Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 1992
QRS complex changes in the V5 ECG lead during cardiac surgery.
The QRS complex in lead V5 was studied during cardiac surgery. R wave amplitude decreased after induction of anesthesia to approximately 50% to 60% of the preanesthetic level before the institution of CPB (P < 0.001). An rS complex appeared immediately after cardioversion and changed in configuration to an Rs complex 15 to 30 minutes after aortic declamping. ⋯ Nonsurvivors had much smaller R waves (26.1 +/- 20.5%) than survivors (P < 0.001). The R wave peaked 30 to 40 ms after initiation of the QRS complex, which indicates recovery of conductivity and the activation sequence of the left ventricular (LV) free wall, which is easily disturbed by hypothermia, cardioplegia, and ischemia during aortic cross-clamping. Monitoring QRS complex changes in lead V5 appears to be important on weaning from cardiopulmonary bypass to detect regional ischemia, and also to observe electrophysiologic recovery of the LV free wall.
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J. Cardiothorac. Vasc. Anesth. · Dec 1992
Variations of blood PAF-acether levels during coronary artery surgery.
Extracorporeal circulation (ECC) is associated with thrombocytopenia and transient leukopenia. After ECC and coronary artery bypass graft (CABG) surgery, some patients can develop pulmonary and cardiac dysfunction, which might be related to the release of various mediators such as thromboxane A2, C5a, and C3a anaphylatoxins. The involvement of PAF-acether (PAF), a potent vasoactive thrombocytopenic and leukoneutropenic agent, has not been determined. ⋯ Blood PAF amounts in the radial artery were significantly higher than in the left atrium following ECC (1.09 +/- 0.36 v 0.06 +/- 0.04, P < 0.05), probably indicating PAF production in the heart. No variation of blood lipo PAF and lyso PAF was observed. No correlation was seen between PAF amounts and blood cell count.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Dec 1992
Temporary transmyocardial pacing using epicardial pacing wires and pacing pulmonary artery catheters.
This study investigated the feasibility of transmyocardially pacing the heart using one temporary epicardial pacing lead and one endocardial lead of a pacing pulmonary artery catheter. Twenty patients undergoing cardiopulmonary bypass with cardioplegic arrest were studied 10 to 45 minutes and 18 to 30 hours after discontinuation of cardiopulmonary bypass. The Swan-Ganz Flow-Directed Pacing TD Catheter (Baxter Healthcare Corporation) was inserted in one group of 10 patients, and the Swan-Ganz Thermodilution A-V Paceport Catheter (Baxter Healthcare Corporation, Irvine, CA) was used in another group of 10 patients. ⋯ Transmyocardial atrial-ventricular sequential pacing was achieved in all cases when both TMA and TMV pacing were independently successful. There were no significant differences between catheters in the success rates of either TMA or TMV. It is concluded that transmyocardial pacing is feasible using one temporary epicardial pacing lead and one endocardial lead of a pacing pulmonary artery catheter.