Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of vecuronium and meperidine on the clinical and metabolic effects of shivering after hypothermic cardiopulmonary bypass.
The use of vecuronium and meperidine on the clinical and metabolic effects of shivering in mechanically ventilated patients after hypothermic cardiopulmonary bypass (CPB) was compared. Twenty adult male patients undergoing cardiac surgery were randomized to meperidine, 25 to 75 mg (n = 10), or vecuronium, 0.1 microgram/kg (n = 10), for the treatment of shivering during postoperative rewarming. Vecuronium was continued as an infusion at 1.0 microgram/kg/min for 4 hours. ⋯ Meperidine administration caused a significant decline in systolic blood pressure (121.9 +/- 10.6 mmHg to 106.9 +/- 8.5 mmHg, p = < 0.02). The authors conclude that, during rewarming after hypothermic CPB, muscle relaxation with vecuronium reverses both the clinical and metabolic effects of shivering more reliably and effectively than repeated boluses of meperidine, and with greater hemodynamic stability. Control can be maintained by continuous infusion of vecuronium with concomitant sedation for up to 4 hours without prolonging intubation time.
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J. Cardiothorac. Vasc. Anesth. · Apr 1995
Comparative StudyOxygen transport and hemodynamics during retrograde whole-body perfusion.
The changes in oxygen transport and hemodynamics during retrograde whole-body extracorporeal perfusion (retro-ECC) were studied in six mongrel dogs. Oxygen consumption during retro-ECC, in which the blood flow rate was set at 25% and 50% of the flow during antegrade extracorporeal perfusion (ante-ECC), respectively, was relatively high compared with that during ante-ECC. These changes were caused by an increase in the oxygen extraction ratio to 71.5% +/- 8.2% and 51.2% +/- 12.4% during retro-ECC/25% and retro-ECC/50%, respectively. ⋯ However, central venous pressure increased markedly to 29.5 +/- 11.6 mmHg and 56.2 +/- 24.5 mmHg during retro-ECC/25% and retro-ECC/50%, respectively, because of massive venous congestion caused by insufficient arterial return of perfused blood. The great venous compliance and increased systemic vascular resistance were the main causes of circulatory failure during retro-ECC. The risk of serious complications owing to the venous congestion must be considered during retrograde perfusion, especially during the clinical application of retrograde cerebral perfusion.
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J. Cardiothorac. Vasc. Anesth. · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialPostthoracotomy pulmonary function: a comparison of epidural versus intravenous meperidine infusions.
It has remained unclear whether epidural opioid analgesia permits better recovery of postthoracotomy pulmonary function than an optimal method of systemic opioid administration. Lumbar epidural meperidine infusions were compared with intravenous patient-controlled analgesic (PCA) meperidine infusions in a prospective randomized unblinded study for 72 hours postthoracotomy. Before induction of general anesthesia, patients received a bolus of meperidine, 1 mg/kg, and an infusion of meperidine, 0.33 mg/kg/hr, was started via either a lumbar epidural or intravenous catheter. ⋯ Normeperidine levels greater than 300 ng/mL were associated with an increased incidence of shakiness and/or tremors. Meperidine provides satisfactory postthoracotomy analgesia via a lumbar epidural infusion. This analgesia is associated with improved recovery of postoperative pulmonary function when compared with an intravenous PCA meperidine infusion.