Articles from Journal of cardiothoracic and vascular anesthesia

J. Cardiothorac. Vasc. Anesth. · Apr 1994

Randomized Controlled Trial Clinical Trial

Alternative perioperative anticoagulation monitoring during cardiopulmonary bypass in aprotinin-treated patients.

Monitoring of anticoagulation during cardiopulmonary bypass by means of the activated coagulation time (ACT) has become questionable due to the prolongation in the clotting time of patients receiving aprotinin. Because the celite-based ACT only indicates intrinsic coagulation, and sufficient anticoagulation is needed to also prevent extrinsic coagulation, the ACT may not be reliable. ⋯ As expected, neither the kaolin-based assay nor the high-dose thrombin time was influenced by aprotinin, whereas the celite-based ACT was significantly prolonged in aprotinin-treated patients as compared to control patients (P < 0.05). This study confirms that both kaolin-based and thrombin-based tests provide a reliable means of determining the degree of heparinization in the presence of aprotinin during cardiopulmonary bypass.

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J. Cardiothorac. Vasc. Anesth. · Apr 1994

Randomized Controlled Trial Clinical Trial

Evaluation of coagulation during cardiopulmonary bypass with a heparinase-modified thromboelastographic assay.

Thromboelastography (TEG) is a useful method of assessing perioperative coagulation function in patients undergoing cardiac surgery. The presence of significant amounts of heparin in blood samples, however, prevents determination of changes in coagulation function by TEG or introduces artifactual error if samples contain heparin that is not present in vivo. For these reasons, whole blood coagulation function monitoring with TEG has not been feasible during cardiopulmonary bypass (CPB) with heparin anticoagulation. ⋯ Subsequently, 51 patients undergoing coronary artery surgery were studied using a modified TEG assay that incorporates in vitro application of heparinase to allow measurement of TEG parameters before, during, and after CPB. Heparinase-modified TEG assays facilitated diagnosis of heparin contamination in preoperative blood samples and permitted baseline TEG evaluation in patients receiving preoperative heparin infusions. Heparinase-modified TEG assays revealed declines in alpha and MA values during CPB, which persisted and significantly correlated with values after protamine infusion (alpha: r = 0.77, P = 0.001; MA: r = 0.78, P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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J. Cardiothorac. Vasc. Anesth. · Apr 1994

Clinical Trial Controlled Clinical Trial

Magnesium and arrhythmias after coronary artery bypass surgery.

Arrhythmias are very common after cardiac surgery and are multifactorial. Magnesium is receiving increased consideration in the management of supraventricular and ventricular arrhythmias. This study was designed to evaluate the role of magnesium in preventing arrhythmias in hypokalemic (K < 3.5 mEq/L) and normokalemic (K > 3.5 mEq/L) patients with normal renal and ventricular function after coronary artery bypass grafting (CABG). ⋯ There was no difference in serum and urine magnesium levels between the hypokalemic and normokalemic patients within each group. Serum magnesium returned to normal in all patients after 48 hours. Therefore, it appears that administration of magnesium during and after cardiac surgery reduces the incidence of arrhythmias in hypokalemic and normokalemic patients.