Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Apr 1990
Sodium nitroprusside decreases spinal cord perfusion pressure during descending thoracic aortic cross-clamping in the dog.
Paraplegia is a devastating complication of surgery on the descending thoracic aorta. During surgical repair, the aorta is cross-clamped, and nitroprusside is often used to treat arterial hypertension that can occur above the cross-clamp. Twenty-one dogs were studied to determine the effects of nitroprusside on intraspinal pressures, mean aortic pressures below the cross-clamp, and spinal cord perfusion pressure. ⋯ Nitroprusside caused a further increase in intraspinal pressure (5.6 +/- 1.5 to 8.3 +/- 2.2 mm Hg) and a decrease in aortic pressure below the cross-clamp (26 +/- 5 to 18 +/- 4 mm Hg). The increase in intraspinal pressure and the decrease in aortic pressure below the cross-clamp after nitroprusside resulted in a decrease in spinal cord perfusion pressure from 19 +/- 5 mm Hg to 11 +/- 4 mm Hg. Because nitroprusside decreases spinal cord perfusion pressure and may increase the risk of spinal cord ischemia, the avoidance of large doses of nitroprusside to arbitrarily return mean arterial pressure above the cross-clamp to pre-cross-clamp levels is recommended.
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J Cardiothorac Anesth · Feb 1990
Randomized Controlled Trial Clinical TrialLung management during cardiopulmonary bypass: influence on extravascular lung water.
Progressive respiratory insufficiency secondary to cardiopulmonary bypass (CPB) is still a hazard after cardiac surgery. Pathophysiologically, impaired capillary endothelial integrity seems to be the fundamental lesion, followed by increased interstitial fluid accumulation. The reasons for this pulmonary damage are controversial; however, management of the nonperfused lungs during CPB has been widely neglected and may be partly responsible. ⋯ Measurements were performed after induction of anesthesia, before onset of CPB, and immediately after weaning from bypass, as well as 60 minutes and 5 hours after termination of CPB. Pulmonary gas exchange (PaO2) and intrapulmonary shunting (Qs/Qt) were also measured. Starting from comparable, normal baseline values, EVLW was increased in all groups after weaning from CPB, with the most pronounced increase in group 4 (maximum, +35%) and group 5 (+40%).(ABSTRACT TRUNCATED AT 250 WORDS)