Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
Intrathecal morphine during thoracotomy, Part II: Effect on postoperative meperidine requirements and pulmonary function tests.
The ability of intrathecal morphine (ITM) to reduce post-thoracotomy pain and meperidine requirements was investigated. Thirty adult patients scheduled for thoracic surgery were studied. Following induction with thiamylal sodium and succinylcholine, anesthesia was maintained with 100 micrograms of fentanyl, vecuronium, and enflurane. ⋯ The patients in the ITM group required significantly less meperidine compared to the control group (59 +/- 68 v 167 +/- 97 mg, respectively) and had lower pain scores (1.4 +/- 1.1 v 2.4 +/- 0.9 mg, respectively). There were no serious side effects attributable to ITM. It is concluded that ITM is an effective adjunctive treatment for control of post-thoracotomy pain.
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
The effect of a cardiac surgical recovery area on the timing of extubation.
The anesthetic and postoperative management of cardiac surgical patients was modified to achieve an early return to spontaneous ventilation. A total of 278 patients were studied to determine the effect of this change. Patients in group I (n = 198) were managed in a cardiac surgical recovery area according to the new policy. ⋯ The median duration of postoperative ventilation was reduced from 5 hours in group II to 1 hour in group I, and the time to extubation was reduced from 7 hours to 2 hours, respectively. There were no major postoperative complications resulting from this change. The factors that influence the duration of postoperative ventilation are discussed.
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
Transesophageal two-dimensional echocardiographic analysis of right ventricular systolic performance indices during coronary artery bypass grafting.
Sixteen patients (aged 59 +/- 14 years) undergoing coronary artery bypass surgery were evaluated to delineate the intraoperative course of transesophageal echocardiographic right ventricular (RV) systolic performance indices. Pre-induction data included thermodilution RV ejection fraction (RVEFTD), 0.43 +/- 0.13, RV end-diastolic volume index (EDVI), 110 +/- 33 mL/m2, cardiac index (CI), 3.4 +/- 1.0 L/min/m2, RV end-diastolic pressure (EDP), 7.1 +/- 4.2 mmHg, and mean pulmonary artery pressure (PAP), 21 +/- 6 mmHg. Eleven patients had significant right coronary artery (RCA) disease (> 70% occlusion). ⋯ Two patients received inotropic support (epinephrine, 0.2 to 0.3 microgram/kg/min). CPB was associated with significant decreases in max major axisLA and 2DLA (P < 0.05) as compared to measurements determined prior to CPB. Maximum major axisLA values pre-CPB were 0.35 +/- 0.06 and 0.33 +/- 0.08 versus post-CPB values of 0.24 +/- 0.08.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
Potential risks of high-dose epinephrine for resuscitation from ventricular fibrillation in a porcine model.
The arterial plasma concentrations and hemodynamic effects of epinephrine, 10 micrograms/kg, IV (group A, N = 8) and 50 micrograms/kg, IV (group B, N = 8) were compared in a porcine resuscitation model after 3 minutes of circulatory arrest induced by ventricular fibrillation. All animals in group A were successfully resuscitated after 4.9 +/- 2.8 minutes and 2.8 +/- 1.6 defibrillations. In group B, only 6 of 8 animals were successfully resuscitated after 6.3 +/- 1.1 minutes and 4.0 +/- 2.7 defibrillations (mean +/- SD). ⋯ Mean arterial peak epinephrine concentrations (group A 197 +/- 133 ng/mL, group B 1173 +/- 298 ng/mL) were approximately fivefold higher in group B. After resuscitation, plasma concentrations returned to baseline levels within 7 minutes in group A and 15 minutes in group B. Later hemodynamic differences between the groups are thereby attributed to a detrimental impact of high-dose epinephrine on the heart during resuscitation.