Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Comparative StudyBlood pressure after cardiopulmonary bypass: which technique is accurate?
To evaluate the accuracy with which a patient's aortic blood pressure can be estimated upon separating from cardiopulmonary bypass (CPB), simultaneously recorded radial artery pressure, oscillometric brachial artery pressure, pressure in the CPB circuit, and the surgeon's estimate of blood pressure by aortic palpation were compared to directly measured aortic root pressure. After obtaining institutional approval and written informed consent, 20 patients requiring CPB for cardiac operations were studied. General anesthesia was induced and maintained with fentanyl, vecuronium, and enflurane. ⋯ The oscillometric technique and CPB line were poor estimates of aortic root pressure. Of the techniques used to estimate aortic blood pressure, including radial arterial, oscillometric, aortic line of the CPB circuit, and digital palpation, the radial arterial was the best, and the aortic line from the CPB machine and palpation by the surgeon were the worst. When a clinician is unsure of the blood pressure during separation from CPB, direct measurement of central aortic blood pressure is advised.
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Total intravenous anesthesia using propofol and alfentanil for coronary artery bypass surgery.
Total intravenous anesthesia (TIVA) using alfentanil and propofol was used in 10 patients undergoing coronary artery bypass grafting. In an attempt to diminish unwanted side effects, lower doses were chosen than if either drug had been used alone. Anesthesia was induced with alfentanil, 75 micrograms/kg, followed by a sleep dose of propofol (mean dose 0.5 mg/kg). ⋯ Anesthesia was satisfactory in all but one patient who developed breakthrough hypertension on sternotomy with transient ST segment depression, and awareness after CPB despite a plasma alfentanil concentration of 450 ng/mL. Mean time to wakening was 55 minutes. The study indicated that TIVA using propofol and alfentanil in the dosages described provides satisfactory basal anesthesia for coronary artery bypass surgery in patients with good left ventricular function, but requires additional pharmacologic manipulation, particularly with boluses of alfentanil, to control breakthrough hypertension.
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-fentanyl anesthesia: a comparison with isoflurane-fentanyl anesthesia in coronary artery bypass grafting and valve replacement surgery.
The hemodynamic effects of propofol-fentanyl and isoflurane-fentanyl anesthesia during the prebypass period were compared in 42 patients undergoing coronary artery bypass grafting (CABG) and 22 patients undergoing valve replacement (VR) for stenotic lesions. Anesthesia was induced with fentanyl, 25 micrograms/kg, and pancuronium, 0.1 mg/kg, and was maintained with a propofol infusion commenced at 4 mg/kg/h (range 1 to 10 mg/kg/h) or with isoflurane commenced at 1% (range 0 to 2%). Additional fentanyl, 7.5 micrograms/kg, was given before sternotomy. ⋯ Propofol produced similar hemodynamic changes in the CABG and VR groups. Both anesthetic techniques caused myocardial depression and effectively controlled the autonomic responses to sternotomy in both groups. The study suggests that propofol-fentanyl anesthesia is an acceptable technique for CABG surgery and for VR in patients with stenotic valvular heart disease.