The Annals of thoracic surgery
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Although low systemic vascular resistance occurs during normothermic and hypothermic cardiopulmonary bypass, the determinants of depressed systemic vascular resistance and its effect on outcomes are unknown. To assess the predictors and clinical effects of low systemic vascular resistance, 555 patients undergoing isolated coronary artery bypass grafting were evaluated prospectively. The extent of low systemic vascular resistance during bypass was estimated by the amount of the vasoconstrictor phenylephrine administered: group 1, 0 to 160 micrograms; group 2, 161 to 800 micrograms; group 3, more than 800 micrograms. ⋯ Patients in group 3 had a higher cardiac index and lower-mean arterial pressure and systemic vascular resistance postoperatively. In those patients who received a left internal mammary artery graft, the incidences of the low-output syndrome (group 1, 4.9%; group 3, 2.7%; p = not significant) and myocardial infarction (group 1, 1.4%; group 3, 1.8%; p = not significant) were not influenced by the amount of phenylephrine infused during cardiopulmonary bypass. In those patients who were at high risk of suffering a stroke preoperatively, the hypotension induced by the low systemic vascular resistance and its treatment with phenylephrine was not associated with an increased incidence of stroke (group 1, 5.8%; group 3, 2.8%; p = not significant).
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Clinical Trial
Postthoracotomy pain management using continuous epidural analgesia in 1,324 patients.
Continuous epidural analgesia consisting of an opioid with or without a local anesthetic agent is a commonly employed technique for pain relief after thoracotomy. In this study, we prospectively evaluated the use of continuous epidural analgesia in 1,324 patients undergoing elective thoracotomy between 1987 and 1993. Epidural pain management was continued for 1 to 3 postoperative days. ⋯ The incidence of inadequate analgesia (a visual analog pain score of 7 or more persisting for 1 to 2 hours after an epidurally administered bolus) was 3.8%. The results from this study support the use of standard protocols for dosing guidelines, the treatment of inadequate analgesia, and the management of side effects. Daily evaluation by a team member of the postoperative analgesia services section of the Department of Anesthesiology enhances patient care and minimizes adverse effects.
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Because many infants who require cardiac operation have cyanotic heart disease, we determined whether the existing calcium content of St. Thomas' II solution (1.2 mmol/L) is optimal to protect the immature rabbit heart hypoxemic from birth during subsequent ischemia. Modified hypothermic St. ⋯ Thomas' II solution. We conclude that the existing calcium concentration of St. Thomas' II solution is responsible, in part, for its inadequate protection of immature myocardium hypoxemic from birth during ischemia.
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Biography Historical Article
Will Camp Sealy: surgical innovator, scholar, exceptional teacher, and true Georgian.
Will Camp Sealy, MD, Professor Emeritus of Surgery, Duke University 1984 and Mercer University 1992, was born in Roberta, Georgia, in 1912. A 1936 medical graduate of Emory University, he was in surgical residency training at Duke University from 1936 to 1942. During the next 4 years as an army surgeon in World War II, he was promoted to lieutenant colonel and, in the European theater, made chief of surgery of the 121st General Hospital and later the 128th Evacuation Hospital. ⋯ In 1950, he became chairman of the division of thoracic and cardiovascular surgery, where in the ensuing years he made a number of important initial observations and significant contributions. Among these were studies on the serious paradoxical hypertension that may follow repair of coarctation of the aorta, and on the combined use of hypothermia and perfusion for open heart surgical procedures. In more recent years, his initiation and landmark studies of the surgical treatment of certain cardiac arrhythmias have gained him worldwide recognition and opened one of the last frontiers of cardiac surgery.