The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain control after thoracotomy: bupivacaine versus lidocaine in continuous extrapleural intercostal nerve blockade.
The use of a continuous bupivacaine extrapleural intercostal nerve block after posterolateral thoracotomy has been shown in randomized controlled studies to be effective in reducing postoperative pain and restoring pulmonary function. It is our hypothesis that when using a continuous infusion for nerve block, a long-acting agent (bupivacaine) is unnecessary and a shorter-acting agent (lidocaine) would offer equivalent results with less systemic toxicity. This study was designed to determine whether lidocaine was as effective as bupivacaine in a continuous extrapleural intercostal nerve block after posterolateral thoracotomy because lidocaine is a less toxic analgesic agent. The study was prospectively randomized and double-blinded. ⋯ Lidocaine offers equivalent pain control to bupivacaine when administered for continuous extrapleural intercostal nerve block after posterolateral thoracotomy, with less risk of systemic toxicity.
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The beneficial effects of the intraaortic balloon pump (IABP) in providing circulatory support must be weighed against its complications, particularly its vascular trauma. ⋯ Careful clinical assessment of the aortofemoral vascular tree is a cornerstone of early diagnosis and early intervention and usually prevents limb loss. The significant decrease in major vascular complications that has occurred over the last 5 years can be explained by the increased use of catheters with smaller diameters. The timing of IABP insertion in relation to operation and the duration of IABP use were the only device-related risk factors identified for morbidity and survival.
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The purpose of this study was to evaluate the results of various surgical modalities that have been evolving for the treatment of ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. ⋯ In single-stage complete unifocalization, more patients had final correction. It reduces the number of operations and hospitalization and hence is more cost effective than multistaged procedures.
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Induced hypothermia may be used to reduce metabolism in acute respiratory failure. Hypothermia is accompanied by an increase in pulmonary vascular resistance, as also seen in the early period after lung transplantation. It was our concern that the combination of the two would lead to an increased workload on the right ventricle. ⋯ Induced hypothermia to 32 degrees C after lung transplantation resulted in a significant decrease in the work done by the right ventricle despite a significant increase in pulmonary vascular resistance.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized study of cardiopulmonary bypass temperature and blood transfusion.
We hypothesized that normothermic cardiopulmonary bypass (CPB) would be associated with decreased blood loss and allogeneic transfusion requirements relative to hypothermic CPB. ⋯ We found that when there was no difference in duration of CPB, normothermic and hypothermic CPB groups demonstrated similar blood loss and transfusion requirements even though other studies have shown hypothermia induces platelet dysfunction and alters the activity of the coagulation cascade.