The Annals of thoracic surgery
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Protamine sulfate, which is used for heparin neutralization, has been reported to induce catastrophic pulmonary vasoconstriction after infusion. However, in the systemic circulation, protamine infusion induces hypotension due to peripheral vasodilation. ⋯ Protamine-mediated pulmonary vasodilatation could be an important mechanism to protect against the constrictive effects of autocoids generated during heparin neutralization. Such a mechanism might be dysfunctional in certain persons and put them at risk for pulmonary vasoconstriction after protamine infusion.
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Randomized Controlled Trial Clinical Trial
Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function.
The recent introduction of normothermic cardiopulmonary bypass (CPB) perfusion has raised concerns regarding the associated risk of renal dysfunction through its potential to exacerbate the systemic inflammatory response and end-organ injury. This study was designed to investigate the influence of CPB perfusion temperature on renal function. ⋯ These data suggest that cardiopulmonary bypass perfusion temperature does not influence renal function in patients undergoing coronary artery bypass grafting.
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With emphasis today on cost containment in health care, the results and costs of cardiac operations in elderly patients are being scrutinized. ⋯ Although mortality, length of stay, and hospital charge are increased in patients 70 years of age and over, they are not excessively so. The results support the continued performance of cardiac surgical procedures in select elderly patients.
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Hypothermic cardiopulmonary bypass with intervals of circulatory arrest is a useful adjunct during operations on the descending thoracic aorta and distal aortic arch when severe aortic disease precludes placement of clamps on the aorta. Hypothermia also has a marked protective effect on spinal cord function during periods of aortic occlusion. ⋯ Hypothermic circulatory arrest is a valuable adjunct for the treatment of complex aortic disease involving the aortic arch and thoracoabdominal aorta. In patients with thoracoabdominal aneurysms, its use has been associated with a low incidence of renal failure and an incidence of paraplegia/paraparesis in traditionally high-risk subsets (type I and II aneurysms, aortic dissection), which may be less than that observed with other surgical techniques.
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This study examined predictors and cost-effectiveness of early extubation after coronary artery bypass grafting. ⋯ Early extubation shortened the postoperative length of stay, resulting in reduction of cost and resource utilization. The average hospital charge per patient was approximately $6,000 less in the early extubation group.