Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1996
Age-related differences in heparin sensitivity and heparin-protamine interactions in cardiac surgery patients.
The present study was conducted to determine how children and adults differ (it at all) with respect to sensitivity to heparin activity and heparin-protamine interactions during cardiac surgery requiring cardiopulmonary bypass (CPB). ⋯ Pre-school children are less sensitive to heparin but also display a wider range of sensitivity. The data in this study support the use of 300 U/kg of heparin before CPB in patients > or = 5 years but suggest that heparin requirements may be greater in the younger patient who may require as much as 500 U/kg to achieve what is believed to be an appropriate target heparin concentration for initiating CPB.
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J. Cardiothorac. Vasc. Anesth. · Jun 1996
Randomized Controlled Trial Clinical TrialEffects of human atrial natriuretic peptide in patients after coronary artery bypass surgery.
To determine the effects of synthetic human atrial natriuretic peptide (ANP) on renal function, hemodynamics, and levels of vasoactive peptides when infused in the immediate postoperative period after coronary bypass surgery in patients with normal kidney function. ⋯ The results of this study show that ANP increases diuresis, natriuresis, and glomerular filtration in the immediate postoperative period after coronary bypass surgery.
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J. Cardiothorac. Vasc. Anesth. · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialPerioperative course and recovery after heparin-coated cardiopulmonary bypass: low-dose versus high-dose heparin management.
To compare two heparin managements for a cardiopulmonary bypass (CPB) procedure with heparin-coated equipment. The hypothesis was that a lower heparin dose may reduce blood loss and homologous transfusion requirements and influence the speed of postoperative recovery. ⋯ Low-dose heparin management enabled uneventful procedures with heparin-coated CPB equipment, significantly decreased protamine and homologous blood requirements, but did not reduce chest drainage or influence the postoperative course and recovery in patients after coronary artery surgery.
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J. Cardiothorac. Vasc. Anesth. · Jun 1996
Methylene blue does not neutralize heparin after cardiopulmonary bypass.
It was hypothesized that methylene blue could neutralize heparin in patients after cardiopulmonary bypass and become an alternative to protamine. ⋯ Methylene blue does not neutralize heparin after cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Jun 1996
The activated coagulation time: suitability for monitoring heparin effect and neutralization during pediatric cardiac surgery.
To determine how the stage of surgery affects the relationship between activated clotting time (ACT) and heparin effect in children undergoing cardiac surgery using cardiopulmonary bypass (CPB) and to compare the results of ACT determinations made with two different coagulation timers using different clot detection technologies and activator compositions. ⋯ In pediatric cardiac surgery, the relationship between ACT and heparin concentration changes depending on when during the surgery the ACT is measured. ACT prolongation in children anticoagulated for CPB correlates poorly with heparin concentrations during CPB. HP and HM ACT tests are not interchangeable. The HM ACT is a better indicator of heparin neutralization than the HP ACT. On the other hand, continued prolongation of the HP ACT after heparin neutralization may be related to risk of postoperative hemorrhagic complications. If devices from different manufactures are freely substituted for each other, clinical practice may be altered in an uncontrolled manner.