Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
Comparative StudyComparison of the pharmacokinetics of methohexital during cardiac surgery with cardiopulmonary bypass and vascular surgery.
The aim of this study was to assess the pharmacokinetics of methohexital (ME) in major vascular surgery (VASC) and to compare these data with the pharmacokinetics of ME during hypothermic cardiopulmonary bypass (HCPB) (temperature: 28 degrees C) and normothermic cardiopulmonary bypass (NCPB) (temperature: 37 degrees C). An ME bolus (2 mg/kg) was administered to 8 VASC patients at the start of surgery and to 11 HCPB patients and 11 NCPB patients at the start of cardiopulmonary bypass (CPB). Twenty-one arterial blood samples were withdrawn over the following 24 hours for ME assays. ⋯ It is concluded that ME clearance is lower in patients undergoing major vascular surgery than in healthy patients. The temperature and the duration of CPB do not seem to substantially influence the pharmacokinetics of ME when a bolus is administered. Parameters such as AUC, TBC, and VD appear modified by hemodilution during CPB; however, T1/2 and MRT, which allow comparisons between CPB and non-CPB patients, were similar in these patients.
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
ReviewCon: the Univent tube is not the best method of providing one-lung ventilation.
The Univent tube is a new form of bronchial blocker and is an addition to the armamentarium of the anesthesiologist for managing thoracic surgical cases. As with any new equipment/technique it will require time until the exact indications for its use become clear. The preference of anesthesiologists has oscillated between bronchial blockers and DLTs for the past 50 years, and no overall "best" method of providing OLV has yet been found. Anesthesiologists will continue to use, and to need to know how to use, DLTs for the foreseeable future.
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
ReviewPro: one-lung ventilation is best accomplished with the Univent endotracheal tube.
Over the years, thoracotomy has changed from a procedure that prompted major concern over cross-contamination caused by infection to pulmonary tumors. Assisting the thoracic surgeon by providing OLV is one of the most specialized skills an anesthesiologist can offer. This must be done in a safe, easy, and efficient manner. ⋯ Double-lumen tubes have performed well in the past and will continue to offer specialized functions, such as postoperative independent lung ventilation in single-lung transplant recipients. As with the acquisition of any new medical skill, the use of the Univent tube has a learning curve. It is worth the time and effort to learn to use the Univent tube.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
Effects of fentanyl on coronary blood flow distribution and myocardial oxygen consumption in the dog.
Little data exist on the effects of fentanyl on coronary blood flow (CBF), myocardial oxygen balance, and the regional distribution of blood flow. These studies were designed to determine whether fentanyl had any intrinsic effects on myocardial oxygen consumption (MVO2) and blood flow distribution. In anesthetized dogs, fentanyl was administered in a dose of 50 micrograms/kg and various measurements were made at 5 and 20 minutes. ⋯ MVO2 was essentially unchanged after atropine. Regional CBF (measured by radiolabelled microspheres) was unchanged at 5 minutes, but all layers exhibited significant reductions at 20 minutes. In the atropine group, only the LV epicardial area appeared to show decreases in flow.(ABSTRACT TRUNCATED AT 250 WORDS)