Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Aug 1988
Randomized Controlled TrialEffects of high-dose fentanyl on fluid and vasopressor requirements after cardiac surgery.
The effects of two different anesthetic techniques on postoperative cardiopulmonary events, fluid and vasopressor requirements, and overall intensive care unit (ICU) course were studied in patients undergoing elective myocardial revascularization (CABG) (N = 20) or single cardiac valve replacement (N = 20). Patients were randomized to receive either high-dose fentanyl (F, 75 microg/kg followed by 0.3 microg/kg/min) or diazepam-ketamine (0.8 mg/kg D and 2 mg/kg K followed by 0.07 mg/kg/h D and 1 mg/kg/h K). No significant differences in preoperative demographics, prebypass hemodynamics, ischemic crossclamp, or total cardiopulmonary bypass times were noted. ⋯ In summary, it was found that F for cardiac surgery was accompanied by increased postoperative fluid and vasopressor requirements with increased Qsp/Qt and longer ICU stays compared to diazepam and ketamine. This study suggests that some anesthetic techniques may provide less complicated and less costly postoperative courses than others, with the same outcome after cardiac surgery. Information on the postoperative effects of long-acting anesthetic agents is sparse and more studies of these effects and their mechanisms are necessary because they may affect patient management after cardiac surgery.
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J Cardiothorac Anesth · Aug 1988
Clinical evaluation of the edwards laboratories and oximetrix mixed venous oxygen saturation catheters.
Mixed venous oxygen saturation is continuously monitored during and following cardiac operations in many institutions. Important therapeutic decisions may depend on the values indicated by the instrument. The accuracy of the system used is therefore of critical importance. ⋯ After preinsertion calibration, the values measured by the instruments were compared to blood samples analyzed with an Instrumentation Laboratories IL 282 cooximeter at eight intervals. It was found that under these clinical conditions there was significantly less difference in the values measured with the Oximetrix catheter v those determined with the IL 282 co-oximeter as compared with the values measured with the American Edwards catheter v the IL 282 co-oximeter. The percentage difference in oxygen saturation (ie, error) measured with the Edwards Laboratories catheter increased over time, averaging more than 7.5% at the last three data points.
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J Cardiothorac Anesth · Jun 1988
Randomized Controlled Trial Comparative StudyComparative hemodynamic effects of propofol and thiamylal sodium during anesthetic induction for myocardial revascularization.
The safety and efficacy of propofol, a new intravenous anesthetic agent, have been demonstrated in healthy patients. Twenty-one patients, ASA III-IV, undergoing elective myocardial revascularization, were randomly chosen to receive either propofol, 2.5 mg/kg, or thiamylal, 4 mg/kg. for the induction of anesthesia. Hemodynamics were recorded at one and three minutes after drug administration during spontaneous respiration. ⋯ Both groups experienced significant increases in HR following intubation, but no evidence of myocardial ischemia was seen in either group. All other parameters returned toward control values. Propofol appeared to be safe and effective for the induction of anesthesia in this group of patients, although its hemodynamic effects were greater than those of thiamylal.