BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone* ; Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Dobutamine* ; Ethics Committees, Research ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Sternotomy ; Vascular Resistance ; Ventilation

Pulse oximetry is a noninvasive technique for measuring O2 saturation (SpO2) continuously. We applied pulse oximetry to 9 pediatric patients with tetralogy of Fallot during shunt surgery. Arterial oxygen tensions (PaO2) and saturations (SaO2) were also measured at the time of postinduction, just before the shunt, after the shunt and at the end of the operation. The SpO2 and SaO2 levels were identically changed in all 4 periods. The PaO2 was increased a little without statistical significance after the shunt procedure and at the end of the operation compared with the values before the shunt. However, SaO2 values increased with statistical significance after the shunt procedure and SpO2 values also showed similar increases with significance. In conclusion, continuous monitoring of SpO2 by pulse oximetry, instead of PaO2, is a very useful and reliable method to assess the improvement of perfusion after shunt, particularly in cyanotic cases.
Child, Preschool ; Human ; Infant ; Intraoperative Period ; *Oximetry ; Oxygen/blood ; Tetralogy of Fallot/blood/*surgery

It is believed that catecholamine secretion is increased during cardiopulmonary bypass. However, the periods of maximum increase in catecholamine levels during cardiopulmonary bypass are different among several authors. 15 patients having valvular surgery were studied. Plasma epinephrine and norepine- phrine were determined by high performance liquid chromatography at 8 stages of the operation. During bypass plasma catecholamine levels continued to rise and maximally increased until aortic cross clamp off, and decreased gradually. Norepinephrine also showed the same results initially, but then increased gradually after the end of bypass. During bypass the maximum increases in epinephrine and norepinephrine were sixfold and twofold respectively in comparison with the levels prior to induction, which suggests that the predominant humoral response to cardiopulmonary bypass appears to be adrenomedullary release of epinephrine. The catecholamine levels at the period of aortic cross clamp off was higher than that of the lowest body temperature. There was no correlation between the increases in catecholamines and mean arterial pressure. Temperautures and eatecholamines also showed no correlations.
Arterial Pressure ; Body Temperature ; Cardiopulmonary Bypass* ; Catecholamines ; Chromatography, Liquid ; Epinephrine* ; Humans ; Norepinephrine* ; Plasma

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.
Anesthesia ; Blood Pressure ; Cardiac Output ; Catheters ; Computer Systems ; Gases ; Humans ; One-Lung Ventilation ; Pneumonectomy* ; Pulmonary Artery ; Thermodilution ; Vascular Resistance ; Ventricular Function, Right*

BACKGROUND: Low values of lung compliance have been reported in patients with increased pulmonary blood flow due to intracardiac left to right(L-R) shunt. The compliance had returned to within normal limits 4 to 6 weeks after surgical correction of the shunt. We investigated whether lung compliance was improved immediately after surgical correction of the shunt. METHODS: Fifty four pediatric patients who were undergoing repair of intracardiac L-R shunt were evaluated. Lung compliance, arterial oxygen tension(PaO2) and arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) were measured after induction of anesthesia and at the completion of surgery. Left atrial pressure(LAP) was monitored. Lung compliance and end-tidal carbon dioxide tension were measured by monitoring system built in Cato anesthetic ventilator system. RESULTS: Lung compliance was significantly lower after surgery(6.57+/-6.46 ml/mbar) than after induction of anesthesia(7.71+/-7.18 ml/mbar). After surgery, PaO2 was significantly decreased and Pa-ETCO2 significantly increased than after induction of anesthesia. The decrease in lung compliance after surgery significantly correlated with a decrease in PaO2(r=0.43) and an increase in Pa-ETCO2 (r=0.47) but not correlated with LAP. CONCLUSIONS: Although surgical correction of intracardiac L-R shunt reduces pulmonary blood flow, the lung compliance decreases in immediate postoperative period. Therefore a deterioration of postoperative lung compliance may need judicious management for pulmonary and hemodynamic instability.
Anesthesia ; Carbon Dioxide ; Compliance ; Hemodynamics ; Humans ; Lung Compliance* ; Lung* ; Oxygen ; Postoperative Period ; Ventilators, Mechanical

