BACKGROUND: The required dose of anesthetics is generally smaller in patients with low cardiac output (CO). A high CO decreases the blood concentration of anesthetics during induction and maintenance of anesthesia. However, a high CO may also shorten the delivery time of anesthetics to the effect site, e.g. the brain. We assessed the time required for induction of anesthesia with propofol administered by target-controlled infusion (TCI), and investigated factors that modify the pharmacodynamics of propofol. METHODS: After measuring CO and blood volume (BV) by dye densitometry, propofol was infused using TCI to simulate a plasma concentration of 3 microg/ml. After infusion, the time taken to achieve bispectral index (BIS) values of 80 and 60 was determined. Age, sex, lean body mass (LBM), and cardiovascular parameters were analyzed as independent variables. The dependent variables were the time taken to achieve each BIS value and the plasma concentration of propofol (Cp) 10 min after the commencement of infusion. RESULTS: Multiple regression analysis revealed that a high CO significantly reduced the time taken to reach the first end point (P = 0.020, R2 = 0.076). Age and LBM significantly prolonged the time taken to reach the second end point (P = 0.001). Cp was negatively correlated with BV (P = 0.020, R2 = 0.073). CONCLUSIONS: Cardiac output was a statistically significant factor for predicting the time required for induction of anesthesia in the initial phase, whereas, age and LBM were significant variables in the late phase. The pharmacodynamics of propofol was intricately altered by CO, age, and LBM.
Anesthesia ; Anesthetics ; Blood Volume ; Brain ; Cardiac Output ; Cardiac Output, Low ; Consciousness Monitors ; Densitometry ; Humans ; Plasma ; Propofol

Capnogram, monitoring of end-tidal CO2, has been a popular tool for assessment of ventilatory status during modern anesthesia. A normal curve on capnogram suggests normal CO2 production, adequate circulation, and adequate ventilation. Level of end-tidal CO2. is different from that of arterial CO2 even in normal individual. The difference is originated from alveolar dead space gas which dilute concentration of CO2 from normal alveoli. In clinical situation, the major factor which determines alveolar dead space is low pulmonary blood flow. Decrease of alveolar capillary perfusion from low cardiac output is the most important cause of low measure of end-tidal CO and large difference between arterial CO2 and end-tidal CO2 concentration in perioperative period. To understand the effect of cardiac output on end-tidal CO2 tension and the difference between arterial CO2 tension and end-tidal CO2 tension, We measured cardiac output before and dutiag administration of nitroglycerine and sodium nitropruside for relieve of myocardial load before aortic clamping in 30 male patients undergoing aortic recontructive surgery under endotracheal anesthesia for repair of infrarenal aortic obstruction. We also measured arterial CO2 tension, and end-tidal CO2 tension at the time of 10% decrease(phasel), 15% decrease(phase2)and 20% decrease(phase3) of cardiac output respectively. Measured values were statistically analyzed to evaluate correlation between cardiac output and end-tidal CO2 tension. The results are as follows: 1) Decreases of cardiac output brought about significant decrease in end-tidal CO2 in all phases compared to control value(p<0,05). 2) Decreases of cardiac output brought about significant increase in the difference between arterial- end-tidal CO2. tension in all phases compared to control value(p<0.05). 3) Changes in cardiac ourput correlated with changes in end-tidal CO2 tension significantly(p=0.0001, r=0.61, slope=2.01). 4) Changes in cardiac ourput correlated with changes in differences between arterial-end-tidal CO2 tension significantly(p=0.0001, r=-0.59, slope=-1.63). In conclusion we suggest that measurement of end-tidal CO2 tension, especially difference between arterial and end-tidal CO2 tension, may be a useful indicator for detection of cardiac output change during operation.
Anesthesia ; Capillaries ; Cardiac Output* ; Cardiac Output, Low ; Constriction ; Humans ; Male ; Nitroglycerin ; Perfusion ; Perioperative Period ; Sodium ; Ventilation

The cardiac pacemaker has been implanted for patients with debilitating low cardiac output associated heart block. Modern technology has provided advanced, controllable and simple cardiac pacemakers throughout the world. The patient with a cardiac pacemaker implanted could give anestheaiolgists many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by varicus origins. Authors have experienced a case of open reduction for malunioned femur fracture with a cardiac pacemaker implanted.
Anesthesia ; Cardiac Output, Low ; Femur ; Heart Block ; Humans

The cardiac pacemaker has been implanted for patients with debilitating low cardiac output associated heart block. Modern technology has provided advanced, controllable and simple cardiac pacemakers throughout the world. The patient with a cardiac pacemaker implanted could give anestheaiolgists many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by varicus origins. Authors have experienced a case of open reduction for malunioned femur fracture with a cardiac pacemaker implanted.
Anesthesia ; Cardiac Output, Low ; Femur ; Heart Block ; Humans

Submitral aneurysm is a rare structural abnormality of congenital or acquired aetiology. Most reported cases are from Africa. Unless promptly treated surgically this condition is invariably fatal. We report a case of a young Indian male who presented with dyspnea of recent onset, diagnosed to have a massive submitral aneurysm causing low cardiac output and compression of cardiac structures.
Africa ; Aneurysm* ; Cardiac Output, Low* ; Dyspnea ; Humans ; Male

