Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 1994
A safer technique of internal jugular venipuncture: experience with 320 cases.
Placement of central venous catheters for monitoring or long-term access has become an indispensable surgical procedure. Various routes to establish central venous access have previously been described. ⋯ Experience with this modified technique in 320 cases where it was used for various purposes is reviewed. The incidence of complication was less than 1% and the improved safety of the procedure is attributed to the vertical direct method of venipuncture through the new access point.
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J. Cardiothorac. Vasc. Anesth. · Dec 1994
Comparative StudyComparison of cardiac output measurement by continuous thermodilution with electromagnetometry in adult cardiac surgical patients.
A pulmonary artery catheter (PAC) capable of continuous cardiac output (CCO) determination by thermodilution has recently been introduced. The purpose of this study was to compare CCO with two other methods of cardiac output (Ot) determination: electromagnetometry (EM) and standard bolus thermodilution cardiac output (BCO). Following median sternotomy and pericardiotomy, an EM ring probe was placed around the ascending aorta in 25 adult cardiac surgical patients and connected to an EM flowmeter interfaced with a calibrated strip recorder. ⋯ Bias, precision, and limits of agreement of CCO compared with BCO were 0.41, 0.82, 1.64 L/min, respectively. Correlation between EM and CCO was r = 0.80 and between CCO and BCO r = 0.64. Cardiac output determined by CCO was within 10% of the EM determination for 37 measurements, between 10% and 20% for 17, and greater than 20% for 7 measurements.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Dec 1994
Comparative StudyOn-line estimation of cardiac output with a new automated border detection system using transesophageal echocardiography: a preliminary comparison with thermodilution.
Continuous estimation of cardiac output would be extremely useful for hemodynamic monitoring of patients in the operating room and intensive care settings. A recently developed echocardiographic imaging system provides real-time automated border detection (ABD) with the ability to measure cyclic changes in cavity area, and thus calculate changes in intracavitary volumes. Eight patients undergoing cardiac surgery were studied with intraoperative transesophageal (TEE), and cardiac outputs obtained with this new imaging system were compared with thermodilution (TD). ⋯ Linear regression yielded the equation: ABD = 0.64TD + 1.57 L/min (r = 0.71). The average difference between the two techniques (bias) for detecting changes in cardiac output between sequential intraoperative times was 0.1 +/- 1.1 L/min. With further development, this new method shows promise for measurement of cardiac output in selected patient care settings.
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J. Cardiothorac. Vasc. Anesth. · Dec 1994
Application of a transpulmonary double indicator dilution method for postoperative assessment of cardiac index, pulmonary vascular resistance index, and extravascular lung water in children undergoing total cavo-pulmonary anastomosis: preliminary results in six patients.
Total cavo-pulmonary anastomosis (TCPA) is used for the functional correction of an increasing spectrum of congenital heart diseases. The passive pulmonary perfusion after surgical exclusion of the right ventricle has significant implications for the postoperative hemodynamic management of these patients. Because conventional pulmonary artery thermodilution catheters present methodologic problems in patients after TCPA, important cardiovascular variables such as cardiac index (CI) and pulmonary and systemic vascular resistance indices (PVRI, SVRI) usually cannot be assessed directly. ⋯ No catheter-related problems occurred during or after the period of investigation. Postoperative EVLW was within the range that is commonly accepted as normal for adults. Mean PVRI initially decreased during the postoperative course but showed a significant increase after extubation.(ABSTRACT TRUNCATED AT 250 WORDS)