Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1991
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative course after sufentanil or fentanyl anesthesia for coronary artery surgery.
Postoperative hemodynamic effects were compared in 50 patients randomly selected to receive either sufentanil, 25 micrograms/kg, or fentanyl, 100 micrograms/kg, anesthesia for coronary artery bypass grafting. The two groups exhibited similar patient demographics; dose of premedicants and muscle relaxants; and use of inhalation agents. Values for 15 hemodynamic variables were recorded at baseline and at six postoperative times. ⋯ Elimination half-lives differed significantly: 554 +/- 91 minutes (fentanyl) versus 277 +/- 60 minutes (sufentanil). Serum concentrations of both decreased linearly. The added advantages of postoperative hemodynamic stability could be important in the choice of anesthetic.
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J. Cardiothorac. Vasc. Anesth. · Oct 1991
Randomized Controlled Trial Clinical TrialEffects of clonidine on variation of arterial blood pressure and heart rate during carotid artery surgery.
The effect of oral premedication with 300 micrograms of clonidine on systemic arterial pressure, heart rate, and plasma norepinephrine levels was assessed in a double-blinded, placebo-controlled study conducted in 29 patients subjected to carotid artery surgery (CAS). Anesthesia was induced with thiopental, 6 mg/kg, and alfentanil, 0.05 mg/kg, and maintained with alfentanil and 0.6% isoflurane in 50% N20/O2. The study was divided into five periods as follows: (1) anesthesia to start of surgery; (2) surgery to carotid artery clamping; (3) carotid artery clamping to unclamping; (4) carotid artery unclamping to the end of surgery; and (5) the first 4 postoperative hours in the recovery room. ⋯ However, during each of the previously defined periods, the variability of heart rate and systemic arterial pressure, assessed by the coefficient of variation, was not different between the two groups. The lability of these hemodynamic parameters, expressed as the percentage of values, which increased or decreased more than 20% of control values during the corresponding period, was also comparable between the two groups. The number of patients who experienced at least one episode of hypertension (systolic arterial pressure greater than 180 mm Hg), hypotension (systolic arterial pressure less than 100 mm Hg), or bradycardia less than 45 beats/min was not different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1991
Randomized Controlled Trial Comparative Study Clinical TrialPriming solutions for cardiopulmonary bypass: comparison of three colloids.
The present study was designed to compare the differences in the clinical effects of three colloidal solutions, albumin, urea-linked gelatin, and succinyl-linked gelatin, when used as priming fluids for cardiopulmonary bypass (CPB) under alpha-stat conditions. A consecutive series of 105 patients scheduled for cardiac surgery were randomized into three identically managed groups, except for the CPB prime. Variables relating to acid-base status, oncotic activity, metabolism, coagulation, and postoperative evaluation were measured. ⋯ There were also no important intergroup differences in hematologic and clotting variables or postoperative parameters such as blood loss or use of blood products. Electrolyte changes were similar except for a significant increase in ionized calcium that occurred in the urea-linked gelatin group after bypass. The results indicate that succinyl-linked gelatin is an adequate and safe alternative to human albumin for use as a colloid during CPB under alpha-stat conditions.
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J. Cardiothorac. Vasc. Anesth. · Oct 1991
Randomized Controlled Trial Comparative Study Clinical TrialDoes the preparation of heparin influence anticoagulation during cardiopulmonary bypass?
Various preparations of heparin from different manufacturers are commercially available. The influence of bovine lung heparin (BLH) and porcine mucosal heparin (PMH) on anticoagulation and heparin plasma concentration was investigated in four groups of 10 patients undergoing elective aortocoronary bypass grafting either after single dose or repetitive dose (after 60 minutes) of one of these heparin preparations. Heparin plasma concentration increased significantly after injection of heparin (BLH: minimum, 1.67 U/mL; maximum, 2.10 U/mL; PMH: minimum, 1.69 U/mL; maximum, 2.15 U/mL). ⋯ Fibrinogen and antithrombin III concentrations, as well as activated clotting time (ACT; always greater than 400 seconds) and partial thromboplastin time (PTT; always greater than 300 seconds), did not differ among the groups, indicating effective anticoagulation during the bypass period with both types of heparin. It can be concluded that sufficient anticoagulation can be achieved with either kind of heparin. PMH seems to be longer acting and a repeat dose in these patients seems to be necessary only if cardiopulmonary bypass lasts longer than 90 minutes.