Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Feb 1987
Hemodynamic variables and the incidence of prebypass ischemia during sufentanil/O2/pancuronium anesthesia in patients undergoing coronary artery surgery.
It has been suggested that sufentanil is a superior anesthetic to fentanyl for patients undergoing myocardial revascularization. This study was performed to determine the incidence of prebypass myocardial ischemia using sufentanil, 20 micrograms/kg for patients undergoing coronary artery bypass grafting (CABG). Twenty-seven patients with normal left ventricular function, scheduled for elective CABG, were studied. ⋯ Three patients (11.1%) had perioperative myocardial infarctions, two of whom had prebypass myocardial ischemia. It is concluded that the incidence of prebypass ischemia with sufentanil anesthesia approximates 26%, which is similar to other studies using sensitive ECG monitoring techniques for the detection of ST segment changes. Hemodynamic instability, in the form of bradycardia, hypertension and hypotension, but not tachycardia, may have contributed to the incidence of prebypass ischemia.
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J Cardiothorac Anesth · Feb 1987
Pulmonary and systemic hemodynamic effects of central venous and left atrial sympathomimetic drug administration in the dog.
Systemic vasopressor or inotropic therapy may exacerbate existing pulmonary hypertension; the optimal agent and route of administration in this situation are unknown. The systemic and pulmonary hemodynamic effects of four sympathomimetic agents (dopamine, epinephrine, norepinephrine, and phenylephrine) during central venous and left atrial administration were investigated in the anesthetized dog. All four drugs increased both systemic and pulmonary artery pressures. ⋯ However, pulmonary arterial concentrations of the three drugs measured (dopamine, epinephrine, and norepinephrine) were markedly lower during left atrial compared to central venous drug administration; systemic drug concentrations were similar or increased during left atrial compared to central venous drug administration. It is concluded that the relative effects on the systemic and pulmonary circulations differ for the four drugs; rational choice of a vasopressor will depend upon the hemodynamic situation and the desired effect. Left atrial catecholamine administration is effective in decreasing pulmonary arterial drug concentrations and may decrease adverse pulmonary effects in clinical practice.