Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Letter Case ReportsIncorrectly labelled double-lumen tube.
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Transesophageal pulsed-Doppler echocardiographic evaluation of transmitral and pulmonary venous flow during ventilation with positive end-expiratory pressure.
During mechanical ventilation with high levels of positive end-expiratory pressure (PEEP) several hemodynamic changes occur, the mechanism of which has been the subject of various previous studies. The effects of increasing levels of PEEP during mechanical ventilation were measured on left atrial and left ventricular filling dynamics, as assessed by pulmonary venous and transmitral flow velocities, respectively. Using transesophageal echocardiography in 12 patients, Doppler flow velocities of pulmonary venous and transmitral flow were studied at baseline (0 cmH2O PEEP) and at 5, 10, 15, and 20 cm H2O with 10-minute intervals, and once more after removal of PEEP. ⋯ In contrast, early and late diastolic velocities and velocity time integrals did not change. In regard to transmitral flow, both early and late diastolic velocities significantly decreased from 51 +/- 7 cm/s and 50 +/- 9 cm/s at baseline to 38 +/- 7 cm/s at 20 cmH2O PEEP, respectively (P < 0.01). Early and late diastolic velocity time integrals decreased from 6.1 +/- 1.8 cm and 4.7 +/- 1.0 cm to 4.5 +/- 1.0 cm (NS) and 3.4 +/- 0.7 cm (P < 0.05), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialSomatosensory evoked potential monitoring of the brachial plexus to predict nerve injury during internal mammary artery harvest: intraoperative comparisons of the Rultract and Pittman sternal retractors.
Brachial plexus injury after coronary artery bypass grafting (CABG) continues to be a common problem postoperatively. With the use of somatosensory evoked potential monitoring (SSEP), neurologic integrity of the brachial plexus during internal mammary artery (IMA) harvest was assessed and the Rultract and Pittman sternal retractors were compared to determine what effect they had on SSEP characteristics. Results showed that the Rultract and Pittman retractors caused large decreases in SSEP amplitudes after insertion, (1.25 +/- 0.14 versus 0.72 +/- 0.09, P < 0.05; and 1.64 +/- 0.27 versus 0.91 +/- 0.14, P < 0.05) respectively. ⋯ The nerve plexus seems to be most at risk for pathologic injury during retraction of the sternum for IMA harvest. Though the Rultract retractor caused greater changes in SSEP characteristics than the Pittman, no clinical outcome differences between the two could be ascertained. Using SSEP monitoring may reduce brachial plexus injury during IMA harvest by allowing early detection of nerve compromise and therapeutic interventions to alleviate the insult while under general anesthesia.