No abstract available.
Blood Gas Analysis*

Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

BACKGROUND: Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. METHODS: Twenty MIDCAB patients were randomly allocated into two groups, group E (n = 10) receiving esmolol 0.3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4). Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of < 0.05. RESULTS: Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. CONCLUSION: Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique.
Anesthesia* ; Blood Pressure ; Bradycardia* ; Central Venous Pressure ; Coronary Artery Bypass ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Myocardial Ischemia ; Neostigmine* ; Oxygen Consumption ; Pulmonary Wedge Pressure ; Transplants

BACKGROUND: Activated clotting time (ACT) and thromboelastography (TEG) are generally accepted as adequate measures of the coagulation system for monitoring of the cardiac system. Aprotinin is alleged to affect ACT and TEG. We performed this study to see if the determination of ACT and TEG can provide a basis for the assessment of coagulation and the prediction of postoperative hemorrhage in cardiac surgical patients treated with aprotinin. METHODS: Twenty patients undergoing cardiac operation were studied. The values (control) of ACT and TEG were obtained just after induction of anesthesia. Each patient was fully heparinized and received aprotinin, 2,000,000 KIU added to the prime solution. At the end of the procedure, protamine, 3 mg/kg was given for the neutralization of heparin. Measurement of ACT and TEG were made 20 minutes after the administration of protamine, at the end of surgery, and 1 hour after transfer to ICU. The values were compared with the amount of hemorrage collected by chest tubes 1 hour, 2 hours and 8 hours after transferred to ICU. RESULTS: The values of ACT at 20 minutes after protamine administration and at the end of surgery significantly (P < 0.05) increased compared with the values of control, but the values in ICU did not show significant change. All values of TEG significantly (P < 0.05) changed compared with the values of control. No single variable of ACT and TEG showed correlation with the amount of hemorrhage through chest tubing postoperatively. CONCLUSIONS: The results indicate that neither ACT nor TEG predict the amount of postperative hemorrhage in aprotinin-treated patients having cardiac surgery. Therefore the TEG results should be interpreted cautiously because of the high rate of unreliable results.
Anesthesia ; Aprotinin* ; Chest Tubes ; Hemorrhage* ; Heparin ; Humans ; Postoperative Hemorrhage ; Thoracic Surgery ; Thorax ; Thrombelastography*

No abstract available.
Cardiopulmonary Bypass* ; Diagnosis*

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.
Central Venous Pressure ; Colloids ; Heart* ; Hemodynamics* ; Hemorrhage ; Humans ; Hydroxyethyl Starch Derivatives* ; Hypotension ; Osmolar Concentration ; Platelet Count ; Prospective Studies ; Pulmonary Wedge Pressure ; Starch ; Thoracic Surgery*

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.
Central Venous Pressure ; Colloids ; Heart* ; Hemodynamics* ; Hemorrhage ; Humans ; Hydroxyethyl Starch Derivatives* ; Hypotension ; Osmolar Concentration ; Platelet Count ; Prospective Studies ; Pulmonary Wedge Pressure ; Starch ; Thoracic Surgery*

The correlation of ventilatory support with sex, age, operation time, aortic cross clamp time was studied in 274 patients undergone open heart surgery after dividing them into total, congenital heart disease, acquired heart disease groups. 1) Ventilatory support time was not significantly different between male and female. 2) In total group, ventilatory support time increased significantly with an increase of pump time, aortic cross clamp time (p<0.05) and age (p<0.01). 3) In congenital heart disease group, ventilatory support time increased significantly with an increase of operation time (p<0.05), pump time, aortic cross clamp time (p<0.001). 4) In acquired heart disease group, ventilatory support time increased significantly with an increase of age (p<0.001).
Anesthesia* ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Male ; Thoracic Surgery*

For autologous transfusion, intraoperative salvage technique with Cell Saver Apparatus was used in open heart surgery. Seventy-eight patients were involved in this study and divided into two groups. They were group of salvage(n=58) and non-salvage(n=20). In each group, they were also divided into four groups of CHD(who underwent surgery of congenital heart disease), UNDO(who underwent first-valvular surgery or repair of dissecting aneurysm), REDO(who underwent redo-valvular surgery) and CABG(who underwent coronary artery bypass surgery) according to the degree of blood loss during surgery. Amount of blood obtained from Cell Saver Apparatus was 811+/-273(mean+/-std) ml. Hematologic profile of blood from this apparatus was as follows, 1) Hemoglobin: 18.2+/-2.0(g/dl), 2) Hematocrit: 52.8+/-5.6(%), 3) Platelet: 35K+/-21K (mm). The hank blood utility ratio{No. of patients who used hank blood (No. of patients who used bank blood+who didnt use bank blood)x100(%)) tended to increase in non-salvage group and statistically significant(p< or =0.05) only in CHD group(non-salvage group vs. salvage group= 63% vs. 17%). And the amount of bank blood transfused tended to be higher in non-salvage group than salvage group and statistically significant(p< or =0.05) only in CHD group. This study suggested that intraoperative salvage technique with Cell Saver Apparatus could decrease the use of bank blood in open heart surgery.
Blood Platelets ; Coronary Artery Bypass ; Heart* ; Hematocrit ; Humans ; Thoracic Surgery*

For autologous transfusion, intraoperative salvage technique with Cell Saver Apparatus was used in open heart surgery. Seventy-eight patients were involved in this study and divided into two groups. They were group of salvage(n=58) and non-salvage(n=20). In each group, they were also divided into four groups of CHD(who underwent surgery of congenital heart disease), UNDO(who underwent first-valvular surgery or repair of dissecting aneurysm), REDO(who underwent redo-valvular surgery) and CABG(who underwent coronary artery bypass surgery) according to the degree of blood loss during surgery. Amount of blood obtained from Cell Saver Apparatus was 811+/-273(mean+/-std) ml. Hematologic profile of blood from this apparatus was as follows, 1) Hemoglobin: 18.2+/-2.0(g/dl), 2) Hematocrit: 52.8+/-5.6(%), 3) Platelet: 35K+/-21K (mm). The hank blood utility ratio{No. of patients who used hank blood (No. of patients who used bank blood+who didnt use bank blood)x100(%)) tended to increase in non-salvage group and statistically significant(p< or =0.05) only in CHD group(non-salvage group vs. salvage group= 63% vs. 17%). And the amount of bank blood transfused tended to be higher in non-salvage group than salvage group and statistically significant(p< or =0.05) only in CHD group. This study suggested that intraoperative salvage technique with Cell Saver Apparatus could decrease the use of bank blood in open heart surgery.
Blood Platelets ; Coronary Artery Bypass ; Heart* ; Hematocrit ; Humans ; Thoracic Surgery*