Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1993
Prevention of postbypass bleeding with tranexamic acid and epsilon-aminocaproic acid.
In this institution, two antifibrinolytic agents have been in routine use before cardiopulmonary bypass (CPB) to prevent bleeding due to fibrinolysis; epsilon-aminocaproic acid (EACA) or tranexamic acid (TA) are administered as intravenous infusions over 2 hours, from the time of anesthetic induction until the onset of CPB. TA is 10 times more potent and binds more strongly to plasminogen than EACA. Data were collected retrospectively on 411 patients undergoing first-time coronary artery bypass grafting with cardiopulmonary bypass who had received one of four therapy regimens: 10 g of EACA (65 patients), 15 g of EACA (60 patients), 6 g of TA (100 patients), or 10 g of TA (75 patients). ⋯ Although 10 g of TA was more effective than 6 g of TA in blood loss control for the first 6 hours, the difference was not significant at 24 hours. A significantly lower number of patients in the 10 g TA group received blood products than in control (28% v 49%) patients (P = 0.02). Pretreatment with 10 g of TA prevented excessive (over 750 mL in 6 hours) bleeding after CPB.
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J. Cardiothorac. Vasc. Anesth. · Aug 1993
Randomized Controlled Trial Clinical TrialClonidine improves perioperative myocardial ischemia, reduces anesthetic requirement, and alters hemodynamic parameters in patients undergoing coronary artery bypass surgery.
The purpose of this study was to determine if clonidine reduces myocardial ischemia or alters anesthetic requirement and perioperative hemodynamic parameters during coronary artery bypass grafting (CABG) surgery. Forty-three patients were randomized in a prospective, double-blind fashion to receive either clonidine (5 micrograms/kg) or placebo. Anesthetic induction and maintenance was accomplished with intravenous sufentanil-midazolam (S-M) in a 1:20 ratio; up to 1.0% enflurane was added during surgery when repeated boluses of S-M failed to maintain the blood pressure within 20% of preinduction values. ⋯ Epinephrine and norepinephrine levels were lower in clonidine-treated patients throughout the perioperative procedure with significant differences noted immediately following sternotomy and release of the aortic cross-clamp (P < 0.05). Critical ST segment depression was significantly less in clonidine-treated patients for the period from sternotomy until application of the aortic cross-clamp (P < 0.01). Following CPB, absolute deviation of ST segments from isoelectric baseline was significantly less in the clonidine-treated group (P < 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Aug 1993
Intraoperative measurement of activated partial thromboplastin time and prothrombin time by a portable laser photometer in patients following cardiopulmonary bypass.
Intraoperative capabilities to rapidly assess coagulation status following cardiopulmonary bypass (CPB) may be of benefit in providing optimal hemostasis and transfusion management, because CPB causes abnormalities in coagulation that may increase morbidity and mortality. The Ciba Corning 512 coagulation monitor (Ciba Corning, Medfield, MA) is a compact and portable device that rapidly determines the prothrombin time (PT) and activated partial thromboplastin time (APTT) in whole blood samples. One hundred patients requiring CPB had APTT and PT determined in whole blood specimens by the 512 coagulation monitor and in plasma specimens by the hospital laboratory from the same arterial blood sample obtained after protamine administration. ⋯ The 512 coagulation monitor accuracy was not affected by a variation of hemoglobin concentration or platelet count between 6 and 12 gm/dL and 15 to 300 x 10(9)/L, respectively. In conclusion, the 512 coagulation monitor provided a rapid APTT and PT result, but the APTT was less accurate. Speeding access to hospital laboratory results would be even more efficacious and accurate.