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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this study, 30 patients undergoing elective myocardial revascularization were divided randomly in three groups (10 patients each) with different management of the lungs during CPB: Group 1, lungs deflated; Group 2, static inflation with PEEP = 5 cmH2O and FIO2 = 1.0; Group 3, static inflation with PEEP = 5 cmH2O and FIO2 = 0.21. Measurements (Qs/Qt, P(A-a)O2, PaO2, Cstat, Cdyn, PIP, AUTO-PEEP, Rrs,max, Rrs,min and DRrs) were performed after the induction of anesthesia (T0), 20 minutes (T1) and 2 hours (T2) after the end of CPB. Respiratory mechanics data were obtained only at T0 and T2 because the sternal retraction. The Group 1 presented a statistically significant increase in Qs/Qt, P(A-a)O2 and Peak Inspiratory Pressure (PIP); in this group we noticed also a decrease in PaO2 values, static compliance (Cstat) and dynamic compliance (Cdyn) values comparing basal versus T1 and T2 values. The Group 2 showed a statistically significant increase in Qs/Qt and P(A-a)O2 values; also in this group we observed a statistically significant decrease in PaO2 and Cdyn values comparing basal versus T1 and T2 values. The Group 3 presented a statistically significant decrease in PaO2 values (basal versus T1 and T2); this group also presented an increase in Qs/Qt values, in the immediate postbypass period (T1), and P(A-a)O2 values significantly increase comparing basal versus T1 and T2 values. In all the three groups the respiratory system resistance and AUTO-PEEP values were unchanged after the end of CPB. The comparison between the groups showed a significant minor impairment of gas exchange (PaO2 and P(A-a)O2), Qs/Qt and Cstat in the third group of patients. These results show that lungs inflation with air during CPB, effectively preserve respiratory system mechanics: this might be due to a preservation of bronchial perfusion simply due to the mechanic expansion of the lung otherwise compromized when the lungs are completely collapsed. However it is necessary to emphasize that CPB has negative effects on gas-exchange whatever technique of lung management is used.
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PMID:Effects of three techniques of lung management on pulmonary function during cardiopulmonary bypass. 886 74

To investigate the endocrine stress response in patients undergoing major surgery with general anesthesia using a balanced technique with sufentanil, isoflurane and midazolam up to the second postoperative day, blood levels of cortisol, epinephrine, norepinephrine, prolactin and growth hormone were determined in 68 males for elective coronary artery bypass grafting (CABG) surgery. Intraoperatively, during extracorporeal circulation none of the measured parameters were significantly increased compared to preoperative values. The endocrine response of patients with perioperative epinephrine medication (n = 32) was not significant different to patients that did not receive exogenous epinephrine (n = 36). On the evening of the day of surgery, levels of cortisol (3 fold), epinephrine (4.7 fold), norepinephrine (1.7 fold) and growth hormone (16.5 fold) were significantly increased. Compared to preoperative values levels of cortisol (3.3 fold), growth hormone (5.5 fold) and norepinephrine (1.8 fold) remained elevated up to the evening of the second postoperative day. In conclusion, the endocrine stress response in patients undergoing CABG-surgery under general anesthesia with sufentanil, midazolam, isoflurane is intraoperatively prevented by anesthesia. Although hemodilution or hormone degradation might be responsible for the lack of an increase in endocrine parameters during CPB, this study indicates that a balanced technique with isoflurane, sufentanil and midazolam is more effective in blocking the endocrine stress response than previously described anesthetic techniques. In the early postoperative period, a sharp increase in cortisol, epinephrine, norepinephrine and growth hormone occurred suggesting that the predominant endocrine stress response begins in the intensive care unit with end of anesthesia. The postoperative elevated levels of cortisol, growth hormone and norepinephrine indicate a persisting stress-response for more than two days after surgical trauma.
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PMID:Persistent endocrine stress response in patients undergoing cardiac surgery. 963 17

