Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 2003
High thoracic epidural anesthesia as the sole anesthetic for performing multiple grafts in off-pump coronary artery bypass surgery.
The feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing beating heart coronary revascularization avoiding general anesthesia was studied. ⋯ Experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2003
Randomized Controlled Trial Clinical TrialManagement of heparin resistance during cardiopulmonary bypass: the effect of five different anticoagulation strategies on hemostatic activation.
Attenuation of hemostatic activation is a central goal during CPB. However, this poses a problem in patients insensitive to heparin. The present investigation was performed to assess different strategies of managing patients with heparin resistance during CPB. ⋯ Activation of hemostasis during CPB in heparin-resistant patients most likely has to be attributed to stimulation of the tissue factor pathway. Even the sole use of high concentrations of UFH does not effectively inhibit this activation. Therefore, in these patients anticoagulation during CPB with UFH should be supplemented with either AT III, a short-acting direct thrombin inhibitor, or a short-acting platelet glycoprotein IIb/IIIa antagonist.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2003
Randomized Controlled Trial Clinical TrialHeparin-coated versus uncoated extracorporeal circuit in patients undergoing coronary artery bypass graft surgery.
To assess the effect of heparin-coated circuits on bleeding, transfusion, and platelet count in patients undergoing primary coronary artery bypass grafting with full heparinization. ⋯ The use of a heparin-coated or uncoated cardiopulmonary bypass circuit and full heparinization marginally reduced only red blood cell transfusion but was not associated with platelet sparing or reduced perioperative bleeding.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2003
Randomized Controlled Trial Clinical TrialRegional oxygenation and systemic inflammatory response during cardiopulmonary bypass: influence of temperature and blood flow variations.
To evaluate the role of target temperature (28 degrees or 34 degrees C) in cardiac surgery on regional oxygenation during hypothermia and rewarming and systemic inflammatory response. ⋯ During cardiopulmonary bypass, hypothermia at 28 degrees C increases regional and central venous oxygenation better than at 34 degrees C. In contrast, venous oxygenation decreases during rewarming irrespective of the preceding temperature. No significant difference in the systemic inflammatory response associated with target temperature was detected.