Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 1991
Randomized Controlled Trial Clinical TrialUse of transcutaneous electrical nerve stimulation in the control of postoperative chest pain after cardiac surgery.
The effect of continuous transcutaneous electrical nerve stimulation (TENS) on postoperative pain following median sternotomy was evaluated in 89 patients with severe chest pain who underwent cardiac surgery in a prospective, randomized, blinded trial. Pain was assessed by visual analog pain scores before and during treatment in each group. In the active TENS group, 79% of the patients were completely free of chest pain during rest at the end of 180 minutes (P less than 0.001). ⋯ In the control group in which inactive TENS was used, the intensity of pain was reduced in 44% of the patients at the end of 90 minutes (P less than 0.001). However, this early placebo effect was noted to diminish with time and at the end of 180 minutes, 80% of the patients complained of severe chest pain and needed narcotics. These data suggest that TENS can be effective in controlling postoperative chest pain due to median sternotomy after cardiac surgery and its continuous application in the early postoperative period can reduce the need for narcotics.
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J. Cardiothorac. Vasc. Anesth. · Dec 1991
Systolic and diastolic pressure-volume relationships during cardiac surgery.
Seven patients undergoing elective coronary artery bypass surgery were studied to assess left ventricular (LV) performance by pressure-volume loops. LV pressure was measured by micromanometry and instantaneous LV volume by a conductance catheter. Continuous pressure-volume relationships were determined during preload reduction before and after cardiopulmonary bypass (CPB). ⋯ From pre-CPB to post-CPB, Ees increased in three patients with a decrease of V75 in two patients, and Ees decreased in four patients with a concomitant increase in V75. Ed increased significantly (P less than 0.01) following CPB, demonstrating a decrease of ventricular distensibility. It is concluded that continuous measurement of LV pressure-volume relationships using the conductance catheter is feasible and may be a useful tool to estimate LV performance during cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Oct 1991
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative course after sufentanil or fentanyl anesthesia for coronary artery surgery.
Postoperative hemodynamic effects were compared in 50 patients randomly selected to receive either sufentanil, 25 micrograms/kg, or fentanyl, 100 micrograms/kg, anesthesia for coronary artery bypass grafting. The two groups exhibited similar patient demographics; dose of premedicants and muscle relaxants; and use of inhalation agents. Values for 15 hemodynamic variables were recorded at baseline and at six postoperative times. ⋯ Elimination half-lives differed significantly: 554 +/- 91 minutes (fentanyl) versus 277 +/- 60 minutes (sufentanil). Serum concentrations of both decreased linearly. The added advantages of postoperative hemodynamic stability could be important in the choice of anesthetic.