A new generation hollow-fibre membrane oxygenator (Spiral Gold) has been introduced by Baxter Healthcare (Irvine, CA, USA). The purpose of this study was to evaluate the operational performance of this device under clinical conditions and to compare it to the Univox Gold membrane oxygenator. Following institutional review board approval, and the obtainment of informed consent, 26 patients undergoing coronary artery bypass grafting were randomly assigned to either a Spiral Gold (Spiral) (n = 13) or Univox Gold (Univox) (n = 13) group. Study parameters were grouped into the following categories: haematological, haemodynamic, oxygenator performance and perioperative outcomes. All patients received identical surgical, anaesthesia and postoperative care. There were no statistically significant differences in either preoperative or operative parameters between groups. During cardiopulmonary bypass, the Spiral group had a significantly lower pressure drop (26.9 +/- 8.2 vs 46.7 +/- 16.2 mmHg, p < 0.001). The Spiral group had significantly lower plasma free haemoglobin levels during all time periods of CPB compared to the Univox group. Heat exchange coefficients were higher during the rewarming period in the Spiral patients (0.59 +/- 0.28) compared to the Univox group (0.36 +/- 0.19), p = 0.06. There were no differences in oxygen transfer between groups, but ventilation gas sweep rates and FiO2 levels were statistically lower in the Spiral group at two of the three sampling time periods. The ratio of ventilating gas sweep rate to blood flow rate was lower in the Spiral group (0.56 +/- 0.12) compared to the Univox group (0.74 +/- 0.23), p < 0.03. The Spiral Gold oxygenator had superior oxygen transfer efficiency and lower haemolysis rates than the Univox Gold oxygenator.
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PMID:Clinical evaluation of a new generation membrane oxygenator: a prospective randomized study. 963 13

The effect of high dose tranexamic acid on blood loss after operations for acute aortic dissection was evaluated. Twenty-eight patients undergoing emergent operations for acute aortic dissection were studied. There were two groups, group T with 13 patients (group T) who were given 7 g of tranexamic acid after induction of anesthesia and 3 g of it after CPB and group C with 15 patients who did not receive tranexamic acid. There was a tendency that group T had less bleeding during operation and after operation (559.6 +/- 865.8 ml in group T and 805.8 +/- 442.9 ml in group C, 1719.2 +/- 1008.7 ml in group T and 3547.7 +/- 4580.1 ml in group C, respectively), but there was no significant difference between two groups. The removal of drainage tubes after operation was significantly earlier in group T (5.0 +/- 2.3 post operative day in group T and 8.1 +/- 5.2 post operative day in group C; p < 0.05). FDP and D-dimer level as measures of fibrinolytic activity were elevated at pre- and postoperative period in both groups, but they tended to be lower in group T at postoperative period. One patient required reexploration because of excessive bleeding and no mediastinal infection was reported in group T, whereas 4 patients underwent reexploration and 2 patients developed mediastinitis in group C. There were 5 hospital death (33.3%) in group C and 2 (15.4%) in group T. High dose of tranexamic acid seems to control fibrinolytic activity, thereby reducing blood loss and requirements, which may contribute to lower morbidity and mortality in operations for acute aortic dissection.
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PMID:[The effect of intraoperative high-dose tranexamic acid on blood loss after operation for acute aortic dissection]. 975 Apr 44

We studied the effect of mild hypothermic cardiopulmonary bypass (30 degrees C) on the EEG Bispectral Index in 10 patients undergoing elective CABG. BIS was recorded at 11 event-related time points during the procedure. After a significant decrease at the induction of anaesthesia, BIS was not further modified during the procedure. BIS was neither affected by surgical stimulation nor by CPB and mild hypothermia. We conclude that we did not find any reason to preclude the use of BIS to assess the hypnotic effects of anaesthetics during normothermic or mild hypothermic CPB.
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PMID:Effects of mild hypothermic cardiopulmonary bypass on EEG bispectral index. 1112 18

