Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Oct 1993
The effect of preoperative beta-blocker therapy on cardiovascular responses to weaning from mechanical ventilation and extubation after coronary artery bypass grafting.
The hemodynamic and electrocardiographic changes during weaning from mechanical ventilation and tracheal extubation were studied in 75 patients after elective coronary artery bypass surgery. Transfer from synchronized intermittent mandatory ventilation to spontaneous respiration through a T-piece was associated with an increase greater than 20% over baseline in systolic (SBP) and diastolic (DBP) blood pressure in 27% of patients, and in heart rate (HR) in 5% of patients. Although baseline SBP, DBP, and HR differed significantly between the patients taking chronic beta-blocker therapy and those not on beta-blockers (P values all < 0.003), there were no differences between these groups in their response to transfer to the T-piece. (P values: SBP = 0.98; DBP = 0.46; HR = 0.20). ⋯ However, there were significant differences between the chronically beta-blocked and non-beta-blocked groups, both in baseline values for SBP, DBP, and HR (P values all < 0.001), and also in the SBP response (P = 0.007) and HR response (P = 0.02) to extubation. Extubation was associated with a greater than 20% increase in SBP in 8.2% and DBP in 12.2% of chronically beta-blocked patients, compared to 40% and 23% of non-beta-blocked patients, although the DBP response was not statistically different (P = 0.14) between the groups. Similar proportions of patients in both groups increased their HR more than 20% above baseline, but the increase was much greater in the non-beta-blocked group (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
-
J. Cardiothorac. Vasc. Anesth. · Oct 1993
Effect of continuous positive airway pressure applied by face mask on right ventricular function after cardiac surgery.
The effect of respiratory therapy with continuous positive airway pressure (CPAP) on right ventricular function 24 hours after elective cardiac surgery was evaluated in patients with or without severe coronary artery disease. The first group included 10 patients following coronary artery bypass graft (CABG) surgery, and the second group included 10 patients following aortic valve replacement (AVR) without preexisting coronary artery disease. Patients of both groups had preoperative left ventricular ejection fractions above 40%. ⋯ Right ventricular function was estimated at end-expiration by a fast-response thermodilution cardiac output catheter. The results demonstrate that in both groups of patients, CPAP did not significantly modify right ventricular indices, ejection fraction, end-systolic and end-diastolic volume indices, and stroke volume index, indicating that CPAP can safely be applied after elective cardiac surgery in patients with or without severe coronary artery disease and preoperative left ventricular ejection fractions above 40%. Furthermore, the concomitant postoperative intravenous infusion of nitroglycerin (to all 10 patients of the CABG group and to 4 patients of the AVR group) counteracted the expected beneficial effect of CPAP therapy on arterial oxygenation.
-
J. Cardiothorac. Vasc. Anesth. · Oct 1993
A quality improvement study of the placement and complications of double-lumen endobronchial tubes.
To assess the complications of conventional and fiberoptic endobronchial intubations using reusable (Leyland, London) and disposable (Rüsch, Waiblinger, Germany; Sheridan, Argyle, NY) double-lumen tubes (DLTs), endobronchial intubations occurring over a 12-month period were prospectively studied at this hospital. Residents working with staff anesthesiologists placed either left or right reusable (Leyland) or disposable (Rüsch or Sheridan) DLTs. The DLT used, the use of fiberoptic bronchoscopy (FOB), findings at FOB if used during the intubation or operation, and complications occurring during the case (SpO2 < 90%, peak inflation pressure > 40 cm H2O, air trapping, poor lung isolation, and airway trauma) were recorded. ⋯ Complications occurred in 42/234 patients (18%). The frequency of specific complications was: decreased SpO2, 9%; increased airway pressures, 9%; poor lung isolation, 7%; air trapping, 2%, and airway trauma, 0.4%. Right-sided Sheridan DLTs had a statistically higher incidence of malposition, resulting in poorer lung isolation.(ABSTRACT TRUNCATED AT 250 WORDS)
-
J. Cardiothorac. Vasc. Anesth. · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia.
Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. In this study, 45 patients, who were scheduled to have epidural analgesia and undergo a lateral thoracotomy, were randomized to receive either a thoracic or a lumbar catheter. ⋯ This study found no statistical difference in pain relief or side effects between lumbar and thoracic epidural analgesia for post-thoracotomy pain. An increased infusion rate (6.4 +/- 1.9 v 5.1 +/- 1.4 mL/h, P = 0.02) was required in the lumbar group to achieve equivalent analgesic levels.