British journal of anaesthesia
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Perioperative levels of jugular bulb oxyhaemoglobin saturation (Sj(O(2))) and lactate concentration (Lj), and postoperative duration of Sj(O(2))<50% were compared between patients undergoing coronary artery bypass grafting (CABG) (n=86), heart valve (n=14) and abdominal aortic (n=16) surgery. Radial artery and jugular bulb blood samples were aspirated after induction of anaesthesia, during re-warming on cardiopulmonary bypass (CPB) (36 degrees C), on arrival in the intensive care unit (ICU) and, subsequently, at 1, 2 and 6 h after ICU admission. Most patients having heart surgery were hypocapnic at 36 degrees C on CPB. ⋯ Following correction for La, there were no postoperative effects on Lj. No significant differences (P=0.2) in duration of Sj(O(2))<50% existed between patients undergoing CABG (1054 (82) min), abdominal aortic (893 (113) min) and heart valve (1073 (91) min) surgery. The lack of significant reciprocal effects on Lj combined with the frequency of hypocapnia and strong influence of Pa(CO(2))()on Sj(O(2)), suggest that Sj(O(2))<50% during CPB and after cardiac surgery represents hypoperfusion as a consequence of hypocapnia rather than cerebral ischaemia.
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We describe the case of a 28-week pregnant woman presenting with severe primary pulmonary hypertension (PPH). She had an elective Caesarean section under general anaesthesia at 32 weeks gestation. Pulmonary artery pressures (PAP) measured from a pulmonary artery catheter before anaesthesia were in excess of 100 mm Hg. ⋯ Seven days later she was discharged from intensive care taking an oral calcium antagonist and warfarin. She developed intractable right heart failure and died 14 days after delivery. Despite increasing experience in the use of drugs to reduce PAP, the clinical course of pregnancy complicated by severe PPH is usually fatal.
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Editorial Comment Review
Nitric oxide as mediator, marker and modulator of microvascular damage in ARDS.