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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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.
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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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Review Case Reports
Acute purulent mediastinitis and sternal osteomyelitis after closed chest cardiopulmonary resuscitation: a case report and review of the literature.
Numerous complications have been associated with cardiopulmonary resuscitation. Acute purulent staphylococcal mediastinitis and sternal osteomyelitis are, however, unusual and do not appear to have been reported previously in association with closed chest resuscitation. ⋯ The source of bacteremia may have been a resolving phlebitis at an intravenous catheter insertion site. Early diagnosis, aggressive surgical debridement, and antibiotic therapy were key to a successful outcome.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antibiotic prophylaxis in open-heart surgery: a comparison of cefamandole, cefuroxime, and cefazolin.
We undertook a prospective randomized evaluation of cefamandole nafate, cefuroxime sodium, and cefazolin sodium as prophylaxis in open-heart operations. A total of 903 patients having an elective procedure were enrolled in the study, and 620 of them were eventually considered evaluable. There were no significant differences between the three study groups. ⋯ The presence of multiple severe underlying conditions was a risk factor for infection, independent of the antibiotic used. We conclude that there are no differences in the efficacies of the three agents in preventing postoperative infections in patients having open-heart operation. Cefuroxime, principally because of its every-12-hour dose, is far less expensive than cefamandole or cefazolin.