Journal of cardiothoracic and vascular anesthesia
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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.
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J. Cardiothorac. Vasc. Anesth. · Apr 2003
Comparative StudyMeasurement of cardiac output after cardiac surgery by a new transesophageal Doppler device.
Assessment of hemodynamics by transesophageal Doppler devices (TDD) may be a less invasive alternative to the pulmonary artery catheter. In contrast to the TDD evaluated so far, a new monitor (HemoSonic100) measures both blood flow velocity and the diameter of the descending aorta. The aim of this study was to assess the accuracy of the cardiac output/index (CO/CI) measured by this device compared with the CO/CI measured by thermodilution. ⋯ The transesophageal Doppler device (HemoSonic100) cannot be recommended as a sole method for monitoring cardiac output in patients after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2003
Comparative StudyComparison of thermodilution bolus cardiac output and Doppler cardiac output in the early post-cardiopulmonary bypass period.
To evaluate the accuracy of measuring cardiac output (CO) in the early post-cardiopulmonary bypass (CPB) period by comparing thermodilution with Doppler methods. ⋯ This study adds further support that DCO is a clinically acceptable method to accurately assess the CO in patients even during periods of uneven regional body temperatures as may occur in the early post-CPB period.
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J. Cardiothorac. Vasc. Anesth. · Apr 2003
Comparative StudyContinuous measurement of cardiac output by inert gas throughflow: comparison with thermodilution.
The throughflow method is a new technique for continuous and minimally invasive measurement of cardiac output by the Fick principle, which uses ventilation of the 2 lungs with unequal inspired gas concentrations by means of a double-lumen endobronchial tube. It exploits steady-state gas exchange and thus permits rapid repetition of measurement. ⋯ The throughflow method showed good agreement with thermodilution. It permits continuous cardiac output measurement without the need for sampling of mixed venous blood, using techniques of lung isolation, which are readily available in clinical anesthetic practice.
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J. Cardiothorac. Vasc. Anesth. · Apr 2003
Thoracic epidural analgesia in coronary artery bypass graft surgery: seven years' experience.
To evaluate the risk of neurologic complications caused by an epidural hematoma in a series of patients who had coronary artery bypass graft surgery with cardiopulmonary bypass under combined general and thoracic epidural anesthesia (TEA). ⋯ In this study, some of the benefits previously reported during cardiac surgery under TEA, such as excellent analgesia and early extubation, were confirmed. In addition, the series adds further evidence that adherence to a set of standard safety measures, in this setting, averts the occurrence of symptomatic epidural hematomas.