Journal of cardiothoracic anesthesia
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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
Randomized Controlled TrialAnesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery.
In a randomized, double-blind trial, 59 patients undergoing coronary artery surgery received fentanyl 10, 15, or 25 microg/kg infused over 5 minutes for anesthetic induction. Half of the patients received intravenous lidocaine, 1.5 mg/kg, 1 minute before laryngoscopy. Efficacy of induction as judged by loss of consciousness was evaluated, and hemodynamic values during induction, laryngoscopy, and tracheal intubation were recorded each minute for 10 minutes. ⋯ Lidocaine partially blocked this restoration (systolic blood pressure 122 +/- 5 v 138 +/- 5 mmHg, lidocaine v placebo, 1 minute after laryngoscopy, P < .05). Fentanyl, 15 or 25 microg/kg, intravenously, is an effective induction agent for patients with coronary artery disease. Supplementation with intravenous lidocaine, 1.5 mg/kg, will obtund the increase in blood pressure that occurs with laryngoscopy and intubation and help prevent infrequent hypertensive responses seen with this opioid technique.