Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of vecuronium and meperidine on the clinical and metabolic effects of shivering after hypothermic cardiopulmonary bypass.
The use of vecuronium and meperidine on the clinical and metabolic effects of shivering in mechanically ventilated patients after hypothermic cardiopulmonary bypass (CPB) was compared. Twenty adult male patients undergoing cardiac surgery were randomized to meperidine, 25 to 75 mg (n = 10), or vecuronium, 0.1 microgram/kg (n = 10), for the treatment of shivering during postoperative rewarming. Vecuronium was continued as an infusion at 1.0 microgram/kg/min for 4 hours. ⋯ Meperidine administration caused a significant decline in systolic blood pressure (121.9 +/- 10.6 mmHg to 106.9 +/- 8.5 mmHg, p = < 0.02). The authors conclude that, during rewarming after hypothermic CPB, muscle relaxation with vecuronium reverses both the clinical and metabolic effects of shivering more reliably and effectively than repeated boluses of meperidine, and with greater hemodynamic stability. Control can be maintained by continuous infusion of vecuronium with concomitant sedation for up to 4 hours without prolonging intubation time.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialIncidence of malposition of polyvinylchloride and red rubber left-sided double-lumen tubes and clinical sequelae.
Currently, fiberoptic bronchoscopy (FB) is recommended for correct positioning of double-lumen endobronchial tubes (DLTs) because of the high incidence of malpositions not appreciated by clinical signs. The aims of this study were to assess whether clinical signs allow accurate confirmation of adequate positioning with left red rubber (RR) or polyvinyl-chloride (PVC) double-lumen tubes and to compare the incidence of malpositions between the two tubes. Another goal was to assess whether these malpositions, not appreciated by clinical assessment, adversely affected outcome. ⋯ While in the SUP position, the tube was "too deep" to permit visualization of the carina during tracheal bronchoscopy in 5 patients (2 RR, 3 PVC). In 17 of 21 (10 RR, 7 PVC), the bronchial cuff could not be visualized, although in 1 patient (RR group), the cuff was overinflated and bulged out to partially obstruct the right main bronchus orifice. Bronchial bronchoscopy showed 4 of 11 patients in the RR group in whom the left upper lobe orifice was occluded compared with 1 only in the PVC group.(ABSTRACT TRUNCATED AT 250 WORDS)
-
J. Cardiothorac. Vasc. Anesth. · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialMagnesium substitution in elective coronary artery surgery: a double-blind clinical study.
Magnesium may be beneficial in the control of ventricular ectopy and supraventricular tachyarrhythmias after coronary artery bypass graft (CABG) surgery, but it is not known whether a high-dose magnesium regimen is superior to a regimen keeping the patient normomagnesemic. A prospective randomized and double-blind clinical comparison was performed in 81 elective CABG patients in order to assess the effects of two different magnesium infusion regimens on electrolyte balance and postoperative arrhythmias. Forty-one patients (high-dose group, H) received 4.2 +/- 0.7 g (mean +/- SD), of magnesium sulfate before cardiopulmonary bypass, followed by an infusion of 11.9 +/- 2.8 g of magnesium chloride until the first postoperative (PO) morning, and a further 5.5 +/- 1.0 g until the second PO morning. ⋯ Continuous Holter tape-recording was used for 12 to 15 hours preoperatively, and for 48 hours postoperatively. Serum magnesium peaked in H patients on the first PO morning at 1.60 +/- 0.25 mmol/L, whereafter it declined to the normal level on the third PO morning. Patients in the L group were normomagnesemic, except after the start of bypass.(ABSTRACT TRUNCATED AT 250 WORDS)