Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
Continuous versus intermittent cardiac output measurement in cardiac surgical patients undergoing hypothermic cardiopulmonary bypass.
Continuous thermodilution cardiac output (CCO) measurement was clinically evaluated in patients who underwent coronary revascularization using hypothermic low-flow, low-pressure cardiopulmonary bypass (CPB). ⋯ Despite an excellent correlation, accuracy, and precision between CCO and ICO before CPB and more than 45 minutes after hypothermic CPB, a lack of correlation in the early phase after CPB has been found. Further investigation is needed to elucidate the underlying cause of these findings and to clarify whether ICO or CCO or both fail to represent the real cardiac output up to 45 minutes after weaning from hypothermic CPB.
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
ReviewPro: early extubation after cardiac surgery decreases intensive care unit stay and cost.
The recurrent or new trends of early extubation after cardiac surgery are here to stay in the 1990s. The preoperative status does not necessarily predict the postoperative course and prolonged mechanical ventilation following cardiac surgery should not be uncritically considered as routine. All patients should be assessed for tracheal extubation at the earliest opportunity when the criteria are met in the ICU. ⋯ The substantial difference in cost savings per cardiac case between "criteria discharge" and "actual discharge" points out the importance of the organization of the process of care being delivered. To achieve maximum cost benefit from early extubation in cardiac patients, the organization of the perioperative management of these patients must be optimized. This process of care includes intraoperative anesthetic modification; organization of ICU and staff expertise; postoperative early extubation and management; acute pain service; ICU discharge policy; utilization of step-down unit and surgical ward; and communication among cardiac patient management teams (cardiovascular surgeon, cardiac anesthesiologist, ICU staff, nurses, respiratory therapists, physiotherapists, and social workers), which are all vital to the success of such a program.
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialContinuous infusions of alfentanil and propofol for coronary artery surgery.
To study the anesthetic efficacy of two different background infusion rates for alfentanil in a total intravenous anesthesia (TIVA) technique using propofol. Therefore, the effects of these infusions on hemodynamic stability and on the suppression of hemodynamic and somatic responses to noxious stimuli were compared. ⋯ Because both infusions provided equally stable anesthesia, the lower infusion regimen for alfentanil is the more appropriate technique. Using this technique, the administration of additional alfentanil boluses just before stressful surgical episodes will further improve hemodynamic stability.
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J. Cardiothorac. Vasc. Anesth. · Aug 1995
Comparative StudyDetermination of normal versus abnormal activated partial thromboplastin time and prothrombin time after cardiopulmonary bypass.
The study's objective was to determine the prothrombin time (PT) and activated partial thromboplastin time (aPTT) values that differentiated normal from excessively bleeding patients immediately after cardiopulmonary bypass (CPB). ⋯ The aPTT and PT values that produce the maximal sensitivity and specificity in the ROC analysis may be helpful to differentiate patients who are bleeding excessively from those patients who are not after CPB and to guide transfusion of blood products. New whole blood coagulation devices with rapid turn-around times had similar predictive value for bleeding tendency compared with standardized laboratory tests.