Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Influence of intravenous calcium gluconate on saphenous vein graft flow in closed-chest patients.
The effects of calcium gluconate on hemodynamics and saphenous vein graft flow in a group of patients undergoing elective coronary artery bypass grafting who developed ionized hypocalcemia at the end of the surgical procedure were examined. The patients received a central venous bolus of 15 mg/kg of calcium gluconate. Heart rate (HR), arterial pressure (AP), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and cardiac output were measured immediately before and 30, 60, 120, 180, and 240 seconds after injection of calcium gluconate. ⋯ HR, CVP, PAP, PCWP, PVR, CI, SVI, and Vbypass-flow remained unaltered. It is concluded that calcium gluconate administered to moderately hypocalcemic patients increases arterial pressure mainly by peripheral vasoconstriction. Because the increase of arterial pressure, and, thereby, coronary perfusion pressure is not associated with an increase of LAD bypass flow, vasoconstriction in the coronary vascular bed distal to the venous graft cannot be ruled out, and deterioration of the myocardial oxygen supply/demand ratio is strongly suggested.
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Clinical TrialDoes aprotinin influence endothelial-associated coagulation in cardiac surgery?
Aprotinin has been reported to reduce bleeding in cardiac surgery patients. Its mechanisms of action on coagulation have not been fully elucidated. In a prospectively randomized study of 40 patients undergoing elective aortocoronary bypass grafting, the influence of high-dose aprotinin (2 million IU of aprotinin before CPB, 500,000 IU/h until the end of operation, 2 million IU added to the prime) (N = 20) on endothelial-related coagulation was compared to a nontreated control group (N = 20). ⋯ During CPB, TM plasma concentrations decreased similarly in both groups (aprotinin: 18 +/- 6 ng/mL, control: 17 +/- 7 ng/mL) followed by a comparable increase in the postbypass period until the first postoperative day (aprotinin: 60 +/- 10 ng/mL, control: 53 +/- 11 ng/mL). Protein C and (free) protein S plasma levels also showed no differences between the two groups. On the first postoperative day, baseline values for protein C and protein S had not yet been reached.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Early extubation after cardiac surgery using combined intrathecal sufentanil and morphine.
The records of 10 patients who had well-preserved respiratory and ventricular function and had received 50 micrograms of sufentanil and 0.5 mg of morphine intrathecally before induction of anesthesia for cardiopulmonary bypass surgery were reviewed. Anesthesia was maintained with isoflurane and no patient received intravenous narcotics intraoperatively. ⋯ No patient required naloxone, reintubation, or treatment for respiratory depression. Combined intrathecal sufentanil and morphine provided conditions that allowed successful early extubation in 8 of 10 of these selected cardiac surgery patients.