Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2000
Association of fast-track cardiac management and low-dose to moderate-dose glucocorticoid administration with perioperative hyperglycemia.
To delineate associations between preoperative risk factors and clinical processes of care and perioperative glucose tolerance in patients managed on a fast-track cardiac surgery clinical pathway with prebypass methylprednisolone administration. ⋯ At this institution, implementation of the fast-track pathway was associated with a deterioration of glucose tolerance. Preoperative diabetes, pre-cardiopulmonary bypass administration of steroids, volume of glucose-containing cardioplegia solution administered, and use of epinephrine infusions were significantly associated multivariate factors.
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J. Cardiothorac. Vasc. Anesth. · Dec 2000
Randomized Controlled Trial Clinical TrialEffect of subarachnoid morphine administration on extubation time after coronary artery bypass graft surgery.
To determine the effects of 2 low doses of intrathecal morphine on extubation time and on postoperative analgesic requirements after coronary artery bypass graft (CABG) surgery. ⋯ Despite decreased postoperative morphine requirements, intrathecal morphine administration did not have a clinically relevant effect on extubation time after CABG surgery. This study suggests that 250 microg is the optimal dose of intrathecal morphine to provide significant postoperative analgesia without delaying tracheal extubation.
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J. Cardiothorac. Vasc. Anesth. · Dec 2000
Clinical TrialPreliminary report on high thoracic epidural analgesia: relationship between its therapeutic effects and myocardial blood flow as assessed by stress thallium distribution.
To extend the duration of high thoracic epidural analgesia (HTEA) treatment compared with the authors' previous studies, to test the hypothesis that the mechanism by which HTEA reduces angina during long-term treatment includes an improvement in myocardial blood flow distribution and a reduction in stress-induced ischemia, and to show that new myocardial infarctions are not masked or missed in patients receiving HTEA. ⋯ The authors previously showed that HTEA is safe and effective in relieving refractory angina pectoris. The current study shows that this therapeutic effect persists and does not appear to be related to a change in myocardial blood flow; rather the improvement in symptoms probably results, in part, from an anesthetic effect. HTEA does not mask the development of new myocardial infarctions.
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J. Cardiothorac. Vasc. Anesth. · Dec 2000
Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias.
To determine the effects of thoracic epidural analgesia (TEA) management on the incidence of atrial arrhythmias (AAs) after thoracotomy for lung resection. ⋯ AAs after thoracotomy were common. These AAs were associated with increased age, cardiac history, abnormal ECG, increased cost, increased length of hospital stay, and time of epidural catheter removal. Although a cause-and-effect relationship cannot be inferred from this study, the presence or absence of TEA was found to have a temporal relationship with the incidence of AAs.