Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Dec 1990
Randomized Controlled Trial Clinical TrialHistamine blockade and cardiovascular changes following heparin administration during cardiac surgery.
Large doses of heparin given as a bolus may produce hypotension; however, conflicting reports exist about the mechanisms involved. This study was undertaken to determine the role of histamine in beef lung heparin-induced hypotension and the efficacy of histamine-receptor blockade in attenuating this undesirable side effect in patients undergoing cardiac surgery. Two hundred patients with good ventricular function were studied after they were randomized into four equal groups. ⋯ Those changes were significantly greater than in group II (P less than 0.025) and Group IV (P less than 0.005) patients, in whom no significant hypotension was found. In group III, mean arterial pressure decreased from 92 +/- 3 to 75 +/- 1 mm Hg (P less than 0.05) after 1 minute and returned toward baseline values after 4 minutes. Histamine levels increased significantly in all groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Cardiothorac Anesth · Oct 1990
Randomized Controlled Trial Comparative Study Clinical TrialComparison of bretylium and lidocaine in the prevention of ventricular fibrillation after aortic cross-clamp release in coronary artery bypass surgery.
The authors compared bretylium and lidocaine for reducing the incidence and persistence of ventricular fibrillation following aortic cross-clamp release performed during coronary artery bypass surgery. Thirty-three adult patients scheduled for elective bypass surgery were randomly assigned in a double-blind fashion to receive a bolus of bretylium, 10 mg/kg, lidocaine, 2 mg/kg, or saline, in equal volumes prior to the release of the aortic cross-clamp. Coronary artery bypass surgery was conducted using standard cardiopulmonary bypass (CPB) procedures with systemic cooling to 24 degrees to 28 degrees C. ⋯ The number of countershocks required to defibrillate, while lower in the bretylium group, did not reach statistical significance. After cardiopulmonary bypass, cardiac output and systemic vascular resistance were comparable. Bretylium warrants further study in this setting.
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J Cardiothorac Anesth · Oct 1990
Randomized Controlled Trial Comparative Study Clinical TrialAcute plasmapheresis during cardiac surgery: volume replacement by crystalloids versus colloids.
Acute plasmapheresis (APP) is an additional tool for blood conservation during cardiac surgery. In a randomized study of 60 aortocoronary bypass patients undergoing APP, the influence of replacement of the withdrawn autologous plasma (10 mL/kg) by either colloids (low molecular weight hydroxyethyl starch solution [6% HES 200/0.5]) or crystalloids (Ringer's solution) was investigated. APP was performed by means of a centrifugation technique producing platelet-poor plasma. ⋯ The platelet count, AT-III and fibrinogen plasma concentrations, colloid osmotic pressure, albumin, and total protein were significantly less compromised in the patients with colloid volume replacement. These parameters were closest to control values in patients receiving colloid replacement and HF. It is concluded that colloid is preferred for replacement of autologous plasma withdrawn by APP, and HF is superior to the CS when the combined technique for blood conservation is used.
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J Cardiothorac Anesth · Aug 1990
Randomized Controlled Trial Clinical TrialValue and accuracy of dual oximetry during pulmonary resections.
During thoracic surgery, one-lung ventilation (1LV) is often required. The purpose of this prospective study was to examine the usefulness and accuracy of dual-oximetry during 1LV. Prior to the induction of anesthesia, 30 patients had a radial artery and a fiberoptic pulmonary artery catheter (15 Edwards, 15 Spectramed by randomization) inserted. ⋯ SpO2 less than 95% reflects hypoxygenation and hypoxia (PaO2 less than or equal to 70 mm Hg). SvO2 is determined primarily by oxygenation (r = 0.005; P less than or equal to 0.05) rather than by CI (r = 0.001, ns). Since DO2I increased during 1LV to maintain the oxygen supply and demand balance, SvO2 monitoring might be useful as an early indicator in identifying high-risk patients with compromised DO2I resulting from decreased CI.
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J Cardiothorac Anesth · Apr 1990
Randomized Controlled Trial Comparative Study Clinical TrialA randomized double-blind comparison of fentanyl- and sufentanil-oxygen anesthesia for abdominal aortic surgery.
Twenty-four patients undergoing abdominal aortic surgery for aneurysm or occlusive vascular disease entered a randomized, double-blind protocol comparing high-dose narcotic anesthesia with fentanyl (125 micrograms/kg) or sufentanil (25 micrograms/kg). All patients received perioperative beta-adrenergic blockade therapy. Hemodynamic and electrocardiographic (leads II and V5) responses to induction, intubation, skin incision, aortic cross-clamping, and declamping were studied. ⋯ Mean plasma fentanyl concentrations varied between 7.2 +/- 1.4 ng/mL and 26.5 +/- 7.9 ng/mL, and mean sufentanil plasma concentrations varied between 1.0 +/- 0.1 ng/mL and 10.6 +/- 7.2 ng/mL throughout surgery. Within this range of narcotic serum levels, the authors were unable to identify a specific threshold level for either narcotic above which hemodynamic responses were consistently attenuated. A low incidence (4.5%) of intraoperative myocardial ischemia was observed.(ABSTRACT TRUNCATED AT 250 WORDS)