Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Predictive factors for usefulness of fiberoptic pulmonary artery catheter for continuous oxygen saturation in mixed venous blood monitoring in cardiac surgery.
The main goal of this prospective study was to identify among cardiac surgery patients, usually monitored through a standard pulmonary artery catheter (PAC), those in whom a fiberoptic catheter oximeter to measure oxygen saturation in mixed venous blood (SVO2 PAC) would be most useful. Data from 286 patients who underwent coronary artery bypass graft (50%) or valvular surgery were recorded, including ASA physical status, New York Heart Association (NYHA) classification, and Parsonnet score (PS). Hemodynamic events and SVO2 changes were collected intra- and postoperatively until weaning from mechanical ventilation. ⋯ Similarly, morbidity was frequent in the useful group, although it was not always significantly different from the nonuseful group according to the type of complications. Mortality was comparable in the groups despite their different degree of illness and was reduced when taking into account the predictive and observed mortality provided by the PS. This study defined independent preoperative factors associated with SVO2 PAC monitoring and proposed a cutoff point above which SVO2 may be useful.
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Jet ventilation is often used during laryngoscopy to permit improved visualization of the larynx and to eliminate a potentially flammable endotracheal tube when laser surgery of the airway is performed. Observation of chest wall movement and blood gas analysis are the usual standards for assessing the adequacy of ventilation during jet ventilation. It is reasonable to hypothesize that measurement of end-tidal CO2 concentrations during jet ventilation can be used to assess the adequacy of ventilation during jet ventilation. ⋯ At the time that each end-tidal measurement was obtained, a sample of arterial blood was also obtained for later blood gas analysis. For both mechanical ventilation and jet ventilation, well defined relationships between end-tidal CO2 and arterial CO2 tensions were obtained. However, the relationships are distinct: the difference in arterial to end-tidal CO2 tension during supraglottic jet ventilation at a conventional respiratory rate was found to be 13.4 +/- 6.8 mm Hg (mean +/- SD) compared with 5.7 +/- 5.2 mm Hg obtained during conventional ventilation through an endotracheal tube.
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Anesthesia and analgesia · Jul 1997
The effect of anesthetic techniques on blood coagulability in parturients as measured by thromboelastography.
Anesthetic techniques may affect blood coagulability and the subsequent incidence of thromboembolic events. The purpose of this study was to evaluate the effect of spinal and general anesthesia on blood coagulability in normal pregnant women undergoing cesarean section, using thromboelastography. In the spinal anesthesia group (n = 15), thromboelastography was performed after crystalloid preloading and during the immediate postanesthesia course. ⋯ In the postanesthesia period, MA and G were similar in both groups. In the spinal anesthesia group, thromboelastographic variables did not change significantly in the postanesthesia compared with the preanesthesia period. We conclude that the use of general anesthesia for cesarean section is associated with accelerated coagulability when compared with spinal anesthesia.