Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialPain management and spirometry following thoracotomy: a prospective, randomized study of four techniques.
Forty-five patients who underwent anterolateral and posterolateral thoracotomy were studied to compare the relative efficacy of cryoanalgesia, epidural morphine, intrapleural analgesia, and intravenous morphine for relief of postoperative pain and prevention of deterioration in pulmonary function. Spirometry (FEV1, FVC) was performed preoperatively and postoperatively. Patients' pain was assessed using the 0 to 100 mm visual analog scale. ⋯ Although the number of evaluable patients was insufficient to draw definitive conclusions, 12-week follow-up suggested a difference in the incidence of post-thoracotomy pain syndrome in patients who received cryoanalgesia. It is concluded that post-thoracotomy pain is best relieved with epidural morphine, compared to intrapleural analgesia, cryoanalgesia, and parenteral morphine. There was no change in the deterioration in spirometric tests after thoracotomy, nor was there any advantage offered by cryoanalgesia or intrapleural analgesia over intravenous morphine, with respect to pain relief.
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J. Cardiothorac. Vasc. Anesth. · Oct 1993
A quality improvement study of the placement and complications of double-lumen endobronchial tubes.
To assess the complications of conventional and fiberoptic endobronchial intubations using reusable (Leyland, London) and disposable (Rüsch, Waiblinger, Germany; Sheridan, Argyle, NY) double-lumen tubes (DLTs), endobronchial intubations occurring over a 12-month period were prospectively studied at this hospital. Residents working with staff anesthesiologists placed either left or right reusable (Leyland) or disposable (Rüsch or Sheridan) DLTs. The DLT used, the use of fiberoptic bronchoscopy (FOB), findings at FOB if used during the intubation or operation, and complications occurring during the case (SpO2 < 90%, peak inflation pressure > 40 cm H2O, air trapping, poor lung isolation, and airway trauma) were recorded. ⋯ Complications occurred in 42/234 patients (18%). The frequency of specific complications was: decreased SpO2, 9%; increased airway pressures, 9%; poor lung isolation, 7%; air trapping, 2%, and airway trauma, 0.4%. Right-sided Sheridan DLTs had a statistically higher incidence of malposition, resulting in poorer lung isolation.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1993
Effect of continuous positive airway pressure applied by face mask on right ventricular function after cardiac surgery.
The effect of respiratory therapy with continuous positive airway pressure (CPAP) on right ventricular function 24 hours after elective cardiac surgery was evaluated in patients with or without severe coronary artery disease. The first group included 10 patients following coronary artery bypass graft (CABG) surgery, and the second group included 10 patients following aortic valve replacement (AVR) without preexisting coronary artery disease. Patients of both groups had preoperative left ventricular ejection fractions above 40%. ⋯ Right ventricular function was estimated at end-expiration by a fast-response thermodilution cardiac output catheter. The results demonstrate that in both groups of patients, CPAP did not significantly modify right ventricular indices, ejection fraction, end-systolic and end-diastolic volume indices, and stroke volume index, indicating that CPAP can safely be applied after elective cardiac surgery in patients with or without severe coronary artery disease and preoperative left ventricular ejection fractions above 40%. Furthermore, the concomitant postoperative intravenous infusion of nitroglycerin (to all 10 patients of the CABG group and to 4 patients of the AVR group) counteracted the expected beneficial effect of CPAP therapy on arterial oxygenation.
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J. Cardiothorac. Vasc. Anesth. · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia.
Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. In this study, 45 patients, who were scheduled to have epidural analgesia and undergo a lateral thoracotomy, were randomized to receive either a thoracic or a lumbar catheter. ⋯ This study found no statistical difference in pain relief or side effects between lumbar and thoracic epidural analgesia for post-thoracotomy pain. An increased infusion rate (6.4 +/- 1.9 v 5.1 +/- 1.4 mL/h, P = 0.02) was required in the lumbar group to achieve equivalent analgesic levels.