Coronary artery spasm immediately after the coronary artery bypass graft (CABG) surgery is rare but it can cause sudden and severe hypotension or a ventricular arrhythmia. We report a case of low cardiac output syndrome caused by a right coronary artery spasm following CABG that did not show any significant stenotic lesions on preoperative coronary angiography.
Arrhythmias, Cardiac ; Cardiac Output, Low* ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels* ; Hypotension ; Spasm* ; Transplants

BACKGROUND: The aim of this study is to evaluate our institutional results of the aortic valve replacement through minimally invasive approaches compared with conventional sternotomy. MATERIALS AND METHODS: From August 1997 to July 2010, 838 patients underwent primary isolated aortic valve replacement. Of them, 73 patients underwent surgery through minimally invasive approaches (MIAS group) whereas 765 patients underwent surgery through the conventional sternotomy (CONV group). Clinical outcomes were compared using a propensity score matching design. RESULTS: Propensity score matching yielded 73 pairs of patients in which there were no significant differences in baseline profiles between the two groups. Patients in the MIAS group had longer aortic cross clamp than those in the CONV group (74.9+/-27.9 vs.. 66.2+/-27.3, p=0.058). In the MIAS group, conversion to full sternotomy was needed in 2 patients (2.7%). There were no significant differences in the rates of low cardiac output syndrome (4 vs. 8, p=0.37), reoperation due to bleeding (7 vs. 6, p=0.77), wound infection (2 vs. 4, p=0.68), or requirements for dialysis (2 vs. 1, p=0.55) between the two groups. Postoperative pain was significantly less in the MIAS group than the conventional group (pain score, 3.79+/-1.67 vs. 4.32+/-1.56; p=0.04). CONCLUSION: Both minimally invasive approaches and conventional sternotomy had comparable early clinical outcomes in patients undergoing primary isolated aortic valve replacement. Minimally invasive approaches significantly decrease postoperative pain.
Aortic Valve ; Cardiac Output, Low ; Dialysis ; Hemorrhage ; Humans ; Pain, Postoperative ; Propensity Score ; Reoperation ; Sternotomy ; Wound Infection

BACKGROUND: The total aortic arch replacement is one of the most difficult operations with high mortality rate. But the arch first technique with subclavian arterial perfusion has been reported to be a safe methods for arch replacement. MATERIAL AND METHOD: Between Feb 2003 and July 2004, 18 patients, 10 men and 8 women, underwent total aortic arch replacement with arch first technique. Their mean age was 59.3+/-12.9 years. The patietns received 11 acute aortic dissections, 3 chronic aortic dissectiong aneurysms, and 4 ruptured aortic arch aneurysms. RESULT: The mean admission period was 20.2+/-7.4 days. There was one early mortality case which died of low cardiac output syndrome and another late mortality case which died of cerebral hemorrhage. The others were discharged without any sequelae and they were followed up for an average period of 180+/-156.3 days. CONCLUSION: The total aortic arch replacement with arch first technique and subclavian arterial perfusion is a good method that will reduce the surgical mortality and the possibility of secondary late reoperation from the remnant distal aortic problems.
Aneurysm ; Aorta, Thoracic* ; Cardiac Output, Low ; Cerebral Hemorrhage ; Female ; Humans ; Male ; Mortality ; Perfusion ; Reoperation

BACKGROUND: The total aortic arch replacement is one of the most difficult operations with high mortality rate. But the arch first technique with subclavian arterial perfusion has been reported to be a safe methods for arch replacement. MATERIAL AND METHOD: Between Feb 2003 and July 2004, 18 patients, 10 men and 8 women, underwent total aortic arch replacement with arch first technique. Their mean age was 59.3+/-12.9 years. The patietns received 11 acute aortic dissections, 3 chronic aortic dissectiong aneurysms, and 4 ruptured aortic arch aneurysms. RESULT: The mean admission period was 20.2+/-7.4 days. There was one early mortality case which died of low cardiac output syndrome and another late mortality case which died of cerebral hemorrhage. The others were discharged without any sequelae and they were followed up for an average period of 180+/-156.3 days. CONCLUSION: The total aortic arch replacement with arch first technique and subclavian arterial perfusion is a good method that will reduce the surgical mortality and the possibility of secondary late reoperation from the remnant distal aortic problems.
Aneurysm ; Aorta, Thoracic* ; Cardiac Output, Low ; Cerebral Hemorrhage ; Female ; Humans ; Male ; Mortality ; Perfusion ; Reoperation

From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years (mean, 53). Thirteen patients were in New York Heart Association (NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty (16 cases), rectangular resection of posterior leaflet (15 cases), chordal shortening (5 cases), triangular resection of anterior leaflet (2 cases), commissurotomy (2 cases), partial transposition of posterior leaflet (1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.
Cardiac Output, Low ; Classification ; Female ; Heart ; Humans ; Male ; Mitral Valve Insufficiency* ; Mitral Valve*