Revista española de anestesiología y reanimación
-
The contributions of remifentanil to anesthesia for heart surgery is described. The pharmacokinetic properties are described along with our clinical experience with the various modes and doses of perfusion for induction as well as during and after surgery.
-
Rev Esp Anestesiol Reanim · Dec 2001
Review[Pulmonary hemodynamics and right ventricular function].
Measurement of continuous blood flow by thermodilution catheter takes into account measures that are intermittent, though the estimation of mean pressures is satisfactory. Natural pulsatile pulmonary circulation would remain unknown. To evaluate pulsatile pulmonary hemodynamics and its importance in right ventricular function, the calculation of impedance based on spectral analysis of pressure and flow waves would allow their respective contributions to resistance, elastance and wave reflection upon after right ventricle loading. Computerization allows bedside monitoring of this sophisticated assessment of right ventricle after loading.
-
Congenital heart disease can increase or decrease pulmonary blood flow, pulmonary vascular resistance (PVR) or pulmonary artery pressure (PAP). PAP is the product of PVR and pulmonary minute volume (Qp), such that pulmonary hypertension (PHT) may develop as a result of an increase in either PVR or Qp or both. Given that the pulmonary vascular bed is a low pressure system with high flow, any increase in resistance would generate PHT. ⋯ The best approaches to diagnosis and prognosis are echocardiography and cardiac catheterization with vasodilators. Anesthetics that do not alter PVR should be used in such patients, who are sensitive to changes in pulmonary ventilation, to changes in cardiac output and to anesthetics. The treatment of PHT during intra and postoperative pediatric surgery is based on the use of high inspirated oxygen concentration (100%), an adequate sedation and the use of vasodilators (prostaglandin I2, nitric oxide, sodium nitroprusiate and milrinone).
-
Rev Esp Anestesiol Reanim · Dec 2001
Review[The pulmonary vasodilatory effect of inhaled prostacyclin and milrinone in heart].
This paper examined the effect of inhaled prostaglandin I2 at a dose of 5-10 microgram/ml on vascular resistance in the treatment of pulmonary hypertension, for its local benefits and lack of effect on systemic vascular resistances. The treatment was also combined with inhaled milrinone at a dose of 1 mg/ml, given that the mechanisms of action of the two drugs are different and possibly complementary. Inhaling both drugs might be an effective approach to treating pulmonary hypertension.
-
The treatment of thoracic or abdominal aorta aneurysms with endoprostheses or aortic stents consists of placing the stents within the aorta to exclude the aneurysm, followed by inflation of a balloon inserted through the vessel in order to fix the stent to the vascular walls. The procedure is minimally invasive, causes little pain, and is performed by femoral arteriotomy or puncture. Absolute immobility of the lower limbs is required if lesions are to be avoided and the duration can not be foreseen. ⋯ Postoperative recovery occurs in a special observation ward in the first few hours after surgery, with strict monitoring of diuresis and hydration. Analgesic requirements are minimal and intravenous metamizol or ketorolac are adequate. In conclusion, stent implant is a complex procedure in patients with severe associated disease who require strict and full monitoring during surgery and in the first few hours afterwards.