Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Oct 1994
Comparative StudyPerioperative management and outcome of patients having cardiac surgery combined with abdominal aortic aneurysm resection.
Patients with abdominal aortic aneurysms (AAA) have a high incidence of associated cardiac disease. If a patient presents with both severe coronary artery disease and a large AAA, a staged procedure of cardiac surgery (CS) followed by AAA resection may present too great a risk of aneurysm rupture and death. A combined procedure may be recommended in this circumstance; however, the literature contains only individual successful case reports of such a procedure. ⋯ The staged procedure of first performing CS and then the AAA resection has a combined operative mortality of 4%. When the nature of both lesions is severe and a combined procedure is necessary, there is an associated in-hospital mortality of approximately 30% at this institution. The S group patients had an unremarkable postoperative course with a relatively short hospital stay when compared to the staged procedure.
-
J. Cardiothorac. Vasc. Anesth. · Oct 1994
Influence of intravenous calcium gluconate on saphenous vein graft flow in closed-chest patients.
The effects of calcium gluconate on hemodynamics and saphenous vein graft flow in a group of patients undergoing elective coronary artery bypass grafting who developed ionized hypocalcemia at the end of the surgical procedure were examined. The patients received a central venous bolus of 15 mg/kg of calcium gluconate. Heart rate (HR), arterial pressure (AP), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and cardiac output were measured immediately before and 30, 60, 120, 180, and 240 seconds after injection of calcium gluconate. ⋯ HR, CVP, PAP, PCWP, PVR, CI, SVI, and Vbypass-flow remained unaltered. It is concluded that calcium gluconate administered to moderately hypocalcemic patients increases arterial pressure mainly by peripheral vasoconstriction. Because the increase of arterial pressure, and, thereby, coronary perfusion pressure is not associated with an increase of LAD bypass flow, vasoconstriction in the coronary vascular bed distal to the venous graft cannot be ruled out, and deterioration of the myocardial oxygen supply/demand ratio is strongly suggested.
-
J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Clinical TrialDoes aprotinin influence endothelial-associated coagulation in cardiac surgery?
Aprotinin has been reported to reduce bleeding in cardiac surgery patients. Its mechanisms of action on coagulation have not been fully elucidated. In a prospectively randomized study of 40 patients undergoing elective aortocoronary bypass grafting, the influence of high-dose aprotinin (2 million IU of aprotinin before CPB, 500,000 IU/h until the end of operation, 2 million IU added to the prime) (N = 20) on endothelial-related coagulation was compared to a nontreated control group (N = 20). ⋯ During CPB, TM plasma concentrations decreased similarly in both groups (aprotinin: 18 +/- 6 ng/mL, control: 17 +/- 7 ng/mL) followed by a comparable increase in the postbypass period until the first postoperative day (aprotinin: 60 +/- 10 ng/mL, control: 53 +/- 11 ng/mL). Protein C and (free) protein S plasma levels also showed no differences between the two groups. On the first postoperative day, baseline values for protein C and protein S had not yet been reached.(ABSTRACT TRUNCATED AT 250 WORDS)
-
J. Cardiothorac. Vasc. Anesth. · Oct 1994
Randomized Controlled Trial Clinical TrialUse of the activated coagulation time and heparin dose-response curve for the determination of protamine dosage in vascular surgery.
The activated coagulation time (ACT) can be used to construct a two-point heparin dose-response curve (HDRC) from the ACT values at baseline and 5 minutes after heparin administration. The ACT value at any subsequent time interval can then be used to estimate the residual heparin activity from the HDRC. The protamine dose is calculated to be the amount of residual heparin multiplied by a correction factor (1.3 was suggested for cardiac surgery). ⋯ Group III received the least protamine (0.64 +/- 0.07 mg/kg, P < 0.05). No adverse protamine reactions or postoperative bleeding occurred. It is concluded that ACT monitoring and use of the HDRC provides a safe and easy method to individualize protamine dosage in vascular surgery.