Anesthesia and analgesia
-
Anesthesia and analgesia · Aug 2002
Case ReportsAn unusual case of pulmonary artery catheter malfunction.
Sudden loss of thermodilution or temperature-monitoring capabilities of an indwelling pulmonary artery catheter may indicate significant damage to the catheter, possibly leading to electrical hazard and infection risk. Blood appearing at the electrical connection port confirms the diagnosis. The catheter, if easily removed, should be replaced as soon as possible.
-
Anesthesia and analgesia · Aug 2002
Comparative Study Clinical TrialIncreasing mean arterial blood pressure has no effect on jugular venous oxygen saturation in insulin-dependent patients during tepid cardiopulmonary bypass.
Preexisting diabetes mellitus is one of the major factors related to adverse postoperative neurological disorders after cardiac surgery. In previous reports, we found that diabetic patients more often experienced cerebral desaturation than nondiabetic patients during normothermic cardiopulmonary bypass (CPB). The purpose of this study was to examine the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen hemoglobin saturation (SjvO2) during tepid CPB in diabetic patients. We studied 20 diabetic patients scheduled for elective coronary artery bypass graft surgery and, as a control, 20 age-matched nondiabetic patients. After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO2. After measuring the baseline partial pressure of the arterial and jugular venous blood gases and cardiovascular hemodynamic values, MAP was increased by the repeated administration of a 10-microg bolus of phenylephrine until it reached 100% of baseline values. There was a significant difference in SjvO2 value between the Diabetic and CONTROL GROUPs after the administration of phenylephrine (Diabetic group, 56% +/- 6%; ⋯ We examined the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen saturation (SjvO2) during tepid cardiopulmonary bypass in diabetic patients and found that increasing MAP had no effect on the SjvO2 value in insulin-dependent patients.
-
Anesthesia and analgesia · Aug 2002
Case ReportsAccelerated idioventricular rhythm associated with desflurane administration.
The rapid administration of desflurane results in transient hypertension and tachycardia, especially in the presence of sympathetic imbalance. We report a case in which rapid administration of desflurane precipitated an accelerated idioventricular rhythm in a patient. This may have been related to a period of inadequate anesthesia.
-
Anesthesia and analgesia · Aug 2002
Case ReportsSuccessful one-lung ventilation in a patient with aberrant tracheal bronchus.
We report a 47-yr-old patient who underwent surgery for esophageal cancer. Because of the isolated ventilation of the right upper lobe after occlusion of the right mainstem bronchus, bronchoscopic re-confirmation exposed an aberrant tracheal bronchus. A Fogarty tube was introduced to block the tracheal bronchus and provide one-lung ventilation.
-
Anesthesia and analgesia · Aug 2002
Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration.
Relatively little is known about the influence of intraoperative hemodynamic variables on surgical outcomes. We drew subjects (n = 797) from a study of patients undergoing major noncardiac surgery. The physiological component of the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality) operative risk stratification index was determined, and intraoperative measurements of heart rate (HR), mean arterial blood pressure, and systolic arterial blood pressure (SAP) were retrieved from computerized anesthesia records. For every 5-min epoch during the surgery, HR, mean arterial blood pressure, and SAP were each classified as low, normal, or high. Negative surgical outcome (NSO) was defined as a hospital stay of >10 days with a morbid condition or death during the hospital stay. Statistical analyses included Mantel-Haenszel tests and multiple logistic regression. There was no significant association between hemodynamic variables and NSO with short operations. In 388 patients with operations longer than the median time of 220 min, NSO occurred in 15.6%. Controlling for POSSUM score and operation time beyond 220 min, both high HR (odds ratio, 2.704; P = 0.01) and high SAP (odds ratio, 2.095; P = 0.009) were associated with NSO in longer operations. Thus, intraoperative tachycardia and hypertension were associated independently with adverse outcomes after major noncardiac surgery of long duration, over and above the risk imparted by underlying medical conditions. ⋯ Intraoperative tachycardia and hypertension were associated with negative postoperative outcomes after major noncardiac surgery of long duration. These results imply that intraoperative tachycardia and hypertension may have independent effects on outcome over and above the risk imparted by underlying medical conditions.