Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1995
Randomized Controlled Trial Clinical TrialClosed mitral valvotomy and elective ventilation in the postoperative period: effect of mild hypercarbia on right ventricular function.
It is customary to extubate patients immediately after closed mitral valvotomy. These patients often have deranged respiratory function caused by chronic lung congestion. The left ventricular function may also be subnormal after valvotomy in some patients. Therefore, elective ventilation for some duration in the postoperative period can be beneficial to these patients. This work is an attempt to find whether elective ventilation should be preferred over immediate extubation in these patients. ⋯ Avoidance of even mild hypercarbia, therefore, appears advisable in the early postoperative period because of potential impedence to right ventricular ejection. Continuous monitoring of end-tidal CO2 and frequent blood gas analyses should be practiced, and elective ventilation should be considered in patients with long-standing disease and pulmonary hypertension.
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J. Cardiothorac. Vasc. Anesth. · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of amrinone with sodium nitroprusside for control of hemodynamics during infrarenal abdominal aortic surgery.
The control of hemodynamic changes during surgical resection of abdominal aortic aneurysms (AAA) remains a challenge to anesthesiologists. In the past, hypertensive episodes have been treated with sodium nitroprusside (SNP). However, amrinone may provide some benefits when compared with SNP because of its positive inotropic and vasodilatory properties. Therefore, the purpose of this study was to compare amrinone with SNP for hemodynamic control during AAA surgery. ⋯ This study demonstrates that amrinone provides equivalent hemodynamic control to SNP during abdominal aortic aneurysm surgery because it allows moderate reductions in blood pressure without affecting other hemodynamic measurements. Further studies are needed to assess whether patients with poor preoperative left ventricular function would benefit from amrinone management during AAA resection.
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J. Cardiothorac. Vasc. Anesth. · Oct 1995
ReviewSafety issues regarding early extubation after coronary artery bypass surgery.
Potential safety issues related to early extubation include the effect of changes in anesthetic management on intraoperative hemodynamics, stress responses and awareness, altered management in the control of pain, shivering and ischemia in the early postoperative period, and the risks of reintubation in patients who might require reoperation for bleeding. The literature does not implicate any technique necessary to facilitate early extubation as being associated with adverse outcome. Definitive outcome studies are only beginning to be presented, but the data so far suggest that early extubation is not associated with any increase risk of mortality or morbidity, including, specifically, myocardial ischemia or infarction. ⋯ Complications such as low cardiac output, arrhythmias, stroke, and perioperative myocardial infarction have not increased with early extubation, at least in patients selected for early extubation on the basis of preoperative characteristics. In summary, available evidence suggests that early extubation, applied to many but probably not all patients, can be accomplished without demonstrable patient harm. A coordinated approach involving anesthesia, surgery, nursing, respiratory therapy, and other support services is essential, and constant reevaluation as events unfold, rather than rigid protocols, allows care to be individualized to the specific needs of each patient.
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J. Cardiothorac. Vasc. Anesth. · Oct 1995
Determinants of systolic pressure variation in patients ventilated after vascular surgery.
To discover the predominant determinant of systolic pressure variation during positive-pressure ventilation in mechanically ventilated patients after a vascular surgical procedure. ⋯ The decrease in systolic pressure provoked by positive-pressure inspiration reflects simultaneous decreases in stroke volume. This suggests that a decrease in left ventricular filling, associated with positive-pressure inspiration, is responsible for systolic pressure variation. This finding confirms the interest in considering systolic pressure variation to provide reliable information about the responsiveness of the heart to preload variations.