Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1991
Comparative Study Clinical Trial Controlled Clinical TrialHeparin rebound: a comparative study of protamine chloride and protamine sulfate in patients undergoing coronary artery bypass surgery.
Heparin rebound has been suggested to occur when protamine sulfate, but not protamine chloride, is used to neutralize heparin. This study was undertaken to compare these two protamine salts in 32 patients undergoing coronary artery bypass surgery. Initial heparin and subsequent protamine doses were determined by constructing a heparin-activated coagulation time response curve. ⋯ The postoperative blood losses were comparable in both groups. Thus, protamine chloride was not a clinically superior antidote to heparin than protamine sulfate. The observed heparin rebound levels were low and clinically insignificant in terms of blood loss, but they were associated with slight changes in coagulation monitoring.
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J. Cardiothorac. Vasc. Anesth. · Apr 1991
High-dose alfentanil for myocardial revascularization: a hemodynamic and pharmacokinetic study.
It has been suggested that high plasma levels of alfentanil are required in order to control hemodynamic responses to noxious stimuli in patients undergoing myocardial revascularization. The present study was designed to determine the hemodynamic profile in 10 patients and the time course of alfentanil plasma concentrations and pharmacokinetics (7 patients) during and following coronary artery surgery using alfentanil administration based on an overdosage principle. Premedication consisted of lorazepam, 0.07 mg/kg, given 2 hours before surgery. ⋯ Recovery time was short, despite the large amounts of narcotic used. It is concluded that very high doses of alfentanil associated with lorazepam premedication resulted in hemodynamic stability and markedly elevated narcotic plasma concentrations in most patients. Such plasma levels seem to provide satisfactory anesthetic conditions.
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J. Cardiothorac. Vasc. Anesth. · Apr 1991
Comparative Study Clinical Trial Controlled Clinical TrialHemodynamic responses to pancuronium and vecuronium during high-dose fentanyl anesthesia for coronary artery bypass grafting.
The hemodynamic and electrocardiographic (ECG) effects of pancuronium and vecuronium were compared during high-dose fentanyl anesthesia for coronary artery bypass grafting (CABG) surgery. Forty-eight morphine-scopolamine premedicated patients scheduled for elective CABG were anesthetized with fentanyl (100 micrograms/kg) in divided doses, and either of two muscle relaxants, pancuronium (n = 26; 0.10 mg/kg) or vecuronium (n = 22; 0.09 mg/kg). Hemodynamic data, blood gas samples, and ECG tracings were obtained at the following intervals: (1) control; (2) prior to intubation; (3) 1 minute after intubation; (4) prior to sternotomy; and (5) 1 minute after sternotomy. ⋯ Four patients in the vecuronium group, all receiving preoperative beta-blocker therapy, became hypotensive and bradycardic after the induction of anesthesia. The present investigation confirms the increased incidence of myocardial ischemia during high-dose fentanyl-pancuronium anesthesia. Although vecuronium was associated with fewer myocardial ischemic changes, the occurrence of bradycardia and hypotension in some patients receiving preoperative beta-adrenergic blocking drugs remains a concern.