Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of cerebral oxygen metabolism during normothermic versus moderate hypothermic cardiopulmonary bypass].
We compared the effects of normothermic (NCPB, N = 5) and moderate hypothermic (HCPB, (N = 5) cardiopulmonary bypass on cerebral oxygen metabolism in patients undergoing coronary artery bypass grafting. For monitoring of cerebral oxygenation, we used jugular venous oxyhemoglobin saturation (SjVO2) and near infrared spectroscopy (NIR). In NCPB group, although SjVO2 decreased temporally at the start of cardiopulmonary bypass, it became stabilized above 50% during the rest of cardiopulmonary bypass. ⋯ Furthermore, SjVO2 decreased under 50% at the end of cardiopulmonary bypass (3/5 cases). We consider that NCPB is a useful technique for preventing cerebral hypoxia, if the decrease of SjVO2 during the early period of cardiopulmonary bypass is avoidable. Lastly, we also advocate that both SjVO2 and NIR are useful monitoring systems for continuous evaluation of cerebral oxygen metabolism during cardiopulmonary bypass.
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The pressures in the radial and brachial artery in the same extremity were measured before and after cardiopulmonary bypass (CBP) in 18 patients. Brachial pressures were measured in two different ways, with and without forearm compression. The forearm compression was achieved by a swelled blood pressure cuff. ⋯ The patient is in the first group had less than 10 mmHg pressure difference between brachial pressure and radial pressure just after CPB. The patients in the second group had higher pressure in brachial than those in radial for over 10 mmHg just after CPB. There were no significant differences in duration in CPB, lowest rectal temperature, hematocrit and doses of catecholamines between the two groups.
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Clinical Trial Controlled Clinical Trial
[Changes in gastric intramucosal pH and hepato-splanchnic oxygen extraction ratio after heart surgery].
The Do2/VO2 balance of splanchnic organs after heart surgery was evaluated using two different methods; the measurement of hepato-splanchnic oxygen extraction ratio (OERspl) and gastric intramucosal pH (pHi) employing a hepatic venous catheter and a gastric tonometric catheter. Systemic oxygen extraction ratio was within normal ranges during the 24 hours of the experiment, but pHi decreased and OERspl increased significantly at 6 hours after admission to the ICU. Both pHi and OERspl returned gradually to normal levels after 24 hours. We conclude that a period of 24 hours is required to restore sufficient blood flow in the visceral organs to meet oxygen demand and that the pHi reflects the splanchnic DO2/VO2 balance as well as OERspl.
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We experienced the anesthetic management of 10 Jehovah's Witness patients. Some patients accepted either blood products, autologous blood transfusion with closed circuit, or Cell Saver. ⋯ It would be desirable to clear up an acceptable standard and write out it in each medical institution to avoid conflicts with the patient and families. Prior agreement is required among medical staffs on refusal of blood transfusion.
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One case of prenatally diagnosed congenital diaphragmatic hernia was reviewed in terms of the anesthetic managements. Concentrations of diazepam, pancuronium and fentanyl were measured in maternal, fetal and umbilical serum. As expectedly, the transition of diazepam through the placenta was large and the concentration of diazepam in the fetal serum was equal to that of maternal serum, but only a small amount of pancuronium was transferred.