Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Randomized Controlled Trial Clinical TrialEffect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults.
The purpose of this study was to examine the effect of cardiopulmonary bypass flow rate on cerebral blood flow and cerebral metabolic rate for oxygen during hypothermic (27 degrees C) cardiopulmonary bypass. ⋯ Brain oxygenation is well maintained at lower than conventional pump flow levels during CPB. There may be practical advantages to reduced flows during hypothermia, and flow reductions do not appear to adversely affect cerebral blood flow or metabolism.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Early extubation after mitral valve surgery: a target-controlled infusion of propofol and low-dose sufentanil.
In the current study, the use of a target-controlled infusion of low-dose propofol was combined with a continuous infusion of sufentanil for patients undergoing mitral valve surgery. The purpose of the study was to evaluate the hemodynamic stability, the time to awakening and spontaneous ventilation, and the feasibility in an early extubation setting of a total intravenous anesthetic technique. ⋯ The simplicity of the method with only one change in infusion rate is a major advantage. The technique permits predictable recovery and return to spontaneous ventilation in all patients. Its use in patients entering early extubation protocols is appealing for its reproducibility, simplicity, and safety.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Comparative StudyRespiratory outcomes with early extubation after coronary artery bypass surgery.
Aortocoronary bypass surgery has undergone recent changes, promoting the concept of "fast tracking," in which patients are extubated and discharged postoperatively at an accelerated pace compared with previous historic patterns. Postoperative respiratory function and complications have not been previously studied in patients selected for "fast tracking." ⋯ Differences in chest radiographs in the late extubation group at the time of extubation may be related to greater use of fluids or increased airway obstruction. The rationale of early extubation is based on cost minimization to decrease hospital duration. This article suggests that respiratory physiological outcomes are not worsened in patients who are extubated and discharged early after elective aortocoronary bypass surgery.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Comparative StudyEvaluation of the accuracy and response time of STAT-mode continuous cardiac output.
This study was conducted to compare continuous cardiac output (CCO) with bolus thermodilution cardiac output (BTD) at steady state, and to compare the response time of STAT CCO with that of trend CCO, mean arterial pressure, and mixed venous oxygen saturation [SvO2] during an acute hemodynamic change. ⋯ STAT and trend CCO are accurate and precise and show close agreement with BTD cardiac output at steady state. The faster algorithm of STAT CCO offers some advantage over trend CCO during an acute hemodynamic change. However, because of the averaging process for determining CCO, the response time of STAT CCO is slower than that of mean arterial pressure and SvO2.
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J. Cardiothorac. Vasc. Anesth. · Jun 1997
Acetylcholine reactivity in the pulmonary artery during cardiac surgery in patients with ischemic or valvular heart disease.
During cardiopulmonary bypass, there is almost no blood flow through the pulmonary artery. Ischemia and reperfusion are known to attenuate the reaction to acetylcholine. An attenuated reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass was previously shown in children. The current study in adult patients was designed to analyze the change over time of acetylcholine reactivity after cardiac surgery. ⋯ These results confirm the finding of altered reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass. In view of the often prolonged tendency toward pulmonary hypertension observed in children, the recovery at 8 hours after surgery was unexpectedly rapid. The attenuated response to acetylcholine is most likely explained by relative ischemia in the pulmonary circulation during cardiopulmonary bypass.