Anesthesiology
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Comparative Study
Continuous Fick cardiac output compared to continuous pulmonary artery electromagnetic flow measurement in pigs.
A system for continuous Fick cardiac output measurement (CFCO) is described and compared to continuous electromagnetic pulmonary artery flow (EMCO) and intermittent thermodilution (TDCO) measurements. Oxygen consumption was determined from continuous respiratory gas exchange analysis and arterio-venous oxygen difference from fiberoptic oximetry. A computer calculated cardiac output and other variables every 20 s. ⋯ CFCO is recommended as a reliable standard of continuous cardiac output measurement. It is not a real time measurement; the technique has a time lag of approximately 20 s which is the result of the time constant of the VO2 measurement. Sources for error are discussed with suggestions for improving quality control.
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In 97 adult patients receiving liver transplants, the coagulation system was monitored by thrombelastography and by coagulation profile including PT; aPTT; platelet count; level of factors I, II, V, VII, VIII, IX, X, XI, and XII; fibrin degradation products; ethanol gel test; protamine gel test; and euglobulin lysis time. Preoperatively, fibrinolysis defined as a whole blood clot lysis index of less than 80% was present in 29 patients (29.9%), and a euglobulin lysis time of less than 1 h was present in 13 patients. Fibrinolysis increased progressively during surgery in 80 patients (82.5%) and was most severe on reperfusion of the graft liver in 33 patients (34%). ⋯ When whole blood clot lysis time was less than 120 min, generalized oozing occurred, and the effectiveness of epsilon-aminocaproic acid was demonstrated in vitro during the pre-anhepatic and post-anhepatic stages, epsilon-aminocaproic acid (1 g, single intravenous dose) was administered. In all 20 patients treated with epsilon-aminocaproic acid, fibrinolytic activity disappeared; whole blood clot lysis was not seen on thrombelastography during a 5-h observation period, and whole blood clot lysis index improved from 28.5 +/- 29.5% to 94.8 +/- 7.4% (mean +/- SD, P less than 0.001). None of the treated patients had hemorrhagic or thrombotic complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study Clinical Trial
Epidural ketamine or morphine for postoperative analgesia.