Anesthesia and analgesia
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Anesthesia and analgesia · May 1997
Randomized Controlled Trial Clinical TrialEffects of dopexamine on creatinine clearance, systemic inflammation, and splanchnic oxygenation in patients undergoing coronary artery bypass grafting.
Impairment of splanchnic and peripheral tissue perfusion during cardiopulmonary bypass (CPB) may be responsible for endotoxin-mediated systemic inflammation and acute phase responses. We examined the effects of dopexamine on hemodynamic parameters, creatinine clearance, systemic and splanchnic oxygenation, gastric mucosal pH (pHi), and mixed and hepatic venous plasma levels of endotoxin, interleukin-6 (IL-6), serum amyloid A (SAA), and C-reactive protein (CRP) in 44 patients scheduled for coronary artery bypass grafting. Patients were randomized to receive continuous infusions of 0.5, 1.0, or 2 micrograms.kg-1.min-1 dopexamine (n = 10 per group) or placebo (n = 14) prior to surgery, intraoperatively, and postoperatively. ⋯ Creatinine clearance was elevated in all dopexamine groups (P < or = 0.025). This elevation was higher with lower dopexamine doses (P < or = 0.025). We conclude that dopexamine improves creatinine clearance and reduces systemic inflammation without affecting splanchnic oxygenation.
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Anesthesia and analgesia · May 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison between conventional axillary block and a new approach at the midhumeral level.
We undertook this prospective, randomized study to compare the success rate, time spent performing the blocks, onset time of surgical anesthesia, presence of complete motor blockade, and lidocaine plasma concentrations between conventional axillary block and a new approach at the midhumeral level. Both techniques were performed using a peripheral nerve stimulator. Two nerves were located at the axillary crease, whereas four nerves were located at the midhumeral level. ⋯ The success rate of the block, as well as the incidence of complete motor blockade, was greater with the midhumeral approach compared with the axillary approach. However, the onset time to complete anesthesia of the upper extremity was shorter in the axillary approach. For brachial plexus anesthesia, we conclude that the midhumeral approach provided a greater success rate than the traditional axillary approach.
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Anesthesia and analgesia · May 1997
Randomized Controlled Trial Clinical TrialThe efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery.
The antifibrinolytic drug, tranexamic acid, decreases blood loss in adult patients undergoing cardiac surgery. However, its efficacy has not been extensively studied in children. Using a prospective, randomized, double-blind study design, we examined 41 children undergoing repeat sternotomy for repair of congenital heart defects. ⋯ Children who were treated with tranexamic acid had 24% less total blood loss (26 +/- 7 vs 34 +/- 17 mL/kg) compared with children who received placebo (univariate analysis P = 0.03 and multivariate analysis P < 0.01). Additionally, the total transfusion requirements, total donor unit exposure, and financial cost of blood components were less in the tranexamic acid group. In conclusion, tranexamic acid can reduce perioperative blood loss in children undergoing repeat cardiac surgery.
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Anesthesia and analgesia · May 1997
Randomized Controlled Trial Clinical TrialThe effect of nasal continuous positive airway pressure on plasma endothelin-1 concentrations in patients with severe cardiogenic pulmonary edema.
We investigated the effects of nasal continuous positive airway pressure (CPAP) on plasma endothelin-1 (ET-1) concentrations in patients with cardiogenic pulmonary edema. Thirty patients were randomly assigned to two groups: 15 patients who received oxygen plus nasal CPAP (CPAP group), and 15 patients who received only oxygen by face mask (oxygen group). The heart rate and the mean pulmonary artery pressure decreased significantly in the CPAP group. ⋯ Arterial plasma ET-1 concentrations in the CPAP group compared with the oxygen group were significantly lower at 24 h. There was a correlation between the arterial plasma ET-1 concentrations and mean pulmonary artery pressure (r = 0.62, P < 0.001), and PaO2/FIO2 (r = -0.46, P < 0.01). Nasal CPAP led to an early decrease in plasma ET-1 concentrations, and improvement in oxygenation and hemodynamics.
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This investigation analyzed the changes in inspiratory airway pressures during transition from two-lung to one-lung ventilation in patients tracheally intubated with a double-lumen endotracheal tube (DLT) using a classical method of intubation without fiberoptic bronchoscopy. All patients were anesthetized in a standardized fashion. Ventilation was accomplished with the Siemens 900 constant-flow mechanical ventilator (Solna, Sweden). ⋯ When the DLT was in a correct position, Ppeak increased by a mean of 55.1% and Pplateau increased by a mean of 41.9%. When the DLT was malpositioned, this increase was significantly larger (74.9% and 68.8%, respectively). Three tests commonly used as markers of malpositioned DLTs were evaluated based on the data of this study, and it was established that, although the pressure differences related to position are statistically significant, as a single value, they cannot be used for clinical decision making.