Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Randomized Controlled Trial Clinical TrialThe effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery.
To investigate the effect of a single induction dose of etomidate on plasma cortisol and adrenocorticotrophic hormone (ACTH) levels in pediatric patients with congenital heart disease. ⋯ These results show that etomidate is a suitable agent for suppressing the increase in cortisol levels associated with the stress response caused by cardiopulmonary bypass in children with congenital heart defects, and can be used safely.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Epidural anesthesia in cardiac surgery: is there an increased risk?
To assess the risk of hemorrhagic complications associated with epidural anesthesia in patients undergoing coronary artery bypass grafting. ⋯ By following certain guidelines, the risk for the development of epidural hematoma is not increased in patients undergoing epidural anesthesia during cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Comparative StudyThe interaction between applied PEEP and auto-PEEP during one-lung ventilation.
To investigate the relationship between applied external positive end-expiratory pressure (PEEP) and auto-PEEP and the resultant total PEEP experienced by the patient during one-lung ventilation (OLV). ⋯ The change in end-expiratory pressure experienced by the ventilated lung during OLV when external PEEP is applied depends on the preexisting level of auto-PEER This may explain some of the inconsistencies in the clinical results of application of external PEEP during OLV. The total PEEP delivered to the patient should be measured whenever external PEEP is applied during OLV.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
Comparative StudyFlow resistances of disposable double-lumen, single-lumen, and Univent tubes.
To compare the airflow resistances of modern double-lumen, single-lumen, and Univent (Fuji Systems Corp; Tokyo, Japan) tubes. ⋯ Flow resistances of modern disposable double-lumen tubes are lower than commonly perceived. In most clinical situations, there will be no decrease in flow resistance when a Rusch or Sheridan double-lumen tube is replaced by a single-lumen tube.
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J. Cardiothorac. Vasc. Anesth. · Apr 1998
ReviewCardiopulmonary bypass-induced inflammation: is it important?
The systemic endotoxemia that occurs with the institution of cardiopulmonary bypass (CPB) is a potent stimulus for the release of proinflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and IL-6. Raised IL-6 levels have been reported to correlate with post-CPB left ventricular wall-motion abnormalities and myocardial ischemic episodes. Neutrophil-endothelial adhesion is strongly implicated in the inflammation and reperfusion injury that may follow a period of CPB, and organ injury is thought to be, in part, neutrophil mediated. ⋯ Recent data suggest that administration of the serine protease inhibitor aprotinin to patients undergoing myocardial revascularization with CPB can reduce TNF-alpha blood levels and blunt neutrophil CD11b upregulation. Preliminary data suggest that aprotinin can inhibit cytokine-induced nitric oxide synthase expression and subsequent NO production by murine bronchial epithelial cells. These effects may explain some of the reported antiinflammatory effects of the serine protease inhibitors.