Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2000
Comparative StudyOff-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction.
Renal dysfunction is a serious complication after coronary bypass surgery with cardiopulmonary bypass (CABG). Because duration of cardiopulmonary bypass (CPB) is associated with renal outcome, it has been proposed that avoidance of CPB with off-pump coronary bypass (OPCAB) may reduce perioperative renal insult. We therefore tested the hypothesis that OPCAB is associated with less postoperative renal dysfunction compared with CABG surgery. With IRB approval, we gathered data for 690 primary elective coronary bypass patients (OPCAB, 55; CABG, 635). Perioperative change in creatinine clearance (DCrCl) was calculated by using preoperative (CrPre) and peak postoperative (CrPost) serum creatinine values, and the Cockroft-Gault equation (DCrCl = CrPreCl - CrPostCl). Univariate and linear multivariate tests were used in this retrospective analysis; P: < 0.05 was considered significant. Multivariate analysis did not identify OPCAB surgery as an independent predictor of DCrCl. However, previously reported associations of PreCrCl, age, and diabetes with DCrCl were confirmed. Power analysis demonstrated an 80% power to detect a 7.0 mL/min DCrCl difference between study groups. In this retrospective study, we could not confirm that OPCAB significantly reduces perioperative renal dysfunction compared with CABG surgery. Our findings suggest that reduction of renal risk alone should not be an indication for OPCAB over CABG surgery. ⋯ Retrospective analysis did not identify any significant difference in perioperative change in creatinine clearance after coronary revascularization with cardiopulmonary bypass compared with off-pump coronary surgery.
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Anesthesia and analgesia · Nov 2000
Comparative StudyPressure control ventilation: three anesthesia ventilators compared using an infant lung model.
We compared three ventilators-Servo 900C (Siemens Medical Systems, Danvers, MA), Aestiva 3000 (Datex-Ohmeda, Madison, WI), and NAD 6000 (North American Dräger, Telford, PA)-set to deliver pressure control ventilation using an infant test lung model. Ventilator settings were selected to test "near-maximum" settings that would be used for a neonatal patient (peak inspiratory pressure [PIP] 30 cm H(2)O) or older child (PIP 60 cm H(2)O). When adjusted for set inspiratory pressure and compliance, the average tidal volume (V(t)) produced by the NAD 6000 was 5.8 mL less than the Servo 900C (P: = 0. 103), and the average V(t) produced by the Aestiva 3000 was 18.9 mL less than the Servo 900C (P: < 0.001). The Servo 900C generated increased peak pressures, tending to overshoot the set maximum inflating pressures, especially during rapid respiratory rates with decreased inspiratory times. The Aestiva 3000 did not achieve the set PIP during testing conditions of decreased inspiratory times, and the NAD 6000 was not greatly affected by changes in inspiratory time. All three ventilators measured expiratory V(t) to be larger than the actual V(t) delivered to the lung; however, the NAD 6000 was more accurate. ⋯ There are differences in performance of ventilators when set to deliver pressure control ventilation to an infant test lung model.
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Anesthesia and analgesia · Nov 2000
Case ReportsThe successful use of regional anesthesia to prevent involuntary movements in a patient undergoing awake craniotomy.
The authors demonstrate that the combination of single and continuous peripheral nerve blocks allows the control of involuntary movements in patients undergoing awake craniotomy.
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Anesthesia and analgesia · Nov 2000
Case ReportsSevere hypotension in a patient receiving pemoline during general anesthesia.
This case reports hypotension under general anesthesia in a patient taking pemoline. Vigilance for unexpected hypotension is important in patients who are treated with psychostimulants. If hypotension occurs, vasopressors that act directly on adrenergic receptors should be used.
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Anesthesia and analgesia · Nov 2000
Thromboelastography identifies sex-related differences in coagulation.
Thromboelastography is an in vitro, point-of-care monitor of whole blood coagulation. Thromboelastography studies have demonstrated a hypercoagulable state during pregnancy. Perhaps the hypercoagulability is attributable to female sex hormones. The aim of the study was to determine if sex, in addition to pregnancy, affected thromboelastography variables by studying male and female (pregnant and nonpregnant) volunteers. Thromboelastography showed significant (P:<0.01) differences in sex, with a significant (P: < 0. 0001) trend of increasing whole blood coagulability from men through nonpregnant to pregnant women. The thromboelastograph, used as a diagnostic tool, shows that women have more whole blood coagulability than men. ⋯ The thromboelastograph, used as a diagnostic tool, shows that women have more whole blood coagulability than men.