Journal of cardiothoracic and vascular anesthesia
-
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.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1994
Randomized Controlled Trial Clinical TrialAlternative 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.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1994
Randomized Controlled Trial Clinical TrialEvaluation 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)