Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Clinical TrialDoes aprotinin influence endothelial-associated coagulation in cardiac surgery?
Aprotinin has been reported to reduce bleeding in cardiac surgery patients. Its mechanisms of action on coagulation have not been fully elucidated. In a prospectively randomized study of 40 patients undergoing elective aortocoronary bypass grafting, the influence of high-dose aprotinin (2 million IU of aprotinin before CPB, 500,000 IU/h until the end of operation, 2 million IU added to the prime) (N = 20) on endothelial-related coagulation was compared to a nontreated control group (N = 20). ⋯ During CPB, TM plasma concentrations decreased similarly in both groups (aprotinin: 18 +/- 6 ng/mL, control: 17 +/- 7 ng/mL) followed by a comparable increase in the postbypass period until the first postoperative day (aprotinin: 60 +/- 10 ng/mL, control: 53 +/- 11 ng/mL). Protein C and (free) protein S plasma levels also showed no differences between the two groups. On the first postoperative day, baseline values for protein C and protein S had not yet been reached.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Clinical TrialUse of the activated coagulation time and heparin dose-response curve for the determination of protamine dosage in vascular surgery.
The activated coagulation time (ACT) can be used to construct a two-point heparin dose-response curve (HDRC) from the ACT values at baseline and 5 minutes after heparin administration. The ACT value at any subsequent time interval can then be used to estimate the residual heparin activity from the HDRC. The protamine dose is calculated to be the amount of residual heparin multiplied by a correction factor (1.3 was suggested for cardiac surgery). ⋯ Group III received the least protamine (0.64 +/- 0.07 mg/kg, P < 0.05). No adverse protamine reactions or postoperative bleeding occurred. It is concluded that ACT monitoring and use of the HDRC provides a safe and easy method to individualize protamine dosage in vascular surgery.
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialHemodynamic and pharmacodynamic comparison of doxacurium and high-dose vecuronium during coronary artery bypass surgery: a cost-benefit study.
Doxacurium (DOX), a new nondepolarizing neuromuscular blocking drug (NMBD), was compared in a randomized, double-blind fashion to high-dose vecuronium (VEC) in 60 coronary artery bypass grafting (CABG) patients. A third group of 15 patients older than 70 years of age (DOX-70) was added to compare the effects of DOX to VEC in the older population. Endpoints of the study were hemodynamic stability, ease of ventilation and intubation, anesthesiologist's satisfaction, drug interventions to correct hemodynamic instability, and total cost of the drug. ⋯ The durations of the induction and maintenance doses of DOX were similar in the younger and older patients. Although the intubating dose of VEC had a faster onset of action, this had no effect on the ease of ventilation, conditions for tracheal intubation, and overall anesthesiologist satisfaction. The total cost for each NMBD was not different.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Biography Historical ArticleKenneth K. Keown, MD: pioneer of cardiac anesthesiology.
In 1948, just 2 years out of his anesthesiology residency at Hahnemann Medical College and Hospital, Kenneth K. Keown, MD, was chosen as the anesthesiologist for the procedure that launched the era of intracardiac surgery--a mitral valves commissurotomy. Although surgery on stenotic mitral valves had met with some success as early as the 1920s, its application had lain dormant for some 25 years. ⋯ He also maintained a vigorous resident recruitment service. Keown held leadership positions in many medical organizations and, during a sabbatical from Missouri, served on the hospital ship Hope in Tunisia. He was Professor and Chief, and later Chairman, Section of Anesthesiology, at the University of Missouri Medical Center, and from 1969 until his death in 1985, he also served as the Center's Medical Director.
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J. Cardiothorac. Vasc. Anesth. · Oct 1994
Effects of atrial pacing on right ventricular contractility after coronary artery surgery.
Increasing heart rate enhances the strength of contraction of cardiac fibers. This has been demonstrated in vitro and recently for the left ventricle. To study this phenomenon on the right ventricle, the effects of increasing heart rate by atrial pacing on right ventricular (RV) contractility were observed after coronary artery surgery in 20 patients. ⋯ The dP/dtmax/EDVI ratio was also increased by pacing (2.32 +/- 0.4 mmHg/min/mL/m2 before pacing v 3.15 +/- 0.5 mmHg/min/mL/m2 during pacing, P < 0.01). Moreover, cardiac index was increased by pacing alone (2.45 +/- 0.2 L/min/m2 v 2.78 +/- 0.2 L/min/m2, P < 0.01), and significantly more when MAST were inflated (2.94 +/- 0.2 mL/m2, P < 0.05 v pacing alone). It is concluded that increasing heart rate by atrial pacing increases RV inotropic status after coronary artery surgery.