Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1992
Randomized Controlled Trial Comparative Study Clinical TrialTotal intravenous anesthesia for infants and children undergoing correction of tetralogy of Fallot: sufentanil versus sufentanil-flunitrazepam technique.
The effects of two total intravenous anesthetic techniques were compared in 20 infants and children undergoing primary correction of tetralogy of Fallot (TOF). All patients (mean body weight, 11.4 +/- 4.2 kg; range, 6 to 20 kg; mean age, 32 +/- 21 months, range, 7 to 85 months) were premedicated with atropine, 0.02, mg/kg, morphine, 0.2, mg/kg, and flunitrazepam, 0.04 mg/kg, intramuscularly, 1 hour preoperatively. Anesthesia was induced with 1 microgram/kg of sufentanil (S) and pancuronium, 0.1 mg/kg, intravenously. ⋯ Following intubation HR, SBP, DBP, and MAP remained close to values measured before induction, but SaO2 increased significantly (P less than 0.01) in all patients. HR, SBP, and MAP decreased during anesthetic loading in both groups. Hemodynamics and plasma E and NE remained essentially unchanged after sternotomy in the SF group.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Apr 1992
Randomized Controlled Trial Comparative Study Clinical TrialCoronary artery bypass grafting using two different anesthetic techniques: Part I: Hemodynamic results.
Hemodynamic changes were studied during two different anesthetic techniques in 54 patients undergoing coronary artery bypass grafting (CABG). All patients had normal to moderately impaired left ventricular function and were randomly assigned to two groups. In 27 patients, high thoracic epidural analgesia (TEA) with bupivacaine 0.375% plus sufentanil 1:200,000 (ie, 5 micrograms/mL) was used in combination with general anesthesia with midazolam/N2O; in the other 27 patients, general anesthesia (GA) with midazolam and sufentanil was used. ⋯ Four GA patients developed electrocardiographic evidence of prebypass ischemia and, therefore, more nitroglycerin was needed for treating myocardial ischemia. More sodium nitroprusside was needed in the GA group during cardiopulmonary bypass (CPB) and the post-bypass period to treat hypertension with a high SVR. In conclusion, hemodynamic stability was more pronounced in the TEA than the GA group before and after CPB.
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J. Cardiothorac. Vasc. Anesth. · Apr 1992
Esmolol infusion during nitroprusside-induced hypotension: impact on hemodynamics, ventricular performance, and venous admixture.
The impact of esmolol infusion on hemodynamics, ventricular performance, venous admixture, sympathoadrenal, and renin-angiotensin system responses during sodium nitroprusside (SNP)-induced hypotension was studied in 11 patients undergoing lymph node dissection during general anesthesia with 60% nitrous oxide and fentanyl. Radial arterial and thermistor-tipped pulmonary catheters were employed for hemodynamic monitoring. Arterial and mixed venous blood gas tensions, arterial plasma renin activity (PRA), and plasma catecholamine levels were measured. ⋯ Compared to prehypotension values, SNP induced significant increases in Qs/Qt and reductions in PaO2, systemic vascular resistance (SVR), and stroke volume index (SVI). Esmolol infusion caused dose-dependent (highest with 400 micrograms/kg/min) reductions in the SNP requirement, heart rate (HR), SVI, Qs/Qt, and PRA, and also led to significant increases in SVR and left ventricular (LV) internal diameter in diastole as well as systole. Furthermore, esmolol infusion was associated with a dose-dependent downward and leftward shift of the ESWS versus VCFC relationship, implying diminished contractility.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Apr 1992
Randomized Controlled Trial Comparative Study Clinical TrialCoronary artery bypass grafting using two different anesthetic techniques: Part 3: Adrenergic responses.
Twenty patients were studied during and after coronary artery bypass grafting (CABG). The patients were randomly assigned to two groups. In 10 patients, intraoperative general anesthesia (GA) was based on a combination of intravenous (IV) sufentanil and midazolam. ⋯ It can be concluded that better hemodynamic stability during the prebypass and bypass periods was accompanied by less E and NE release during these periods. Co release in the TEA group was higher during the bypass period. Weaning from bypass was characterized by better hemodynamics in the TEA group.(ABSTRACT TRUNCATED AT 250 WORDS)