Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
ReviewCardiopulmonary bypass-induced inflammation: is it important?
The systemic endotoxemia that occurs with the institution of cardiopulmonary bypass (CPB) is a potent stimulus for the release of proinflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and IL-6. Raised IL-6 levels have been reported to correlate with post-CPB left ventricular wall-motion abnormalities and myocardial ischemic episodes. Neutrophil-endothelial adhesion is strongly implicated in the inflammation and reperfusion injury that may follow a period of CPB, and organ injury is thought to be, in part, neutrophil mediated. ⋯ Recent data suggest that administration of the serine protease inhibitor aprotinin to patients undergoing myocardial revascularization with CPB can reduce TNF-alpha blood levels and blunt neutrophil CD11b upregulation. Preliminary data suggest that aprotinin can inhibit cytokine-induced nitric oxide synthase expression and subsequent NO production by murine bronchial epithelial cells. These effects may explain some of the reported antiinflammatory effects of the serine protease inhibitors.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Comparative StudyFlow resistances of disposable double-lumen, single-lumen, and Univent tubes.
To compare the airflow resistances of modern double-lumen, single-lumen, and Univent (Fuji Systems Corp; Tokyo, Japan) tubes. ⋯ Flow resistances of modern disposable double-lumen tubes are lower than commonly perceived. In most clinical situations, there will be no decrease in flow resistance when a Rusch or Sheridan double-lumen tube is replaced by a single-lumen tube.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Comparative StudyThe interaction between applied PEEP and auto-PEEP during one-lung ventilation.
To investigate the relationship between applied external positive end-expiratory pressure (PEEP) and auto-PEEP and the resultant total PEEP experienced by the patient during one-lung ventilation (OLV). ⋯ The change in end-expiratory pressure experienced by the ventilated lung during OLV when external PEEP is applied depends on the preexisting level of auto-PEER This may explain some of the inconsistencies in the clinical results of application of external PEEP during OLV. The total PEEP delivered to the patient should be measured whenever external PEEP is applied during OLV.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Respiratory mechanics and gas exchange during one-lung ventilation for thoracic surgery: the effects of end-inspiratory pause in stable COPD patients.
To examine the effects of end-inspiratory pause (EIP) of different durations on pulmonary mechanics and gas exchange during one-lung ventilation (OLV) for thoracic surgery. ⋯ During the period of OLV in the lateral position of patients with preexisting pulmonary hyperinflation, the magnitude of PEEPi increased and oxygenation decreased significantly, whereas the efficacy of ventilation was not changed by the addition of an end-inspiratory pause to the ventilatory pattern. Because arterial oxygenation is affected by the presence of pulmonary hyperinflation, the method of ventilation should take into account the magnitude of preoperative pulmonary hyperinflation.