Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 1994
Clinical Trial Controlled Clinical TrialMagnesium and arrhythmias after coronary artery bypass surgery.
Arrhythmias are very common after cardiac surgery and are multifactorial. Magnesium is receiving increased consideration in the management of supraventricular and ventricular arrhythmias. This study was designed to evaluate the role of magnesium in preventing arrhythmias in hypokalemic (K < 3.5 mEq/L) and normokalemic (K > 3.5 mEq/L) patients with normal renal and ventricular function after coronary artery bypass grafting (CABG). ⋯ There was no difference in serum and urine magnesium levels between the hypokalemic and normokalemic patients within each group. Serum magnesium returned to normal in all patients after 48 hours. Therefore, it appears that administration of magnesium during and after cardiac surgery reduces the incidence of arrhythmias in hypokalemic and normokalemic patients.
-
Historically, intracardiac operations have carried a higher risk of neurologic complications than coronary artery bypass grafting (CABG) procedures, although the incidence of such complications has been increasing after CABG in recent years. In both intracardiac and extracardiac surgery, macroemboli from the surgical field cause most neurologic complications. The periods of highest risk for emboli are during aortic cannulation, onset of bypass, and weaning from bypass. ⋯ Studies suggest a role for barbiturate protection in intracardiac but not in extracardiac surgery. Studies have not shown better neurologic or neuropsychological outcome with the use of membrane oxygenation and arterial filtration. Recent studies suggest no correlation of neurologic injury with serum glucose levels during CABG, with either duration or severity of hypotension during hypothermic CABG, or with blood gas management during hypothermic CABG.
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
ReviewCardiac anesthesia risk management. Hemorrhage, coagulation, and transfusion: a risk-benefit analysis.
Transfusion risks include the possibility of ABO/Rh incompatibility, sepsis, febrile reactions, immunosuppression, and viral transmission; incidences and consequences of these complications are reviewed. Predonation of autologous blood generally reduces the need for homologous blood by about 30% to 40%, but relatively few coronary artery bypass surgery (CABG) patients predonate blood. Drug products to decrease blood use include 1-deamino-8-D-arginine vasopressin (DDAVP), tranexamic acid, epsilon-aminocaproic acid, and aprotinin. ⋯ Duration of stay in the intensive care unit was not increased by use of aprotinin, thus alleviating some concerns that aprotinin might promote coronary thrombosis. A recent report cites early graft closure as a major concern with aprotinin therapy, but data from other studies show no significant differences in rates of graft closure between patients receiving and those not receiving aprotinin. Routine use of a thromboelastogram with all cardiopulmonary bypass surgery at the University of Washington Hospital has reduced use of blood products by 30%.
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
Another application of two-dimensional transesophageal echocardiography: spinal cord imaging. A preliminary report.
This prospective study was performed in 17 consecutive patients continuously monitored intraoperatively and postoperatively for cardiac function with two-dimensional (2D) TEE. Prior to systematic evaluation of spinal cord imaging by 2D TEE, the aims of this study were to determine: (1) the feasibility of such imaging, and (2) the relationship between spinal cord images and fixed structures (like vertebral bodies); 7.5 +/- 2.3 spinal segments were identified in the patients. ⋯ Successful imaging of the spinal cord was achieved in all 17 patients with visualization of discs, spinous processes, spinal canal, and a pulsating spinal cord. Further studies are needed to better define the potential applications of this new technique: detection of spinal cord trauma, visualization of a thoracic epidural catheter, and successful preservation of spinal cord vascularization during thoracic aortic surgery.
-
J. Cardiothorac. Vasc. Anesth. · Feb 1994
The effects of loading changes on intraoperative Doppler assessment of mitral regurgitation.
Anesthetic agents may significantly alter the patient's blood pressure, and thus affect the intraoperative assessment of mitral regurgitation. This study examined the impact of an increase in afterload on a variety of parameters thought to reflect the severity of mitral regurgitation, and related them to changes in hemodynamic parameters. Twenty-four patients with mitral regurgitation undergoing cardiac surgery were studied. ⋯ These changes in pulmonary venous flow were not related to the changes in the driving force across the incompetent mitral valve. Also, an additional six patients developed systolic flow reversal after phenylephrine administration. Intraoperative hemodynamic variations can significantly alter the apparent severity of mitral regurgitation, and this factor must be considered during decision making.