Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Randomized Controlled Trial Clinical TrialEsmolol and intraoperative myocardial ischemia: a double-blind study.
Forty patients scheduled to undergo elective myocardial revascularization were included in a randomized, double-blind, placebo-controlled study to evaluate any influence of esmolol on the incidence of myocardial ischemia. Calibrated recordings of ECG leads II and V5 were continuously monitored with the QMED Monitor One TC (Qmed Inc, Clark, NJ) from the time of arrival in the operating room holding area through the induction of anesthesia, using a high-dose opioid technique, and until the initiation of cardiopulmonary bypass. One group received a bolus of esmolol, 1.0 mg/kg, followed by a continuous infusion of 100 micrograms/kg/min. ⋯ Heart rate, mean arterial pressure, and the number of patients developing myocardial ischemia during the course of the study also did not differ significantly between the groups. There were significant decreases in heart rate and mean arterial pressure compared with the awake baseline values in both groups during multiple study points. It is concluded that esmolol was ineffective at treating preexisting or new-onset myocardial ischemia at this dosage in this clinical setting.
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Comparative StudyBlood pressure after cardiopulmonary bypass: which technique is accurate?
To evaluate the accuracy with which a patient's aortic blood pressure can be estimated upon separating from cardiopulmonary bypass (CPB), simultaneously recorded radial artery pressure, oscillometric brachial artery pressure, pressure in the CPB circuit, and the surgeon's estimate of blood pressure by aortic palpation were compared to directly measured aortic root pressure. After obtaining institutional approval and written informed consent, 20 patients requiring CPB for cardiac operations were studied. General anesthesia was induced and maintained with fentanyl, vecuronium, and enflurane. ⋯ The oscillometric technique and CPB line were poor estimates of aortic root pressure. Of the techniques used to estimate aortic blood pressure, including radial arterial, oscillometric, aortic line of the CPB circuit, and digital palpation, the radial arterial was the best, and the aortic line from the CPB machine and palpation by the surgeon were the worst. When a clinician is unsure of the blood pressure during separation from CPB, direct measurement of central aortic blood pressure is advised.
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Total intravenous anesthesia using propofol and alfentanil for coronary artery bypass surgery.
Total intravenous anesthesia (TIVA) using alfentanil and propofol was used in 10 patients undergoing coronary artery bypass grafting. In an attempt to diminish unwanted side effects, lower doses were chosen than if either drug had been used alone. Anesthesia was induced with alfentanil, 75 micrograms/kg, followed by a sleep dose of propofol (mean dose 0.5 mg/kg). ⋯ Anesthesia was satisfactory in all but one patient who developed breakthrough hypertension on sternotomy with transient ST segment depression, and awareness after CPB despite a plasma alfentanil concentration of 450 ng/mL. Mean time to wakening was 55 minutes. The study indicated that TIVA using propofol and alfentanil in the dosages described provides satisfactory basal anesthesia for coronary artery bypass surgery in patients with good left ventricular function, but requires additional pharmacologic manipulation, particularly with boluses of alfentanil, to control breakthrough hypertension.