Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Aug 1990
Predicting arterial oxygenation during one-lung ventilation with continuous positive airway pressure to the nonventilated lung.
Forty patients undergoing elective thoracotomy were studied to assess the possibility of predicting PaO2 during one-lung ventilation (OLV) when continuous positive airway pressure (CPAP) was applied to the nondependent lung. The first 20 patients were studied retrospectively and the three most significant independent variables that correlated with PaO2 during OLV with CPAP were: side of operation (P = 0.04), FEV1/FVC ratio (P = 0.01), and the intraoperative PaO2 during two-lung ventilation (P = 0.0002). ⋯ The second 20 patients were studied prospectively and the predicted PaO2 correlated significantly with the observed PaO2 during OLV with CPAP (r = 0.86, P less than 0.001). Therefore, it is concluded that the PaO2 during OLV with CPAP can be predicted using routinely available data.
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J Cardiothorac Anesth · Jun 1990
Epidural anesthesia with the Trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: a hemodynamic study.
The hemodynamic effects of epidural anesthesia (EA) with the Trendelenburg position were studied in seven patients with severe mitral stenosis undergoing emergency cesarean section (CS) because of hemodynamic deterioration. In six patients, the CS was immediately followed by an open mitral commissurotomy under general anesthesia, whereas in one patient, the CS was performed alone. A significant reduction in heart rate (120 +/- 5 to 83 +/- 7 beats/min; P less than 0.001) was observed after induction of EA. ⋯ When the PCWP was approximately 25 mm Hg, MAP and Cl increased to 72 +/- 7 mm Hg and 3.1 +/- 0.4 L/min/m2, respectively, and a satisfactory hemodynamic state was achieved. Systemic vascular resistance decreased after induction of EA (2,250 +/- 250 to 1,750 +/- 450 dyne.s.cm-5; P less than 0.001), and remained unchanged during the perioperative period. It is concluded that the combination of epidural anesthesia with tilting of the table is a safe method for urgent CS in pregnant women with critical mitral stenosis in whom termination of pregnancy is indicated because of hemodynamic deterioration.
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J Cardiothorac Anesth · Jun 1990
Comparative StudyCardiovascular effects of pancuronium, vecuronium, and atracurium during induction of anesthesia with sufentanil and lorazepam for myocardial revascularization.
The hemodynamic effects of three commonly used muscle relaxants, pancuronium, vecuronium, and atracurium were investigated during induction of anesthesia with sufentanil and lorazepam in patients undergoing coronary artery bypass surgery. Direct hemodynamic variables were recorded, and indirect parameters were calculated using standard formulae. ⋯ No differences were found in any other parameter during the study. A slow induction with sufentanil, lorazepam, and any of the three muscle relaxants was shown to minimize the hemodynamic changes.
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The combination of benzodiazepines and high-dose narcotics has been reported to produce hypotension in patients undergoing coronary artery surgery. This study was performed to evaluate the cardiovascular effects of lower doses of the narcotic sufentanil administered with the benzodiazepine midazolam. Thirty adult patients with good ventricular function undergoing elective coronary revascularization received sufentanil, 2.5 micrograms/kg, and midazolam, 0.1 mg/kg, followed by infusions of sufentanil, 0.7 to 1.5 micrograms/kg/h, and midazolam, 0.07 to 0.15 mg/kg/h. ⋯ Blood pressure decreases exceeding 20% of the baseline value did not occur. Two of 15 patients receiving beta-blockers, versus 3 of 15 not receiving beta-blockers, developed ischemic electrocardiographic changes before CPB (NS); one of these patients without beta-blockade had a postoperative myocardial infarction. The results of this study show that the infusion of low doses of sufentanil with midazolam provides a hemodynamically safe and stable anesthetic for coronary artery surgery and avoids the hypotension seen when a high-dose narcotic is combined with a benzodiazepine.