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*

To compare the respiratory depressant effect of nalbuphine and morphine, six healthy male volunteers (mean age 26 yr) were given the nalbuphine at a dose of 0.15 mg/kg and morphine at a dose of 0.1 mg/kg intravenously, at intervals of 2 weeks in a double-blind laboratory study. Respiratory depression was monitored by ventilatory responses during CO2 rebreathing at 1 min, 30 min, 60 min and 90 min after injection. The displacement (mean intercept at Petco2 60 mmHg) and the slope of the linear relationship between minute ventilation with Petco2 were measured, There were no significant differences in the slope and the displacement of CO2 response curve between nalbuphine group and morphine group. Also, no significant differences in the slope and the displacement among 1 min, 30 min, 60 min and 90 min after injection of nalbuphine and morphine were noted. These findings demonstrate that the respiratory depressant effect of nalbuphine in similar to morphine at equianalgesic dose, and occurs within 10 min, and continues more than 90 min.
Healthy Volunteers* ; Humans ; Injections, Intravenous* ; Male ; Morphine* ; Nalbuphine* ; Respiratory Insufficiency ; Ventilation ; Volunteers

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*

In respiratory intensive care unit, hemodnamic changes following extubation with or without bolus esmolol were evaluated in fourty two patients who underwent open heart surgery. They were divided into three groups. E0 group(no esmolol was given before extubation), E, group(esmolol in a dose of 1.0 mg/kg was given before extubation), and E; group(esmolol in a dose of 1.5 mg/kg was given before extubation). Number of patients in each group was fourteen, respectively. In Eo group, heart rate was increased significantly(p< 0.0l) just after extubation compared to baseline. But, in E, and E1 group, heart rate was unchanged significantly during extubation. The changes of heart rate due to extubation were significantly(p< 0.05) different between Eo and E, group, Eo and E, group but not different between E, and E group. Systolic blood pressure was not changed during extubation in Ei and Ei group and the changes of systolic blood pressure due to extubation were not different between groups. We may suggest that 1.0 mg/kg bolus esmolol attenuates cardiovascular responses to extubation and we should pay a special attention to the drug interaction of esmolol with other adrenergic blockers.
Adrenergic Antagonists ; Blood Pressure ; Drug Interactions ; Heart Rate ; Humans ; Intensive Care Units ; Thoracic Surgery

In respiratory intensive care unit, hemodnamic changes following extubation with or without bolus esmolol were evaluated in fourty two patients who underwent open heart surgery. They were divided into three groups. E0 group(no esmolol was given before extubation), E, group(esmolol in a dose of 1.0 mg/kg was given before extubation), and E; group(esmolol in a dose of 1.5 mg/kg was given before extubation). Number of patients in each group was fourteen, respectively. In Eo group, heart rate was increased significantly(p< 0.0l) just after extubation compared to baseline. But, in E, and E1 group, heart rate was unchanged significantly during extubation. The changes of heart rate due to extubation were significantly(p< 0.05) different between Eo and E, group, Eo and E, group but not different between E, and E group. Systolic blood pressure was not changed during extubation in Ei and Ei group and the changes of systolic blood pressure due to extubation were not different between groups. We may suggest that 1.0 mg/kg bolus esmolol attenuates cardiovascular responses to extubation and we should pay a special attention to the drug interaction of esmolol with other adrenergic blockers.
Adrenergic Antagonists ; Blood Pressure ; Drug Interactions ; Heart Rate ; Humans ; Intensive Care Units ; Thoracic Surgery