Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialDopexamine unloads the impaired right ventricle better than iloprost, a prostacyclin analog, after coronary artery surgery.
To evaluate the ventricle-unloading properties of dopexamine and iloprost and to compare their effects on right ventricular (RV) function and oxygen transport in patients with low RV ejection fraction (RVEF) after cardiac surgery. ⋯ The findings suggest that dopexamine is more effective than iloprost for support and unloading of the postoperatively disturbed RV in terms of RVEF and end-systolic volume. The reduction of pulmonary vascular resistance after administration of iloprost without a decrease in end-systolic volume might not be considered a reduction of RV afterload. Iloprost increases the pulmonary shunt fraction, however, more than dopexamine, indicating a more prominent vasodilator effect.
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C).
Prophylactic administration of tranexamic acid (TA), an antifibrinolytic agent, decreases bleeding after cardiac surgery with systemic hypothermia (25 degrees C to 29 degrees C). Warmer systemic temperatures during cardiopulmonary bypass (CPB) may reduce bleeding and thus alter the requirement for TA. The effect of three different doses of TA on bleeding after cardiac surgery with mild systemic hypothermia (32 degrees C) is evaluated. ⋯ Of the three doses of TA studied, the most efficacious and cost-effective dose to reduce bleeding after cardiac surgery with mild hypothermic systemic perfusion is 100 mg/kg.
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialPain management in cardiac surgery patients: comparison between standard therapy and patient-controlled analgesia regimen.
To compare standard nurse-based pain therapy with a patient-controlled analgesia (PCA) regimen. ⋯ Because of the beneficial effects with regard to degree of pain and satisfaction, pain management using PCA systems can be recommended for cardiac surgery patients. It appears to be superior to standard nurse-based pain therapy.
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
ReviewPatient selection and anesthetic management for early extubation and hospital discharge: CABG.
Three model systems have been described that may facilitate an increase in the numbers of patients passing through the hospital within the resource allocation available: (1) early fast-track extubation, < 3 hours after surgery, (2) planned intensive care unit discharge < 18 hours, and (3) early hospital discharge < 5 days. Thus far, studies have not clearly identified patient group or risk demonstrating a need for prolonged intubation or delayed intensive care unit and hospital length of stay. It thus appears appropriate to suggest that all patients be considered suitable for early extubation, mobilization, and hospital discharge. ⋯ The ultrashort action of remifentanil facilitates the ability to plan and control the period of recovery of spontaneous ventilation and extubation while providing profound reduction of intraoperative stress responses and hemodynamic stability. Safe extubation requires that the patient be alert and cooperative, be hemodynamically stable and warm, is not bleeding, and has adequate respiratory function. Interventions with anti-inflammatory and hemostatic agents such as the serine protease inhibitor aprotinin or with corticosteroids can have a major impact on achieving the criteria needed to ensure rapid discharge from the intensive care unit.
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
ReviewThe implications of hypothermia for early tracheal extubation following cardiac surgery.
Thermoregulation is impaired during anesthesia for cardiac surgery. Redistribution of body heat and heat loss to the environment result in mild hypothermia before cardiopulmonary bypass. Maintenance of normothermia, rather than hypothermia, may facilitate early tracheal extubation. ⋯ Coagulopathies, increased incidence of surgical wound infection, and perioperative cardiac morbidity are other potential risk factors identified in noncardiac patients. Hypothermia, however, does have potential benefits to the patient, including protection from cerebral ischemia and hypoxemia. Mild core hypothermia (approximately 34 degrees C) may represent the optimal balance between risks and benefits for fast-track patients.