Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 1998
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-based versus fentanyl-isoflurane-based anesthesia for cardiac surgery.
To evaluate drug costs, time of mechanical ventilation, complications, and hospital length of stay comparing propofol-based with fentanyl-isoflurane-based anesthesia. ⋯ Fentanyl-isoflurane provides an inexpensive anesthetic that permits as prompt an extubation as propofol, thus conserving resources for other patients.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1998
ReviewSafety issues in heparin and protamine administration for extracorporeal circulation.
This article reviews past approaches to heparin and protamine dosing and summarizes current practice. The author elucidates his experience with the Celite activated coagulation time (ACT), with attention to his adoption of a value of 400 seconds for this time; the adoption of an ACT of 480 seconds by Bull et al (J Thorac Cardiovasc Surg 69:674-684, 1975) and Young et al (Ann Thorac Surg 26:231-240, 1978); the proposed use of heparin response curves by Bull et al; the author's experience with a unitized dosing system to individualize dosing of heparin; and the use for this purpose by Despotis et al (J Thorac Cardiovasc Surg 110:46-54, 1995) of a system based on protamine titration. In more than 270 adult cardiac surgery patients, the unitized dosing system identified patients with high sensitivity or resistance to heparin and facilitated exact individualized doses to be given to produce the desired effect. ⋯ Aprotinin is not a procoagulant during cardiopulmonary bypass. Emerging studies suggest that graft patency is not affected by aprotinin use. The Celite ACT should not be used to monitor heparin effect and safety when using aprotinin; the kaolin ACT should be used instead.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1998
Effects of inhaled nitric oxide on respiratory system mechanics, hemodynamics, and gas exchange after cardiac surgery.
To evaluate the hemodynamic and respiratory effects of inhaled nitric oxide (NO) in postoperative cardiac patients. ⋯ The effects of NO as a powerful and useful vasodilator agent were confirmed. However, it is important to be aware that the effects observed on respiratory mechanics may interfere with the final response of the respiratory system to NO.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1998
Comment Case ReportsOne-lung ventilation in patients with difficult airways.