[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1992
[Hematologic and endocrinologic effects of pulsatile cardiopulmonary bypass using a centrifugal pump].
The effects of pulsatile and nonpulsatile flow during cardiopulmonary bypass (CPB) with of centrifugal pump (Sarns) and membrane oxygenator, on blood cells, hemodynamics, and hormonal response were studied. In the pulsatile group (group P) in which pulsatile flow was generated by centrifugal pump and a 20 Fr arterial cannula was used, hemolysis and reduction of platelet count during CPB were more marked than in the nonpulsatile group (group NP), in which the same type of circuit was used. When the 20 Fr arterial cannula was replaced with a 24 Fr cannula (group Pc), the rate of hemolysis during CPB was significantly reduced compared with that in group P (p less than 0.05). ⋯ During CPB, there was no change in levels of thyroid hormones, including free T3, free T4 and reverse T3, in either pulsatile groups P and Pc or nonpulsatile group. TSH level in group Pc was significantly elevated in contrast with that in the nonpulsatile group (p less than 0.05), in which no change in TSH level was seen. It is suggested that pulsatile perfusion using a centrifugal pump might maintain sufficient hypothalamic-pituitary function to permit secretion of TSH in response to various stimuli.
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1992
[Experimental and clinical study of cardiopulmonary hemodynamics under one-lung ventilation during transthoracic esophagectomy].
Cardiopulmonary hemodynamics in pre- and postoperative period after transthoracic esophagectomy under one-lung ventilation (OLV) was investigated in experimental and clinical studies. In experimental study, 30 mongrel dogs were assigned to one of the groups: Group 1 (n = 10): 2 hour right thoracotomy alone under one (n = 5)- or two-lung ventilation (TLV) (n = 5), Group 2 (n = 10): thoracotomy + esophagectomy, Group 3 (n = 10): esophagectomy + right thoracic vagotomy. For further evaluation of the effect of vagotomy on increase of extravascular lung water (EVLW) on 3rd POD, the following 2 groups were designed as Group 4-1) (n = 5): thoracotomy + right thoracic vagotomy and Group 4-3) (n = 5): esophagectomy + left thoracic vagotomy. ⋯ Cardiopulmonary parameters and postoperative complications were not different between OLV and TLV groups in clinical study. In conclusion, OLV is a desirable procedure, not only for good exposure of the operative filed, but also for its safety regarding the cardiopulmonary hemodynamics. Transthoracic esophagectomy plus vagal branch denervation, which is necessary for aggressive lymphadenectomy around the trachea, increases EVLW and subsequent pulmonary edema compared with thoracotomy alone.