers of splanchnic perfusion and intestinal translocation of endotoxins during cardiopulmonary bypass: effects of dopamine and milrinone.
To investigate markers of splanchnic perfusion and the extent of endotoxemia during cardiopulmonary bypass (CPB) and to compare the effects of dopamine and milrinone on both splanchnic perfusion and endotoxemia. ⋯ Endotoxemia occurs during routine CPB. Neither pHi nor lac/pyr values showed adverse change, but hepatic venous oximetry may be a more sensitive indicator of splanchnic dysoxia in that S(HV)O2 was reduced during rewarming. Whether dopamine or milrinone confer protection against splanchnic ischemia remains uncertain.