Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Feb 1990
Comparative StudyA clinical evaluation of pulse oximetry during thoracic surgery.
To evaluate the utility of pulse oximetry for monitoring oxygenation during thoracic surgery, pulse oximeter oxygen saturation (SpO2) values from the Nellcor N-100 (Nellcor Inc, Haywood, CA) and Novametrix model 500 (Medical Systems Inc, Wallingford, CT) were compared with simultaneous arterial saturation values (SaO2) in 20 patients. A total of 255 matched observations were recorded, and the data were divided for statistical analysis into preinduction of anesthesia and postinduction groups. ⋯ However, once anesthesia was induced, there was no longer any correlation for either of the pulse oximeters versus simultaneous SaO2 values, although on average, the SpO2 values were significantly higher than the corresponding SaO2 values. It was concluded that pulse oximetry is useful in following trends of oxygenation in patients with preexisting lung pathology undergoing thoracic surgery, but it cannot replace arterial blood gas sampling for the intraoperative management of respiratory function.
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J Cardiothorac Anesth · Feb 1990
Letter Case ReportsInadvertent thermal injury from surgical instruments.
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J Cardiothorac Anesth · Feb 1990
Randomized Controlled Trial Clinical TrialLung management during cardiopulmonary bypass: influence on extravascular lung water.
Progressive respiratory insufficiency secondary to cardiopulmonary bypass (CPB) is still a hazard after cardiac surgery. Pathophysiologically, impaired capillary endothelial integrity seems to be the fundamental lesion, followed by increased interstitial fluid accumulation. The reasons for this pulmonary damage are controversial; however, management of the nonperfused lungs during CPB has been widely neglected and may be partly responsible. ⋯ Measurements were performed after induction of anesthesia, before onset of CPB, and immediately after weaning from bypass, as well as 60 minutes and 5 hours after termination of CPB. Pulmonary gas exchange (PaO2) and intrapulmonary shunting (Qs/Qt) were also measured. Starting from comparable, normal baseline values, EVLW was increased in all groups after weaning from CPB, with the most pronounced increase in group 4 (maximum, +35%) and group 5 (+40%).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Cardiothorac Anesth · Feb 1990
Comparative StudyMeasurement of arterial pressure after cardiopulmonary bypass with long radial artery catheters.
Radial arterial pressure can significantly underestimate central aortic pressure in the postcardiopulmonary bypass (post-CPB) period. At the study institution, routine monitoring of perioperative arterial pressure in adult patients undergoing cardiac surgery is performed with a long radial artery catheter with the distal end positioned in the subclavian artery. In 68 patients presenting for elective cardiac surgery, both a conventional short radial artery catheter and a contralateral long radial artery catheter were placed. ⋯ In 28 patients, central aortic pressure was measured post-CPB, and subclavian artery pressure was found to be an excellent estimator of central aortic pressure. There were no significant complications related to using long radial artery catheters in the 68 patients who were followed prospectively. Monitoring subclavian arterial pressure by percutaneous insertion of a long radial artery catheter provides a reliable estimation of central aortic pressure, even in patients with significant radial artery-to-central aortic pressure gradients post-CPB.