Masui. The Japanese journal of anesthesiology
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Cardiopulmonary bypass (C-P bypass) was performed on two patients who had not responded to conventional cardiopulmonary resuscitation (CPR). The first patient, a 56-y-o male, with bilateral pulmonary thromboembolism repeatedly underwent cardiac massage and electric defibrillation for recurrent ventricular fibrillation. A veno-arterial bypass route was prepared during cardiac massage, and bypass circulation was started 3 hours after the onset of the first ventricular fibrillation. ⋯ Emergency veno-arterial bypass for CPR is effective means to maintain life until the cardiopulmonary and cerebral functions are restored. Recent advances in emergency C-P bypass are introduced and a new acronym extracorporeal lung and heart assist, ECLHA, is proposed. Emergency ECLHA with veno-arterial cannulations through percutaneous puncture will become a promising adjunct of cardiopulmonary-cerebral resuscitation in the near future.
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The changes in arterial partial pressure of oxygen were studied following intravenous injections of either ephedrine, 0.2mg.kg-1, or phenylephrine 2.5 micrograms.kg-1, to restore arterial hypotension. Eighty one adult patients underwent general anesthesia, being mechanically ventilated, were divided into two groups; both lung ventilation group (68 patients) and one lung ventilation group (13). In both lung ventilation group, PaO2/FIO2 changed from 390 +/- 132 to 400 +/- 137 mmHg, and 428 +/- 124 to 438 +/- 136 following administrations of ephedrine and phenylephrine, respectively. ⋯ In the one lung ventilation group, PaO2/FIO2 did not change significantly from 190 +/- 45 to 186 +/- 29 with ephedrine and 267 +/- 138 to 317 +/- 230 with phenylephrine. We observed neither arrhythmia, severe hypoxemia, nor decrease in PaO2/FIO2 by more than 100mmHg. These results indicate that with respect to changes in arterial partial pressure of oxygen, the clinical doses of ephedrine and phenylephrine can be safely administered to patients under general anesthesia to restore arterial hypotension.