Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Dec 1988
Randomized Controlled TrialInfluence of acute preoperative hemodilution on right ventricular function.
In a randomized study, the effects of acute, preoperative hemodilution (HD) (12 mL/kg) on right ventricular function were investigated in coronary artery surgery patients with reduced left ventricular function (ejection fraction < 50%) and significant stenosis of the right coronary artery (RCA). Blood was replaced either by hydroxyethyl starch (HES) solution (ratio 1:1; HD-HES; n = 15) or by Ringer's lactate, (RL) (ratio 2.5:1; HD-RL; n = 15). Fifteen comparable patients without HD served as a control group. ⋯ Furthermore, right ventricular function of the hemodiluted patients was not impaired by the subsequent ECC procedure. None of the traditionally measured parameters could be correlated significantly to the right ventricular thermodilution variables. It is concluded that moderate HD does not change right ventricular function even when the RCA is significantly stenosed.
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J Cardiothorac Anesth · Dec 1988
Regional hemodynamics and oxygen supply during isovolemic hemodilution in the absence and presence of high-grade beta-adrenergic blockade.
Studies were performed in 16 pentobarbital-anesthetized dogs to evaluate regional circulatory effects of isovolemic hemodilution in the absence (group 1) and presence (group 2) of high-grade beta-adrenergic blockade with propranolol. Regional blood flow measured with 15 microm radioactive microspheres was used to calculate regional oxygen supply. In group 1, hemodilution with 5% dextran (40,000 molecular weight) reduced arterial hematocrit and oxygen content by approximately one half and had heterogeneous effects on regional blood flows. ⋯ In group 2, intravenous administration of propranolol (1 mg/kg) itself decreased blood flow in the spleen and myocardium and had no other regional effects. Hemodilution after propranolol caused regional circulatory changes that were essentially similar to those in the absence of propranolol. It is concluded that (1) during isovolemic hemodilution, oxygen supply to the brain and myocardium is maintained at the expense of oxygen supply to less critical organs, and (2) this pattern of regional circulatory response during hemodilution remains intact in the presence of high-grade beta-adrenergic blockade with propranolol.
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J Cardiothorac Anesth · Dec 1988
Right upper lobe obstruction with right-sided double-lumen endobronchial tubes: a comparison of two tube types.
Twenty-nine patients undergoing left thoracotomy consecutively were intubated with right-sided double-lumen endotracheal tubes in the conventional "blind" fashion. The first 20 received Leyland red-rubber double-lumen tubes, and the subsequent nine received Mallinckrodt polyvinylchloride double-lumen tubes. The patency of the right upper lobe bronchial orifice was then assessed by flexible fiberoptic bronchoscopy. Right upper lobe obstruction occurred in 89% of the polyvinylchloride tube intubations and in 10% of the red-rubber tube intubations.
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J Cardiothorac Anesth · Dec 1988
Influence of high-dose opioid anesthesia on posterior tibial nerve somatosensory cortical evoked potentials: effects of fentanyl, sufentanil, and alfentanil.
The effects of high doses of fentanyl (group F), sufentanil (group S), and alfentanil (group A) on posterior tibial nerve somatosensory cortical evoked potentials were studied in 30 patients scheduled for elective valve replacement surgery. Anesthesia was induced with either fentanyl, 75 microg/kg, sufentanil, 5 microg/kg, or alfentanil, 125 microg/kg. The lungs were ventilated with oxygen/air. ⋯ A bolus dose of fentanyl, 25 microg/kg, given in group F at 30 minutes after induction of anesthesia did not change latencies and amplitudes. No significant differences in latency or amplitude were found at any time among the three study groups. It is concluded that anesthesia with high doses of fentanyl, sufentanil, or alfentanil is a suitable technique when intraoperative monitoring of posterior tibial nerve somatosensory cortical evoked potentials is indicated.
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J Cardiothorac Anesth · Dec 1988
Editorial CommentImproving the design and function of double-lumen tubes.