Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
ReviewNeurophysiologic monitoring and outcomes in cardiovascular surgery.
The first step to make in improving neurologic outcome is to recognize and accept neurologic injury occurs in all patient groups undergoing CPB. Fortunately, that stage has now been passed. Accurate detection and documentation of the incidence of brain injury is the next progression. ⋯ A strategy that confers absolute myocardial protection would be ideal, but at what cost to the protection of the kidneys, intestines, and brain? A neuroprotective strategy would ideally eliminate brain injury and be beneficial for all organs. The only way to continue to make progress is by the scientific evaluation of new techniques. The use of appropriate monitoring and outcome measures is fundamental to this process.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Randomized Controlled Trial Clinical TrialThe safety and effectiveness of esmolol in the perioperative period in patients undergoing abdominal aortic surgery.
To determine (1) if perioperative use of esmolol in major vascular surgery patients provides strict heart rate (HR) control, (2) what doses of esmolol are required to do this, and (3) does this control influence myocardial ischemia or result in adverse consequences. ⋯ Using esmolol for HR control in the intraoperative period for abdominal vascular surgery patients is effective and safe. HR control was much less effective in the postoperative period, but esmolol is safe when used at recommended doses. Further study with a larger number of patients is necessary to determine whether strict HR control with esmolol affects the incidence of myocardial ischemia or infarction in this patient population.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Recurrent laryngeal nerve palsy after cardiovascular surgery: relationship to the placement of a transesophageal echocardiographic probe.
To examine the relationship between the incidence of recurrent laryngeal nerve palsy after cardiovascular surgery and the placement of a transesophageal echocardiographic probe. ⋯ These results suggest that placement of the transesophageal echocardiographic probe is not responsible for postoperative recurrent laryngeal nerve palsy. It seems likely that surgical manipulation itself and the durations of surgery, cardiopulmonary bypass, and tracheal intubation are related to the incidence of laryngeal nerve palsy.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Assessment of ventricular function in critically ill patients: limitations of pulmonary artery catheterization. Institutions of the McSPI Research Group.
To determine the accuracy of conventional hemodynamic assessment using pulmonary artery catheter-derived data in critically ill patients. ⋯ Evaluable data included 130 of 150 (87%) observations of simultaneously collected CA and TEE data, averaging 5.6+/-4.4 observations per patient. The overall predictive probability for conventional clinical assessment of normal ventricular function was 98% (118/121), whereas for abnormal ventricular function it was 0% (0/9). For CA of volume, the overall predictive probabilities for hypovolemia, normovolemia, and hypervolemia were 50% (3/6), 60% (69/115), and 22% (2/9). Although conventional clinical assessment of normal LV function in the intensive care unit correlates well with echocardiographic assessment, both LV dysfunction and extremes of preload (hypovolemia or hypervolemia) are assessed poorly by clinicians using conventional clinical monitoring with pulmonary artery catheterization.
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J. Cardiothorac. Vasc. Anesth. · Oct 1999
Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy: effects of hemodilution, temperature, and flow.
To determine the effects of hemodilution, PaCO2, PaO2, arterial pressure, and temperature on cerebral oxygenation during mild hypothermic cardiopulmonary bypass (CPB). ⋯ In early stages of CPB, a diminished cerebral oxygen supply was found, which may be caused by acute hemodilution. Despite an increased extraction of oxygen as demonstrated by the decrease in Hb-diff, cerebral energy balance reflected by CtO2 was maintained within a safe range during cooling. Because NIRS measures regional cerebral oxygenation, it is useful as an adjunct to global measures in the early noninvasive detection of cerebral hypoxia.