Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Feb 1990
Comparative StudyMeasurement of arterial pressure after cardiopulmonary bypass with long radial artery catheters.
Radial arterial pressure can significantly underestimate central aortic pressure in the postcardiopulmonary bypass (post-CPB) period. At the study institution, routine monitoring of perioperative arterial pressure in adult patients undergoing cardiac surgery is performed with a long radial artery catheter with the distal end positioned in the subclavian artery. In 68 patients presenting for elective cardiac surgery, both a conventional short radial artery catheter and a contralateral long radial artery catheter were placed. ⋯ In 28 patients, central aortic pressure was measured post-CPB, and subclavian artery pressure was found to be an excellent estimator of central aortic pressure. There were no significant complications related to using long radial artery catheters in the 68 patients who were followed prospectively. Monitoring subclavian arterial pressure by percutaneous insertion of a long radial artery catheter provides a reliable estimation of central aortic pressure, even in patients with significant radial artery-to-central aortic pressure gradients post-CPB.
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J Cardiothorac Anesth · Feb 1990
Comparative StudyA clinical evaluation of pulse oximetry during thoracic surgery.
To evaluate the utility of pulse oximetry for monitoring oxygenation during thoracic surgery, pulse oximeter oxygen saturation (SpO2) values from the Nellcor N-100 (Nellcor Inc, Haywood, CA) and Novametrix model 500 (Medical Systems Inc, Wallingford, CT) were compared with simultaneous arterial saturation values (SaO2) in 20 patients. A total of 255 matched observations were recorded, and the data were divided for statistical analysis into preinduction of anesthesia and postinduction groups. ⋯ However, once anesthesia was induced, there was no longer any correlation for either of the pulse oximeters versus simultaneous SaO2 values, although on average, the SpO2 values were significantly higher than the corresponding SaO2 values. It was concluded that pulse oximetry is useful in following trends of oxygenation in patients with preexisting lung pathology undergoing thoracic surgery, but it cannot replace arterial blood gas sampling for the intraoperative management of respiratory function.
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J Cardiothorac Anesth · Feb 1990
Noninvasive versus invasive assessment of cardiac output after cardiac surgery: clinical validation.
The accuracy of noninvasive cardiac output (CO) measurement techniques, such as electrical bioimpedance (BIO), suprasternal continuous-wave Doppler (CWD), pulsed-wave Doppler (PWD), and transesophageal continuous-wave Doppler (TED) ultrasound has been variably judged in recent years. In addition, clinical comparisons are hampered by the fact that there is no generally accepted gold standard in CO measurement. After coronary artery bypass surgery in 25 patients, CO was simultaneously determined by invasive standard techniques (thermodilution [TD] and Fick methods) plus BIO, CWD, PWD, and TED. ⋯ Correlation of absolute COTED values to thermodilution depended on the method used for calibration. All investigated noninvasive CO measurement techniques unreliably measured relative CO changes. Despite its invasiveness, TD remains the method of choice for accurate CO determination in adult patients following cardiac surgery.
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A controversy exists over whether or not preoperative exercise testing can predict postthoracotomy complications. This study was designed to evaluate the usefulness of a presurgical exercise protocol in patients with lung disease, but no evidence of cardiac disease. Seventy patients underwent baseline pulmonary function testing and split function perfusion studies, when indicated, to calculate predicted postoperative pulmonary function. ⋯ The percentages of predicted VE max and predicted maximum heart rate were related to the occurrence of total complications, but not specifically to cardiopulmonary complications. The results emphasize the difficulty in attempting to exercise thoracotomy candidates with chronic lung disease to maximal performance. Excluding patients from further surgical consideration because of exercise limitation is not feasible based on these data.