Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Apr 1989
Perioperative cardiac pacing using an atrioventricular pacing pulmonary artery catheter.
An atrioventricular pacing thermodilution pulmonary artery catheter was evaluated in 40 patients undergoing cardiac surgery. The catheter was inserted in all study patients in a timely fashion without difficulty and functioned well during the perioperative period. Before the start of cardiopulmonary bypass, atrial capture was achieved in 98% of the patients (threshold mean 4.9 mA), ventricular capture in 100% (threshold mean 3.0 mA) and atrioventricular sequential (AVS) pacing in 98%. ⋯ Minor complications included diaphragmatic stimulation in one patient and supraventricular tachycardia, possibly related to atrial pacing postoperatively, in one patient. These data suggest that this catheter/pacing system is effective and reliable for hemodynamic monitoring and temporary atrial or AVS pacing. In addition, the atrial pacing probe can be used perioperatively to record atrial electrograms to facilitate the diagnosis of supraventricular tachyarrhythmias.
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J Cardiothorac Anesth · Apr 1989
Clinical Trial Controlled Clinical TrialIntrapleural bupivacaine--technical considerations and intraoperative use.
The authors evaluated the incidence and type of technical problems associated with blind insertion of intrapleural catheters placed in 21 anesthetized patients and then injected in a double-blind fashion with 0.5% bupivacaine (1.5 mg/kg) or isotonic saline. The patients' chests were then opened, catheter positions located, and the lungs inspected. Eleven of the catheters were located with the tips intrapleurally, three extrapleurally, and seven actually in lung tissue. ⋯ It is concluded that blind insertion of intrapleural catheters can be hazardous, especially if followed by positive-pressure ventilation. In addition, catheter placement in lung tissue, which was not uncommon, delays the time for peak plasma concentrations and may increase risk of toxicity. Intrapleural bupivacaine was not found to be a useful adjunct to general anesthesia during thoracotomies.
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J Cardiothorac Anesth · Feb 1989
Randomized Controlled Trial Comparative Study Clinical TrialComparison among manual, computer-assisted, and closed-loop control of blood pressure after cardiac surgery.
Forty-five patients who required vasodilator therapy for systemic arterial hypertension following cardiac surgery were randomly allocated to receive: (1) manual control of a sodium nitroprusside (SNP) infusion; (2) computer-assisted control where the nurse was provided with a color graphical display of performance; or (3) automatic closed-loop control. Limits of acceptable systolic pressure were prescribed for each patient, and the percentage time spent outside these limits was calculated for each patient. ⋯ The results suggest that the quality of blood pressure control achieved by nurses can be improved by providing them with a clear graphical display of their performance. Better control of blood pressure should reduce the adverse effects of hypotension and hypertension following cardiac surgery.