Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 1992
Comparative StudyAge and right ventricular function during cardiac surgery.
Elderly patients undergoing cardiac surgery are reported to be at a higher risk for circulatory failure than younger patients, most likely because of ventricular decompensation. To assess the role of the right heart in these patients, right ventricular (RV) hemodynamics in 40 consecutive elderly patients (greater than 70 years; mean = 77.1 +/- 3.4 years) were compared with 40 consecutive younger patients (50 to 60 years; mean = 55.2 +/- 3.0 years) undergoing elective coronary artery bypass surgery. In addition to standard hemodynamic variables, RV ejection fraction (RVEF) and RV end-systolic and end-diastolic volumes (RVESV, RVEDV) were studied perioperatively using a thermodilution technique. ⋯ Inotropic support during and after termination of CPB was necessary more often in the older (epinephrine, 6.7 +/- 2.0 micrograms/min) than in the younger patients (epinephrine, 4.4 +/- 2.2 micrograms/min). It is concluded that older patients undergoing myocardial revascularization can have excellent results. However, they may be predisposed to right heart complications because of their reduced RV function.
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J. Cardiothorac. Vasc. Anesth. · Feb 1992
Right ventricular function in patients with reduced left ventricular function undergoing myocardial revascularization.
Complex interrelationships exist between the right (RV) and the left ventricles (LV). Therefore, in 30 consecutive patients with reduced LV function (left ventricular ejection fraction [LVEF]) less than 40% undergoing myocardial revascularization, RV hemodynamics were studied from the beginning of anesthesia until the end of the operation. The data were compared with 30 consecutive patients with normal LVEF (greater than 70%). ⋯ RVEDV and RVESV were significantly higher in these patients. In conjunction with the lower RVEF and normal PAP, this suggests reduced RV function. It can be concluded that a severely reduced preoperative LVEF (less than 30%) may also be associated with impaired RV function.
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J. Cardiothorac. Vasc. Anesth. · Dec 1991
Comparative StudyLeft ventricular end-systolic pressure estimated from measurements in a peripheral artery.
Aortic and radial arterial pressure measurements were compared after cannulation and before cardiopulmonary bypass in 26 patients scheduled for coronary artery bypass grafting. The radial artery blood pressure range was 89 to 147 mm Hg systolic and 44 to 75 mm Hg diastolic. A difference was found between the central and peripheral dicrotic notch pressures, the former being 7.9 +/- 2.7 (SD) mm Hg higher than the latter. ⋯ The mean difference was -0.15 mm Hg with a 95% confidence interval of -1.2 to 0.9 mm Hg. It was not possible to calculate peak systolic aortic pressure with the same accuracy from the systolic and diastolic pressure measurements in the radial artery. It is concluded that left ventricular end-systolic pressure measured as the aortic dicrotic notch pressure can be calculated from the dicrotic notch pressure in the radial artery with reasonable accuracy.
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J. Cardiothorac. Vasc. Anesth. · Dec 1991
Randomized Controlled Trial Comparative Study Clinical TrialAnesthesia for elective cardioversion: a comparison of four anesthetic agents.
Elective cardioversion is a short procedure performed under general anesthesia for the treatment of cardiac dysrhythmias. Selection of the anesthetic agent is important, because a short duration of action and hemodynamic stability are required. Forty-four patients scheduled for elective cardioversion in the coronary care unit were studied prospectively. ⋯ Etomidate produced myoclonus and pain on injection; however, it was the only agent that did not decrease arterial blood pressure. Thiopental reduced blood pressure but otherwise seemed an appropriate anesthetic for this procedure. In conclusion, all four anesthetic agents were acceptable for cardioversion, although their pharmacological differences suggest specific indications for individual patients.