Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Feb 1988
Comparative StudyComparison of sufentanil-oxygen and fentanyl-oxygen anesthesia for mitral and aortic valvular surgery.
The cardiovascular responses, speed of anesthetic induction, incidence of chest wall rigidity, need for anesthetic supplements (phentolamine, N2O, and nitroprusside) to control intraoperative hypertension, and speed of postoperative recovery were measured and compared in 44 patients undergoing aortic and mitral valvular replacement with fentanyl-O2 or sufentanil-O2 anesthesia. After a lorazepamatropine premedication and pancuronium pretreatment, fentanyl was administered intravenously at a rate of 400 micrograms/min and sufentanil at 200 micrograms/min until patients were unconscious; at this time they were given succinylcholine and their tracheas were intubated. After intubation, an amount of fentanyl or sufentanil equal to the dose producing unconsciousness was infused over the next 30 minutes, at which time the operation began. ⋯ Total doses of fentanyl and sufentanil required for the entire operation were 113 +/- 11 and 9.0 +/- 0.4 micrograms/kg (mean +/- SD), respectively. Heart rate, cardiac output, and mean right atrial pressure remained unchanged throughout the study in both groups. Mean arterial blood pressure (MBP) and SBP were significantly decreased during induction and after intubation in patients receiving sufentanil, but not fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)
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The use of an alfentanil infusion as a supplement to a nitrous oxide-halothane anesthetic and the pharmacokinetics of alfentanil were evaluated in infants and children undergoing surgery for correction of congenital heart defects. Eleven patients, six infants and five children, were studied. Anesthesia was induced with nitrous oxide-halothane and pancuronium, 0.15 mg/kg. ⋯ All patients could be extubed within 34 minutes of stopping the alfentanil infusion. Naloxone was not required in any patient, and postoperative respiratory depression did not occur. In the infants and children, total plasma clearance was 8.2 +/- 2.2 mL/kg/min and 6.3 +/- 0.8 mL/kg/min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Cardiothorac Anesth · Feb 1988
Oxygenation and hemodynamic changes during one-lung ventilation: effects of CPAP10, PEEP10, and CPAP10/PEEP10.
The effects of 10 cm H2O positive end-expiratory pressure (PEEP10), 10 cm H2O continuous positive airway pressure (CPAP10), and their combination (CPAP10/PEEP10) on oxygenation and hemodynamics were studied in 20 patients undergoing one-lung ventilation (OLV) with 50% nitrous oxide, isoflurane, and oxygen. Compared to OLV alone, CPAP10 and CPAP10/PEEP10 significantly increased PaO2 (from 80 +/- 6 to 125 +/- 11 and 137 +/- 17 mmHg, respectively); increased SaO2 (from 93.9 +/- 0.8 to 97.1 +/- 0.5 and 97.0 +/- 0.6%, respectively); and decreased Qs/Qt% (from 36.4 +/- 1.6 to 26.2 +/- 2.0 and 23.2 +/- 2.0%, respectively). ⋯ Application of CPAP10, PEEP10 or their combination had no significant effect on heart rate, arterial, pulmonary arterial, mean pulmonary capillary wedge or central venous pressures, systemic or pulmonary vascular resistances, or mixed venous oxygen saturation. Overall, CPAP10 had the most beneficial effect on oxygenation and hemodynamics during OLV with 50% N2O, isoflurane and oxygen.
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J Cardiothorac Anesth · Dec 1987
The incidence of awareness, and amnesia for perioperative events, after cardiac surgery with lorazepam and fentanyl anesthesia.
One hundred patients (mean age 59 +/- 10 years) were premedicated with morphine, 0.15 mg/kg, and scopolamine, 0.008 mg/kg. Anesthesia was induced with lorazepam, 50 microg/kg, followed by fentanyl, 50 microg/kg, oxygen and pancuronium, 0.15 mg/kg. Isoflurane was given for short periods before and after cardiopulmonary bypass to 57 patients when hypertension was uncontrolled by addition of fentanyl and/or nitroglycerin. ⋯ In the two postoperative periods (morning of the day after surgery and intensive care stay), 9% and 15% of patients had complete, and 35% and 47% of patients exhibited partial amnesia. Amnesia was statistically significantly greater in patients over 60 years of age in the preinduction period. Duration of cardiopulmonary bypass did not affect the incidence of amnesia.