Journal of cardiothoracic and vascular anesthesia
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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
ReviewSafety issues in heparin and protamine administration for extracorporeal circulation.
This article reviews past approaches to heparin and protamine dosing and summarizes current practice. The author elucidates his experience with the Celite activated coagulation time (ACT), with attention to his adoption of a value of 400 seconds for this time; the adoption of an ACT of 480 seconds by Bull et al (J Thorac Cardiovasc Surg 69:674-684, 1975) and Young et al (Ann Thorac Surg 26:231-240, 1978); the proposed use of heparin response curves by Bull et al; the author's experience with a unitized dosing system to individualize dosing of heparin; and the use for this purpose by Despotis et al (J Thorac Cardiovasc Surg 110:46-54, 1995) of a system based on protamine titration. In more than 270 adult cardiac surgery patients, the unitized dosing system identified patients with high sensitivity or resistance to heparin and facilitated exact individualized doses to be given to produce the desired effect. ⋯ Aprotinin is not a procoagulant during cardiopulmonary bypass. Emerging studies suggest that graft patency is not affected by aprotinin use. The Celite ACT should not be used to monitor heparin effect and safety when using aprotinin; the kaolin ACT should be used instead.
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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.
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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
Comment Case ReportsOne-lung ventilation in patients with difficult airways.