The vulnerability of right ventricle (RV) to ischemic insult during cardiac surgery is being increasingly recognized. This study aims to evaluate right ventricular function by measuring hepatic venous flow (HVF) patterns using intraoperative transesophageal echocardiography (TEE), and to compare HVF with other conventional two-dimensional echocardiographic and hemodynamic indices of RV performance. Patients undergoing coronary artery bypass grafting (CABG) were studied intraoperatively using a multiplane dual frequency 5/3.7-MHz phased array transducer, a pulmonary artery catheter, and an arterial catheter. Peak velocities and time velocity integrals of HVF pattern were studied. Peak systolic-diastolic ratio (S/D) of biphasic HVF and reverse flow ratio (% reverse flow/forward flow = % RF/FF) were also examined. Two-dimensional echocardiographic measurements included: (1) transverse plane long-axis (LA) and short-axis (SA) planimetered areas expressed as ratios; LA maximum major and minor-axis shortening fractions; (2) tricuspid annular plane systolic excursion (TAPSE) ratio. All data were obtained after induction of anesthesia (stage 1), after sternotomy (stage 2), aftercardiopulmonary bypass (CPB) (stage 3), and after sternal closure (stage 4). Pre-CPB all 35 patients had biphasic HVF by Doppler. In 31 patients peak S/D ratio was >1. After CPB, there was significant reduction in systolic forward flow (S wave), along with an increase in late systolic reverse flow (V wave) and an increase in % RF/FF. At this stage TAPSE ratio decreased (pre CPB 0.33 +/- 0.12 vs post CPB 0.30 +/- 0.11). There was simultaneous decrease in 2-D long-axis LA (pre CPB 0.52 +/- 0.11 vs post CPB 0.31 +/- 0.01) and max major axis LA (pre CPB 0.38 +/- 0.06 vs post CPB 0.31 +/- 0.11). Max major axis LA correlated significantly with changes in right atrial pressure (P < 0.05). Tricuspid annular motion diminished significantly at sternal closure. Hepatic systolic forward flow and TAPSE ratio can be an indirect measure of RV systolic functions in correlation with maximum major axis LA changes. Evaluation of HVF provides unique insight into right ventricular dynamics. It is an easy, safe, and sensitive method for assessing RV functions intraoperatively.
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PMID:Evaluation of Right Ventricular Function During CABG: Transesophageal Echocardiographic Assessment of Hepatic Venous Flow Versus Conventional Right Ventricular Performance Indices. 1117 10

Pulmonary artery thromboendarterectomy is a potentially curative procedure in chronic, major vessel thromboembolic pulmonary hypertension. However, persistent pulmonary hypertension and unrelenting reperfusion edema have serious complications, often requiring prolonged mechanical ventilation. A 50-year-old man who was diagnosed with a thromboembolism in both pulmonary arteries underwent a bilateral pulmonary endarterectomy. He received O2-isoflurane-fentanyl anesthesia. When the lungs were reperfused with CPB weaning, massive hemorrhage occurred in the left lung. After the operation, the patient was taken to the intensive care unit. Mechanical ventilation was performed immediately and then both inhaled NO and i.v. furosemide therapies were administered. The patient was discharged from ICU 15 days postoperation.
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PMID:Reperfusion pulmonary edema after pulmonary endarterectomy. 1147 83

The objectives of this study were to explore the mechanisms of cardiac autonomic system (CAS) impairment and to assess whether warm blood cardioplegia can prevent the decrease of heart rate variability (HRV) after CPB. Twelve adult mongrel dogs were divided into two groups. One group received warm blood cardioplegia and maintained at a systemic temperature of 38 degrees C throughout the experiment (WB group). The other received cold crystalloid cardioplegia at 31 degrees C and topical hypothermia (CC group). Anesthesia was induced and maintained with sodium pentobarbital and isoflurane. The heart was exposed through a right thorectomy. CPB was established using a single right atrial cannula. The arterial cannula was placed in the right femoral artery. The crossclamp time for both groups was 30 minutes. Serum potassium levels were normalized throughout the study. Each animal's ECG was continuously recorded for 24 hours before surgery and for the first five postoperative days (POD) using a two-channel Holter monitor. The data were analyzed for heart rate variability (TP = total power, 0.01-1.00; LF = low frequency, 0.04-0.15; HF = high frequency, 0.15-0.40; LF/HF). There were no differences in the preoperative values. In both groups the TP, LF, and HF decreased, compared to control (P < 0.05), with CC group having significantly lower TP, LF and HF than the WB group (P < 0.05). The LF/HF did not change both between groups and between before- and after-CPB in each group (P > 0.05). The mean heart rate at 24 hours (MHR) increased in both groups, compared to control (P < 0.05), with CC group having a significantly higher MHR than WB group (P < 0.05). The data suggest that CPB, with warm blood or cold crystalloid cardioplegia does not disturb the balance of CAS, but it causes the decrease of HRV, and warm blood cardioplegia can not prevent the impairment of HRV.
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PMID:[Effects of warm blood and clot crystalloid cardioplegia on the heart rate variability of canine]. 1221 48

