The Annals of thoracic surgery
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Increasing numbers of operations requiring cardiopulmonary bypass have been accompanied by greater demands for blood resources. Improved techniques of blood conservation have diminished the average blood requirements per operation and have increased the percent of operations that can be done without homologous blood. ⋯ The availability of techniques for filtration, centrifugation, and washing of blood have improved the safety of autotransfusion. The techniques that gives the best cost/benefit ratio appear to be preoperative withdrawal of blood, reinfusion of centrifuged oxygenator contents, and reinfusion of filtered blood from chest drainage.
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A new use of the cuffed endotracheal tube as a right atrial venous return cannula in emergency cardiopulmonary bypass operations is described. The ready availability, low cost, and design of the cuffed endotracheal tube make it ideal in this situation. We have used it successfully on three occasions.
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Comparative Study
Oxygen transport to tissue under normovolemic moderate and extreme hemodilution during coronary bypass operation.
Oxygen transport to tissue was studied in 12 patients undergoing coronary bypass operation under normovolemic moderate and extreme hemodilution. Normovolemic moderate hemodilution (15 ml per kilogram of body weight), carried out immediately after induction of anesthesia, decreased the mean hematocrit from 0.43 to 0.33. Simultaneously, the cardiac index and the left ventricular filling pressure increased slightly but the systemic oxygen transport was reduced by 20%. ⋯ In general, total-body oxygen consumption changed along with tissue PO2. Blood lactate concentration underwent a clear increase in the early phase of extracorporeal circulation and remained rather stationary thereafter. No perioperative myocardial infarctions were encountered, and each patient made an uneventful recovery.
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A massive bolus of oxygen was forced into the right atrium and venous system of a patient during cardiopulmonary bypass using a Bentley BOS-10 oxygenator. The unique design of the oxygenator canister provides an explanation for the event. Methods are outlined to avoid this type of venous embolism.
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Fifty consecutive patients with pulmonary coccidioidomycosis undergoing operation in an eight-year period were analyzed with regard to clinical and roentgenographic indications, surgical procedure, complications, and recurrence. Surgical indications could be divided into operation necessary primarily for diagnosis (22 out of 50, 44%) and operation because of suspected residual complications of coccidioidomycosis requiring therapy (28 out of 50, 56%). ⋯ Of 24 patients with coccidioidomycosis cavities, 14 underwent lobectomy and 10 had lesser resections, with three recurrences. Results indicate that (1) resection for primary pulmonary coccidioidomycosis for both diagnosis and therapy is associated with low perioperative risk, (2) routine administration of amphotericin is not indicated, (3) skin tests, serological study, bronchoscopy, and mediastinoscopy may not be diagnostic, and (4) lobectomy is not necessarily indicated since lesser resections are associated with equally low recurrence and complications rates.