Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
The effects of loading changes on intraoperative Doppler assessment of mitral regurgitation.
Anesthetic agents may significantly alter the patient's blood pressure, and thus affect the intraoperative assessment of mitral regurgitation. This study examined the impact of an increase in afterload on a variety of parameters thought to reflect the severity of mitral regurgitation, and related them to changes in hemodynamic parameters. Twenty-four patients with mitral regurgitation undergoing cardiac surgery were studied. ⋯ These changes in pulmonary venous flow were not related to the changes in the driving force across the incompetent mitral valve. Also, an additional six patients developed systolic flow reversal after phenylephrine administration. Intraoperative hemodynamic variations can significantly alter the apparent severity of mitral regurgitation, and this factor must be considered during decision making.
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
Risk management in cardiac anesthesia: the ASA Closed Claims Project perspective.
The ASA Closed Claims Project has generated a standardized collection of case summaries of adverse anesthetic outcomes, with the objectives of identifying major areas of anesthesiologist liability and the contribution of substandard care to anesthetic injury. Seventy-six (3%) of the files in the project's current database of over 2,400 case summaries are for anesthesia-related injuries sustained during cardiac surgery. ⋯ Conversely, respiratory-related damaging events were responsible for only 9% of adverse outcomes in the cardiac group, compared with 32% of adverse outcomes in the noncardiac claims (P = < 0.01); incidences of damaging events related to the cardiovascular system and those events related to inadequate or inappropriate fluid therapy were similar in both groups. Although there are several important limitations intrinsic to closed-claims analysis, data from the Closed Claims Project suggest that careful attention to IV catheter management and cardiopulmonary bypass equipment will reduce the risk of injury to patients.
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
ReviewCardiac anesthesia risk management. Hemorrhage, coagulation, and transfusion: a risk-benefit analysis.
Transfusion risks include the possibility of ABO/Rh incompatibility, sepsis, febrile reactions, immunosuppression, and viral transmission; incidences and consequences of these complications are reviewed. Predonation of autologous blood generally reduces the need for homologous blood by about 30% to 40%, but relatively few coronary artery bypass surgery (CABG) patients predonate blood. Drug products to decrease blood use include 1-deamino-8-D-arginine vasopressin (DDAVP), tranexamic acid, epsilon-aminocaproic acid, and aprotinin. ⋯ Duration of stay in the intensive care unit was not increased by use of aprotinin, thus alleviating some concerns that aprotinin might promote coronary thrombosis. A recent report cites early graft closure as a major concern with aprotinin therapy, but data from other studies show no significant differences in rates of graft closure between patients receiving and those not receiving aprotinin. Routine use of a thromboelastogram with all cardiopulmonary bypass surgery at the University of Washington Hospital has reduced use of blood products by 30%.
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
Comparative StudyIntraoperative cardiac output monitoring: comparison of impedance cardiography and thermodilution.
Impedance cardiography (IC) is a noninvasive, simple to use method of cardiac output (CO) determination. A prospective evaluation of IC monitoring was performed in 50 patients undergoing noncardiac surgery. IC CO measurements (NC-COM3-Revision 7, BoMed Manufacturing) were compared to simultaneous measurements of thermodilution (TD) CO to assess the validity of this technique for intraoperative cardiac monitoring. ⋯ Trending data showed IC to accurately track the direction of TD CO changes but to underestimate their magnitude (r = 0.60, intercept -0.7 L/min, slope 0.47). Factors that may have impaired the performance of IC in this study include the high prevalence of cardiac disease in the study population and electrical noise in the operative setting. Further development of IC appears warranted if it is to prove useful as an intraoperative cardiac monitor.
-
Historically, intracardiac operations have carried a higher risk of neurologic complications than coronary artery bypass grafting (CABG) procedures, although the incidence of such complications has been increasing after CABG in recent years. In both intracardiac and extracardiac surgery, macroemboli from the surgical field cause most neurologic complications. The periods of highest risk for emboli are during aortic cannulation, onset of bypass, and weaning from bypass. ⋯ Studies suggest a role for barbiturate protection in intracardiac but not in extracardiac surgery. Studies have not shown better neurologic or neuropsychological outcome with the use of membrane oxygenation and arterial filtration. Recent studies suggest no correlation of neurologic injury with serum glucose levels during CABG, with either duration or severity of hypotension during hypothermic CABG, or with blood gas management during hypothermic CABG.