Anesthetic management of cardiac patients with complete transposition of the great arteries (TGA) undergoing arterial switch operation (ASO) is challenging. The anesthetic course and perioperative problems were studied. A prospective data collection study of 87 patients was performed between January 1991 and February 2002. The patients were divided into 3 groups: Group 1; 27 neonates with TGA with an intact ventricular septum (IVS), Group 2; 21 with TGA, with IVS who underwent two-stage ASO, and Group 3; 39 with TGA, with a large VSD. The anesthesia consisted of low-dose fentanyl, thiopental, atracurium and isoflurane. Monitoring included ECG, radial or femoral arterial pressure, CVP, LAP, core temperature, SpO2, P(E)CO2, urine output, ABG's, Hct, ACT, serum glucose and potassium. Fortunately the courses of anesthesia were uneventful. Usual vasoactive medication administered following CPB included nitroglycerin, dobutamine and dopamine. Groups I, 2 and 3 contained 18.5 per cent, 14.3 per cent and 33.3 per cent of patients who required adrenaline respectively. And only 7.7 per cent of patients in Group 3 had milrinone as an inotrope. Early tracheal extubation, 2 hours after admission to ICU was performed in 3 patients. Perioperative complications included bleeding, low cardiac output, diaphragmatic paresis, digitalis intoxication, metabolic alkalosis, convulsion, pulmonary hypertensive crisis and death. Two patients who developed a pulmonary hypertensive crisis were successfully managed with inhaled nitric oxide. The overall hospital mortality rate was 19.54 per cent. In conclusion, the anesthetic management for ASO in 87 simple dTGA patients was uneventful at Siriraj Hospital. The major perioperative morbidity and hospital mortality were not directly anesthetic contribution.
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PMID:Anesthesia for arterial switch operation in simple transposition of the great arteries: experience at Siriraj Hospital. 1245 17

Pediatric cardiac transplantation is currently an accepted option for end-stage heart disease and congenital cardiac malformations. This report focuses on the anesthetic perioperative management in 12 yr. From 1988 to 2001 we performed 90 heart transplantations in 88 children, infants and neonates. The pediatric heart transplant program of the children's heart center at our university hospital started in June 1988 with the transplantation of a 2-yr-old boy who was suffering from congenital heart disease. Since then, 88 transplants have been performed. We divided our patients into two groups. Group 1 ranged from 1988 to 1996 and Group 2 from 1997 to 2001. The patient characteristics have not significantly changed over the years in our institution. At the time of transplantation, mean age of the patients was 2.6 +/- 4.3 yr from the period of 1988-1996 and 2.5 +/- 4.1 yr from 1997 to 2001. Since 1988, 90 transplants (Tx) in 88 patients have been performed. Two patients needed re-Tx within 2 days after the initial operation because of primary graft failure. Indications for Tx were congenital heart disease (n = 67) and cardiomyopathy (n = 21). In the subgroup of the patients suffering from congenital heart disease there were 46 with the diagnosis of HLHS, followed by endocardial fibroelastosis (n = 7); the remaining 14 patients had other complex cardiac malformations and some underwent corrective palliative cardiac surgery before Tx. Sixty-three patients were younger than 1 yr of age and only five children were older than 10 yr. Twenty-three percent of the patients on the waiting list died before Tx was possible. The overall survival rate was 79% at 1 yr and 73% at 5 and 10 yr. Infants with HLHS had a lower probability of survival after 5 yr compared with other diagnosis (69% vs. 84%). Until now 21 patients have died after Tx. The duration of anesthesia, time of CPB and the age at the time of surgery decreased over the years. It is always a challenge for the anesthesiologist to treat these patients with pulmonary hypertension as one of the most critical risks in this group of patients. The preventive therapy with vasodilators as well as the availability of mechanical assist devices before and after heart transplantation reduces the effects of transitional pulmonary hypertension and prevents the development of post-operative right heart failure.
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PMID:Perioperative management in pediatric heart transplantation from 1988 to 2001: anesthetic experience in a single center. 1517 60


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