Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Oct 1988
Randomized Controlled TrialInfluence of beta-blockers on vecuronium/sufentanil or pancuronium/sufentanil combinations for rapid induction and intubation of cardiac surgical patients.
Use of pancuronium or vecuronium with the priming principle was evaluated in regards to hemodynamic changes and adequacy of relaxation for a rapid induction-endotracheal intubation sequence with sufentanil in 24 ASA Class III-IV patients undergoing cardiac surgery. Twelve patients taking beta-blockers (groups B-P and B-V) were compared with 12 patients not receiving beta-blockers (groups NB-P and NB-V). Patients randomly received vecuronium or pancuronium (15 microg/kg), followed in 4 minutes by sufentanil 5 microg/kg and another 85 microg/kg of the appropriate relaxant through a central vein. ⋯ Chronic beta-blocker therapy was able to attenuate the tachycardia from pancuronium and was not associated with bradycardia when used with vecuronium. In patients with cardiac disease not on beta-blockers, pancuronium was associated with tachycardia. Therefore, vecuronium appears to be more suitable for these patients.
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J Cardiothorac Anesth · Oct 1988
Comparative StudyLow-compliance, volume-controlled, high-frequency positive-pressure ventilation versus conventional ventilation during coronary artery bypass grafting.
Low-compliance, volume-controlled, high-frequency positive-pressure ventilation (HFPPV) was compared to conventional intermittent positive-pressure ventilation (IPPV) immediately before and after surgery in a series of ten patients who underwent coronary artery bypass grafting (CABG). Direct and indirect hemodynamic and respiratory variables were recorded and calculated. ⋯ Airway pressures were lowered significantly by HFPPV as compared to IPPV. This may be useful in cases in which increased airway pressure might be harmful due to decreased venous return and cardiac output (CO).
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J Cardiothorac Anesth · Oct 1988
Simultaneous measurements of cardiac output by thermodilution, esophageal Doppler, and electrical impedance in anesthetized patients.
Simultaneous intraoperative measurements of cardiac output were obtained in nine patients with transesophageal Doppler, transthoracic impedance, and pulmonary artery thermodilution techniques to evaluate the utility of the noninvasive methods. Pairs of noninvasive and thermodilution measurements were obtained 25 times with transesophageal Doppler and 58 times with transthoracic impedance. ⋯ Changes in cardiac output at sequential time points as measured by thermodilution were predicted with 95% confidence only when a change of >4 L/min was observed by transesophageal Doppler or >8 L/min was observed by transthoracic impedance. Therefore, it is concluded that neither noninvasive technique reliably estimated cardiac output as determined by thermodilution, and neither tracked trends.
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J Cardiothorac Anesth · Oct 1988
Cardiopulmonary effects of one-lung ventilation in supine patients.
The cardiopulmonary effects of one-lung ventilation (OLV), with continuous positive airway pressure (CPAP, 5 cm H2O) to the nonventilated lung, were compared to the effects of two-lung ventilation (TLV) in 12 supine patients undergoing coronary artery bypass grafting (CABG). Monitoring was performed with electrocardiography (ECG), arterial, and pulmonary artery catheters. ⋯ Mean values for CI, HR, MAP, MPAP, PVR, and SvO2 demonstrated no significant changes between OLV and TLV; systemic vascular resistance (SVR) and pulmonary artery occlusion pressure (PAOP) were statistically (P < 0.05) different, but of minor clinical significance. The data suggest that OLV, accompanied by CPAP (5 cm H2O) to the nonventilated lung, produces minimal changes in cardiopulmonary measurements in supine patients.
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J Cardiothorac Anesth · Oct 1988
Rapid-sequence induction technique in patients with severe ventricular dysfunction.
The hemodynamic effects of a rapid-sequence induction and intubation technique using etomidate, fentanyl, and succinylcholine for emergency surgery in patients with severe ventricular dysfunction were studied. Ten patients undergoing orthotopic heart transplantation received fentanyl, 10 microg/kg, etomidate, 0.3 mg/kg, and succinylcholine, 1.5 mg/kg, intravenously (IV) in rapid-sequence fashion for induction. Intubation was performed 60 seconds later. ⋯ Systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were calculated from the measured data. No statistically significant changes in hemodynamics occurred with induction or intubation. These results indicate that etomidate, fentanyl, and succinylcholine given in a rapid-sequence technique produce a hemodynamically stable induction with minimal response to intubation in patients with end-stage cardiac disease.