The Annals of thoracic surgery
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Case Reports
Venovenous extracorporeal membrane oxygenation for noncardiogenic pulmonary edema after coronary bypass surgery.
A 71-year-old woman with noncardiogenic acute pulmonary edema early after having a coronary operation was treated with venovenous extracorporeal membrane oxygenation for uncontrollable hypoxia. Adequate oxygenation was achieved, the rapid deterioration of her condition was reversed, and ventilatory settings could be moderated. ⋯ At the time of this writing, the patient was in her sixth postoperative month and doing well. Details of this fairly simple but powerful technique are described.
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The Southern Arizona Red Cross Blood program, in conjunction with participating hospitals and cardiac surgeons, evaluated the effect of a program to harvest autologous platelet-rich plasma (PRP) from patients immediately prior to undergoing cardiopulmonary bypass surgery. The PRP was transfused back to the patient after heparin neutralization was achieved at the completion of cardiopulmonary bypass. The effect of this autologous PRP product on homologous plasma and platelet usage was examined. The study demonstrates a significant decrease in homologous plasma and platelet usage when autologous PRP is used in cardiac surgery.
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There is renewed interest in protecting jeopardized myocardium during regional and global ischemia by coronary sinus retroperfusion. Advances in catheter design and imaging techniques have made access to the coronary sinus easier and safer. Retrograde coronary sinus perfusion, aortovenous bypass, pressure-controlled intermittent coronary sinus occlusion, and synchronized retrograde perfusion have emerged as new techniques by which blood can be redirected through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. The purpose of this review is to summarize the current results and applications of these coronary sinus interventions, and show how they can benefit the cardiac surgeon in clinical practice.
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Others have demonstrated the effectiveness of intercostal analgesia with bupivacaine hydrochloride (Marcain Plain; Astra). We present a greatly simplified method of effecting this. Our method is dependent on an intact pleura. ⋯ Only 2 patients had postoperative pulmonary complications. No complication related either to the procedure or to the infusion of bupivacaine occurred. The technique as described here is a safe and reliable method of providing analgesia without any side effects after thoracotomy.