Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialVolume loading with hypertonic saline solution: endocrinologic and circulatory responses.
Hypertonic saline solution appears to be an attractive method of volume expansion. In 45 patients undergoing elective aorto-coronary bypass grafting, endocrinologic and circulatory responses to volume loading with hypertonic saline solution prepared in low molecular weight (MW) hydroxyethyl starch (HES) solution (72 g/L NaCl, HES concentration: 6%; MW: 200,000 D; degree of substitution [DS]: 0.5) (HS-HES) was compared randomly to patients who had received low molecular weight HES solution (LMW-HES). A group of patients without volume loading served as a control. ⋯ Epinephrine and norepinephrine plasma levels increased most markedly in the control patients and were highest in the postbypass period in these patients. CI increased most after infusion of HS-HES (+65%) (P < 0.05). In the postbypass period, CI remained significantly higher in both volume groups than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
ReviewPredictive accuracy of alfentanil infusion in coronary artery surgery: a prebypass study in middle-aged and elderly patients.
Twenty-three informed and consenting patients scheduled for CABG were anesthetized using computer-controlled infusions of alfentanil, midazolam, and pancuronium. Thirteen middle-aged patients received a preprogrammed infusion scheme of alfentanil, simulated using the population pharmacokinetic set of Maitre et al (Group M), and 10 elderly patients received a preprogrammed infusion scheme simulated using the model of Helmers et al (Group H). The target alfentanil concentrations in groups M and H for tracheal intubation were: 300-500 ng/mL and for sternotomy: 500-700 ng/mL. ⋯ The sets of Maitre et al and Helmers et al were found not to be accurate (MDAPE > 40%) in both groups M and H. The set of Scott et al with the lowest clearance (2.4 mL/kg/min) shows the best accuracy (MDAPE: 19.5%) and precision (P10: -40%, P90: 16%). In conclusion, the set of Scott et al should preferably be selected to predict prebypass alfentanil infusion accurately in either middle aged or elderly patients who have normal myocardial function (LVEF > 50%) and are scheduled for CABG.
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-fentanyl anesthesia: a comparison with isoflurane-fentanyl anesthesia in coronary artery bypass grafting and valve replacement surgery.
The hemodynamic effects of propofol-fentanyl and isoflurane-fentanyl anesthesia during the prebypass period were compared in 42 patients undergoing coronary artery bypass grafting (CABG) and 22 patients undergoing valve replacement (VR) for stenotic lesions. Anesthesia was induced with fentanyl, 25 micrograms/kg, and pancuronium, 0.1 mg/kg, and was maintained with a propofol infusion commenced at 4 mg/kg/h (range 1 to 10 mg/kg/h) or with isoflurane commenced at 1% (range 0 to 2%). Additional fentanyl, 7.5 micrograms/kg, was given before sternotomy. ⋯ Propofol produced similar hemodynamic changes in the CABG and VR groups. Both anesthetic techniques caused myocardial depression and effectively controlled the autonomic responses to sternotomy in both groups. The study suggests that propofol-fentanyl anesthesia is an acceptable technique for CABG surgery and for VR in patients with stenotic valvular heart disease.