The Annals of thoracic surgery
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An autotransfusion technique has been developed for collection and reinfusion of shed mediastinal blood. This system has been routinely applied in the postoperative management of 592 consecutive adult and 108 pediatric cardiac surgical patients. Two hundred seventy-one adult patients (46%) and thirty-six pediatric patients (33%) actually received autologous blood. ⋯ In 1976 at our institution, homologous transfusion requirements averaged 8.4 +/- 0.7 units per adult patient. During 1978, with the routine use of postoperative autotransfusion, bank blood transfusions were lowered to 4.2 +/- 0.3 units per patient (p less than 0.001). In contrast to perioperative autotransfusion techniques, collection and reinfusion of shed mediastinal blood is particularly useful for intravascular volume replacement in patients with serious postoperative bleeding.
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Between 1967 and 1978, an 11-year-old boy had undergone 3 separate systemic-pulmonary artery shunt operations. Two of the 3 shunt operations failed. ⋯ Repair was successfully accomplished with the use of an internal vascular conduit and an external vascular conduit with a glutaraldehyde-treated porcine valve. Four months after the corrective procedure, the patient's exercise tolerance had improved dramatically.
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Ten patients underwent an aortapulmonary artery shunt with a polytetrafluoroethylene (PTFE) tube between December, 1976, and October, 1977. Five of them were less than 1 month old. The diameter of the PTFE tube was 5 mm in 9 patients and 4 mm in 1 patient. ⋯ In our institution, the Blalock-Taussig shunt is the procedure of choice. The PTFE shunt is used when the anatomy of a patient is unsuitable for a Blalock-Taussig shunt. A tube diameter of 5 mm is optimal for infants when further growth is considered, even if digitalization is necessary to control congestive heart failure.
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Randomized Controlled Trial Clinical Trial
Prospective randomized evaluation of intrathoracic intercostal nerve block with bupivacaine on postoperative ventilatory function.
This prospective and randomized study demonstrates the beneficial effect of intrathoracic intercostal block with bupivacaine on the recovery of pulmonary function after thoracotomy. A significantly (p less than 0.05) better forced expiratory volume was seen in the treated group in the early post-operative period. ⋯ Also, the requirements for analgesics were decreased in the treated group. We believe that intrathoracic intercostal block with bupivacaine when properly utilized can be a good adjuvant in the improvement of pulmonary function after thoracotomy.