Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Effects of atrial natriuretic peptide on renal function after cardiac surgery and in cyclosporine-treated heart transplant recipients.
The study investigated the effects of intravenous infusion of atrial natriuretic peptide (human ANP 99-126) on renal function and central hemodynamics after coronary artery bypass grafting (CABG), and the ability of ANP to reverse the acute nephrotoxic effects of cyclosporine after heart transplantation. Ten patients with an EF > 0.5 and normal renal function were studied 2 to 4 hours after CABG surgery. Furthermore, six heart transplant recipients receiving cyclosporine for immunosuppression who developed renal dysfunction 2 to 4 days after transplantation were studied. ⋯ In the heart transplant recipients, baseline GFR was markedly reduced compared to pretransplantation values (-65%). UF, GFR, and RBF increased 240%, 69%, and 53%, respectively, while renal vascular resistance decreased 45% during the highest dose of ANP infused. At this ANP dose level, circulating ANP concentrations were sixfold to eightfold higher than the preinfusion control level.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Aug 1994
Use of monitoring devices during anesthesia for cardiac surgery: a survey of practices at public hospitals within the United Kingdom and Ireland.
A questionnaire was sent to all 42 public hospitals, within the United Kingdom (UK) and Ireland, known to conduct elective cardiac surgery. Information was sought with regard to the availability of intraoperative monitoring equipment. ⋯ Similarly, continuous monitoring of arterial oxygen tension and oxygen fraction in the gas flow to the bypass machine was not conducted in 28 and 32 hospitals, respectively. This survey revealed that essential anesthetic monitoring devices, as defined by the United Kingdom Association of Anesthetists, are not in routine usage during the pre-bypass and post-bypass phases of anesthesia for cardiac surgery within the British Isles.
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialVolume loading with hypertonic saline solution: endocrinologic and circulatory responses.
Hypertonic saline solution appears to be an attractive method of volume expansion. In 45 patients undergoing elective aorto-coronary bypass grafting, endocrinologic and circulatory responses to volume loading with hypertonic saline solution prepared in low molecular weight (MW) hydroxyethyl starch (HES) solution (72 g/L NaCl, HES concentration: 6%; MW: 200,000 D; degree of substitution [DS]: 0.5) (HS-HES) was compared randomly to patients who had received low molecular weight HES solution (LMW-HES). A group of patients without volume loading served as a control. ⋯ Epinephrine and norepinephrine plasma levels increased most markedly in the control patients and were highest in the postbypass period in these patients. CI increased most after infusion of HS-HES (+65%) (P < 0.05). In the postbypass period, CI remained significantly higher in both volume groups than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Jun 1994
Randomized Controlled Trial Clinical TrialEsmolol and intraoperative myocardial ischemia: a double-blind study.
Forty patients scheduled to undergo elective myocardial revascularization were included in a randomized, double-blind, placebo-controlled study to evaluate any influence of esmolol on the incidence of myocardial ischemia. Calibrated recordings of ECG leads II and V5 were continuously monitored with the QMED Monitor One TC (Qmed Inc, Clark, NJ) from the time of arrival in the operating room holding area through the induction of anesthesia, using a high-dose opioid technique, and until the initiation of cardiopulmonary bypass. One group received a bolus of esmolol, 1.0 mg/kg, followed by a continuous infusion of 100 micrograms/kg/min. ⋯ Heart rate, mean arterial pressure, and the number of patients developing myocardial ischemia during the course of the study also did not differ significantly between the groups. There were significant decreases in heart rate and mean arterial pressure compared with the awake baseline values in both groups during multiple study points. It is concluded that esmolol was ineffective at treating preexisting or new-onset myocardial ischemia at this dosage in this clinical setting.