Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1991
Changes in cerebrospinal fluid pressure and spinal cord perfusion pressure prior to cross-clamping of the thoracic aorta in humans.
Little is known about what influences cerebrospinal fluid pressure (CSFP) during anesthesia prior to aortic cross-clamping (AXC). Therefore, this study measured the effect of anesthetic induction, of various drugs administered during the course of surgery prior to AXC, and of hemodynamic changes on CSFP, and calculated spinal cord perfusion pressure (SCPP = mean arterial pressure [MAP] - CSFP) in 11 patients undergoing surgery on the descending thoracic aorta. A lumbar drainage catheter was placed to facilitate drainage of CSF and to measure CSFP. ⋯ Subsequent drainage of 20 mL of CSF improved SCPP (P less than 0.05). IP did not have any effect on hemodynamics or CSFP. CSFP showed a strong correlation with CVP (r = 0.86).(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Aug 1991
Utility of biplane transesophageal echocardiography in left ventricular wall motion analysis.
The biplane transesophageal echocardiography (BTEE) probe increases capabilities for scanning cardiac structures in cross-sectional and longitudinal planes. The present study was undertaken to determine if BTEE would enhance diagnosis of perioperative ischemia by identification of new segmental wall motion abnormalities (SWMAs), and the initial experience in 94 patients (37 intraoperative and 57 intensive care unit) is presented. The left ventricular wall motion at the midpapillary level was observed and recorded on 0.5-in videotape by both transverse and longitudinal scanning transducers. ⋯ In the remaining 9 patients (45%) the SWMAs were detected in both planes. Persistent diagnostic electrocardiographic changes of myocardial infarction and elevation of CK enzymes were observed in 6 of the 20 patients within 3 postoperative days. In conclusion, biplane imaging appears to be superior to the traditional single-plane imaging for evaluation of left ventricular function and myocardial ischemia.
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J. Cardiothorac. Vasc. Anesth. · Aug 1991
Comparative StudyContinuous determination of cardiac output using a flow-directed Doppler pulmonary artery catheter.
A newly developed, flow-directed, Doppler pulmonary artery catheter that uses multiple ultrasonic transducers to measure instantaneous and continuous cardiac output was evaluated in 20 patients undergoing cardiac and vascular surgical procedures. Cardiac output was determined using the product of the average velocity and the area of the main pulmonary artery. Pulmonary artery area was obtained from measurements of diameter via ultrasound transit time, and average velocity of blood flow was determined from the Doppler shift frequency. ⋯ Catheter indwelling time varied from 18 through 94 hours (mean +/- SD, 40 +/- 19 hours) with 2 to 26 (mean +/- SD, 12 +/- 6) sets of triplicate cardiac output measurements obtained per patient. Doppler catheter cardiac output correlated well with thermodilution (r = 0.76, slope or m = 0.87, and SEE = 0.05 with P = 0.0001) and mean predictive error (bias) appeared clinically insignificant (bias +/- SD, -0.13 +/- 0.79 L/min). Accurate, continuous monitoring of instantaneous and mean cardiac output appears possible with use of this Doppler pulmonary artery catheter system.