Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Jun 1989
Comparative StudyMyocardial oxygen balance and cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.
The frequency of anaerobic myocardial metabolism was studied in 14 patients undergoing coronary artery bypass surgery during enflurane-supplemented high-dose fentanyl anesthesia and compared with other clinical monitors of myocardial ischemia including the configuration of the pulmonary capillary wedge pressure (PCWP) and electrocardiographic findings. Hemodynamic parameters, coronary sinus blood flow, myocardial oxygen and lactate extractions, and a seven-lead ECG were recorded before and after cannulation of the aorta and vena cava, during total cardiopulmonary bypass (CPB) in a vented heart, during rewarming after global myocardial ischemia and cold cardioplegia, and 15 minutes after coming off bypass. The cannulation for CPB induced no changes in the central or coronary hemodynamics, but four patients had abnormal lactate metabolism. ⋯ Two patients had ECG evidence of a perioperative myocardial infarction, but they had no significant clinical consequences. Four patients had a fascicular block at discharge. These results indicate that anaerobic myocardial metabolism is common during and after CPB, and that associated myocardial ischemia cannot always be reliably detected by changes in the ECG or the PCWP tracings.
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J Cardiothorac Anesth · Jun 1989
Comparative StudyA comparison of two pulmonary artery mixed venous oxygen saturation catheters during the changing conditions of cardiac surgery.
Continuous mixed venous oxygen saturation (SvO2), using modified pulmonary artery (PA) catheters, can assist in the management of cardiac surgery patients. Two FDA-approved catheters are available for SvO2 monitoring. One system uses two wavelengths of light and the other is a three-wavelength system. ⋯ Two-wavelength determinations varied inconsistently from cooximeter values, while three-wavelength measurements did not differ significantly. Changes in hematocrit were responsible in part for the variability in two-wavelength measurements. In summary, three-wavelength measurements by the Shaw system were more accurate than two-wavelength measurements by the Edwards system.
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J Cardiothorac Anesth · Jun 1989
Brachial plexus lesions following cardiac surgery with median sternotomy and cannulation of the internal jugular vein.
There are many possible complications after cannulation of the internal jugular vein (IJV) including injury to the brachial plexus. Neurologic injuries can also occur from sternal splitting. The present study looked at the incidence of brachial plexus lesions after cardiac surgery with and without IJV cannulation. ⋯ No posterior first rib fractures could be detected by radiographs. The brachial plexus lesions were transient but the Horner's syndromes were longer-lasting. It is concluded that the injuries are due to compression and traction of the plexus due to stretching and possibly from hematoma formation from the IJV punctures.