Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
Potential risks of high-dose epinephrine for resuscitation from ventricular fibrillation in a porcine model.
The arterial plasma concentrations and hemodynamic effects of epinephrine, 10 micrograms/kg, IV (group A, N = 8) and 50 micrograms/kg, IV (group B, N = 8) were compared in a porcine resuscitation model after 3 minutes of circulatory arrest induced by ventricular fibrillation. All animals in group A were successfully resuscitated after 4.9 +/- 2.8 minutes and 2.8 +/- 1.6 defibrillations. In group B, only 6 of 8 animals were successfully resuscitated after 6.3 +/- 1.1 minutes and 4.0 +/- 2.7 defibrillations (mean +/- SD). ⋯ Mean arterial peak epinephrine concentrations (group A 197 +/- 133 ng/mL, group B 1173 +/- 298 ng/mL) were approximately fivefold higher in group B. After resuscitation, plasma concentrations returned to baseline levels within 7 minutes in group A and 15 minutes in group B. Later hemodynamic differences between the groups are thereby attributed to a detrimental impact of high-dose epinephrine on the heart during resuscitation.
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
ReviewPro: one-lung ventilation is best accomplished with the Univent endotracheal tube.
Over the years, thoracotomy has changed from a procedure that prompted major concern over cross-contamination caused by infection to pulmonary tumors. Assisting the thoracic surgeon by providing OLV is one of the most specialized skills an anesthesiologist can offer. This must be done in a safe, easy, and efficient manner. ⋯ Double-lumen tubes have performed well in the past and will continue to offer specialized functions, such as postoperative independent lung ventilation in single-lung transplant recipients. As with the acquisition of any new medical skill, the use of the Univent tube has a learning curve. It is worth the time and effort to learn to use the Univent tube.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
ReviewCon: the Univent tube is not the best method of providing one-lung ventilation.
The Univent tube is a new form of bronchial blocker and is an addition to the armamentarium of the anesthesiologist for managing thoracic surgical cases. As with any new equipment/technique it will require time until the exact indications for its use become clear. The preference of anesthesiologists has oscillated between bronchial blockers and DLTs for the past 50 years, and no overall "best" method of providing OLV has yet been found. Anesthesiologists will continue to use, and to need to know how to use, DLTs for the foreseeable future.
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J. Cardiothorac. Vasc. Anesth. · Feb 1993
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialInfluence of acute preoperative plasmapheresis on platelet function in cardiac surgery.
Withdrawal of autologous plasma offers the possibility of improving patients' hemostasis and of reducing homologous blood consumption in cardiac surgery. The influence of acute, preoperatively performed plasmapheresis (APP) on platelet function was investigated in elective aortocoronary bypass patients subjected to APP producing either platelet-poor plasma (PPP; group 1; n = 12) or platelet-rich plasma (PRP; group 2; n = 12). APP-treated patients were randomly compared to patients without APP (control group; n = 12). ⋯ After CPB, maximum aggregation and maximum gradient of aggregation were reduced in all groups (ranging from -6% to -25% from baseline values). Retransfusion of autologous plasma improved platelet aggregability significantly only in the PRP-group. By the first postoperative day, maximum aggregation and maximum gradient of aggregation recovered in all groups (including the control group) or even exceeded baseline values (ranging from +8% to +42% from baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)