Journal of cardiothoracic anesthesia
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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.