Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Oct 1990
Randomized Controlled Trial Comparative Study Clinical TrialComparison of bretylium and lidocaine in the prevention of ventricular fibrillation after aortic cross-clamp release in coronary artery bypass surgery.
The authors compared bretylium and lidocaine for reducing the incidence and persistence of ventricular fibrillation following aortic cross-clamp release performed during coronary artery bypass surgery. Thirty-three adult patients scheduled for elective bypass surgery were randomly assigned in a double-blind fashion to receive a bolus of bretylium, 10 mg/kg, lidocaine, 2 mg/kg, or saline, in equal volumes prior to the release of the aortic cross-clamp. Coronary artery bypass surgery was conducted using standard cardiopulmonary bypass (CPB) procedures with systemic cooling to 24 degrees to 28 degrees C. ⋯ The number of countershocks required to defibrillate, while lower in the bretylium group, did not reach statistical significance. After cardiopulmonary bypass, cardiac output and systemic vascular resistance were comparable. Bretylium warrants further study in this setting.
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J Cardiothorac Anesth · Aug 1990
Randomized Controlled Trial Clinical TrialValue and accuracy of dual oximetry during pulmonary resections.
During thoracic surgery, one-lung ventilation (1LV) is often required. The purpose of this prospective study was to examine the usefulness and accuracy of dual-oximetry during 1LV. Prior to the induction of anesthesia, 30 patients had a radial artery and a fiberoptic pulmonary artery catheter (15 Edwards, 15 Spectramed by randomization) inserted. ⋯ SpO2 less than 95% reflects hypoxygenation and hypoxia (PaO2 less than or equal to 70 mm Hg). SvO2 is determined primarily by oxygenation (r = 0.005; P less than or equal to 0.05) rather than by CI (r = 0.001, ns). Since DO2I increased during 1LV to maintain the oxygen supply and demand balance, SvO2 monitoring might be useful as an early indicator in identifying high-risk patients with compromised DO2I resulting from decreased CI.
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J Cardiothorac Anesth · Aug 1990
Clinical TrialEnoximone treatment of impaired myocardial function during cardiac surgery: combined effects with epinephrine.
Enoximone belongs to a new class of noncatecholamine-positive inotropes, which selectively inhibit phosphodiesterase type III and increase cyclic AMP (cAMP). This study was performed in 30 coronary artery surgery patients with impaired myocardial function (ejection fraction [EF] less than 50%). The study's two purposes were to investigate the hemodynamic effects of enoximone, 0.5 mg/kg, administered following induction of anesthesia (phase I), and to assess whether enoximone can potentiate the actions of sympathomimetic agents during weaning from cardiopulmonary bypass (CPB) (phase II). ⋯ Weaning was successful in both groups, but the combined therapy produced a larger increase in cl and a more pronounced decrease of the elevated filling pressure (PCWP). PAP was not changed in the combined therapy group, but increased in the patients receiving epinephrine alone. It is concluded that enoximone has beneficial hemodynamic effects in the perioperative period, and that potentiation of the effects of epinephrine in severe heart failure may be one of the drug's most useful features.