Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Aug 1989
Randomized Controlled Trial Comparative Study Clinical TrialSufentanil is preferable to etomidate during rapid-sequence anesthesia induction for aortocoronary bypass surgery.
To evaluate rapid-sequence anesthetic induction techniques for aortocoronary bypass grafting, 20 patients scheduled for elective surgery were randomly assigned to receive bolus injections of either etomidate, 0.4 mg/kg, intravenously (IV), or sufentanil, 5 micrograms/kg, IV, with succinylcholine, 1 mg/kg, IV. Patients in the two groups had similar demographic characteristics and baseline (preinduction) hemodynamic values. ⋯ No sufentanil patient demonstrated either ischemia or infarction. It is concluded that sufentanil-succinylcholine provides more stable hemodynamics and fewer ischemic myocardial events than etomidate-succinylcholine in patients undergoing myocardial revascularization surgery.
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This article has attempted to familiarize the anesthesiologist with the bronchoscopic appearance of normally and abnormally positioned double-lumen endobronchial tubes. Double-lumen tubes are being used in an increasing proportion of thoracic surgical cases in major centers. Double-lumen tubes are also being used more frequently in intensive care units for independent lung ventilation, bronchopleural fistula, massive hemoptysis, and other asymmetrical pulmonary disorders. ⋯ When used as described, the FOB is a monitor. Like all new monitors it will take some time before there is a general consensus whether it is to be used routinely or only for certain indications. Whatever the final consensus on the indications for the FOB in double-lumen tube positioning, it is certain that all anesthesiologists involved in managing thoracic cases should be familiar with this technique.
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J Cardiothorac Anesth · Aug 1989
Comparative StudyEarly extubation after coronary artery surgery in efficiently rewarmed patients: a postoperative comparison of opioid anesthesia versus inhalational anesthesia and thoracic epidural analgesia.
Twenty-eight patients were studied after uncomplicated aortocoronary bypass surgery with hypothermic cardiopulmonary bypass (CPB). In all patients residual hypothermia was effectively treated by the use of extended rewarming during CPB and postoperatively by an external heat source. This treatment almost eliminated postoperative shivering, and it resulted in the lowering of oxygen uptake, carbon dioxide production, and required ventilatory volumes to stable levels where spontaneous breathing could be used safely. ⋯ The patients had good pain relief and were mentally alert. Adequate spontaneous breathing was resumed quickly and endotracheal extubation was performed within the first two postoperative hours (1.6 +/- 0.5 hours). No complications or increased morbidity occurred, and no patient needed to be reintubated in Group II.
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J Cardiothorac Anesth · Aug 1989
Clinical experience with a new right-sided endobronchial tube in left main bronchus surgery.
Clinical experience during one-lung anesthesia using a new right-sided endobronchial tube (Portex Ltd, Hythe, Kent, UK) is reported in 148 patients with cancer of the left lung. The method allowed a reliable airtight separation of the lungs as well as right upper lobe ventilation in all cases. ⋯ Airway pressures and arterial blood gases were similar to those obtained with standard double-lumen tubes during one-lung ventilation. There were no complications due to the new tube system.
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J Cardiothorac Anesth · Aug 1989
Intravenous labetalol for the treatment of hypertension after carotid endarterectomy.
Hypertension after carotid endarterectomy has a variable incidence ranging up to 56%. Blood pressure (BP) control is essential due to possible increased risk of morbidity from neurologic deficits or cardiovascular complications. This study evaluated intravenous labetalol for control of hypertension after carotid endarterectomy. ⋯ In the patients developing hypertension, there was a significant elevation in epinephrine just before treatment, that decreased by 30 minutes after treatment. Norepinephrine levels became significantly elevated five minutes after labetalol treatment in the group with hypertension and remained elevated for 120 minutes. Concomitantly, there was a significantly lower plasma renin activity seen in this group.(ABSTRACT TRUNCATED AT 250 WORDS)