Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1995
ReviewSafety issues regarding early extubation after coronary artery bypass surgery.
Potential safety issues related to early extubation include the effect of changes in anesthetic management on intraoperative hemodynamics, stress responses and awareness, altered management in the control of pain, shivering and ischemia in the early postoperative period, and the risks of reintubation in patients who might require reoperation for bleeding. The literature does not implicate any technique necessary to facilitate early extubation as being associated with adverse outcome. Definitive outcome studies are only beginning to be presented, but the data so far suggest that early extubation is not associated with any increase risk of mortality or morbidity, including, specifically, myocardial ischemia or infarction. ⋯ Complications such as low cardiac output, arrhythmias, stroke, and perioperative myocardial infarction have not increased with early extubation, at least in patients selected for early extubation on the basis of preoperative characteristics. In summary, available evidence suggests that early extubation, applied to many but probably not all patients, can be accomplished without demonstrable patient harm. A coordinated approach involving anesthesia, surgery, nursing, respiratory therapy, and other support services is essential, and constant reevaluation as events unfold, rather than rigid protocols, allows care to be individualized to the specific needs of each patient.
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J. Cardiothorac. Vasc. Anesth. · Oct 1995
Determinants of systolic pressure variation in patients ventilated after vascular surgery.
To discover the predominant determinant of systolic pressure variation during positive-pressure ventilation in mechanically ventilated patients after a vascular surgical procedure. ⋯ The decrease in systolic pressure provoked by positive-pressure inspiration reflects simultaneous decreases in stroke volume. This suggests that a decrease in left ventricular filling, associated with positive-pressure inspiration, is responsible for systolic pressure variation. This finding confirms the interest in considering systolic pressure variation to provide reliable information about the responsiveness of the heart to preload variations.