Postoperative atrial arrhythmia after thoracotomy is relatively common, with a reported incidence ranging from 8% to 30%. These arrhythmias may cause hypotension, congestive heart failure and lengthen the period of postoperative hospitalization. The most important precipitating factor is atrial dilation and identified risk factor is an advanced age of the patient. The effect of various prophylactic regimens to reduce atrial arrhythmias is controversial. We report a case of postoperative atrial fibrillation in a 73 year-old female patient undergoing repair of esophageal hiatal hernia.
Aged ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Female ; Heart Failure ; Hernia, Hiatal* ; Hospitalization ; Humans ; Hypotension ; Incidence ; Precipitating Factors ; Risk Factors ; Thoracotomy

Catheterization of the innominate vein or superior vena cava vein via the external and internal jugular veins was attempted in 68 pediatric patients weighing less than 20 kg in body weight who were scheduled for cardiovascular and pulmonary surgery. Both jugular veins were utilized in 63 cases, of these, and post operative X-ray confirmed a 19% malposition rate. Catheterization was performed in 45 cases throuhg the left external jugular veins and in 18 cases through the right external jugular vein,and the malposition rates were 25% and 6% respectively. The right internal jugular vein, utilized in 5 cases and, all provided successful results. Difficulty was encountered in passing of the catheter in 32% of the cases using both external jugular veins. Catheter curling was noted in 1 cases. No complications were encountered during and after catheterization.
Body Weight ; Brachiocephalic Veins ; Catheterization ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Child* ; Humans ; Jugular Veins* ; Veins ; Vena Cava, Superior

A 38-year old male patient underwent tracheal reconstruction because of a tracheal tumor. A CT scan showed that the mass was located 5 cm above the carina, the size was 2x1.5cm, and there was a 50% narrowing of the stenotic segment. After endotracheal intubation (1.D. 8mm), a pediatric suction catheter (lenght:40cm, diameter: 2mm) was inserted with a stylet at the side of the tube to pass the stenotic segment with fiberoptic bronchoscopic guidance. Conventional ventilation with an inhalation agent was performed and HFJV was started just prior to the tracheal incision. A driving gas pressure of 1 kg/cm, respiratory rate of 120/min., I:E ratio fo 1:1, and Fio2 of 1.0 were applied through the suction catheter. Ten minutes after HFJV, PaCO2showed 50mmHg. Hypercabia was relieved by increasing the driving gas pressure from 1kg/cm(2) to 1.5 kg/cm(2). HFJV was performed for one and a half hours. During the procedure, blood gas analyses were perfomed frequently and all results revealed an adequate ventilatory status. After completing the end to end anastomosis, conventional ventilation was started until surgery was ended. The patient's course proceeded uneventfully and he was discharged 13 days after surgery.
Adult ; Blood Gas Analysis ; Catheters ; High-Frequency Jet Ventilation* ; Humans ; Inhalation ; Intubation, Intratracheal ; Male ; Respiratory Rate ; Suction ; Tomography, X-Ray Computed ; Ventilation

BACKGROUND: Vasoconstricting drugs such as dopamine, phenylephrine (PE) and epinephrine constrict normoxic lung vessels preferentially, thereby disproportionately increasing normoxic lung pulmonary vascular resistance (PVR) and inhibit hypoxic pulmonary vasoconstriction (HPV). In this study, we evaluated the effect of PE on HPV and arterial oxygenation. METHODS: This study was performed on 21 patients undergoing thoracotomy. After induction of anesthesia, Swan-Ganz catheter was inserted. After one lung ventilation was started, systolic blood pressure (SBP) of the patient was reduced to 100 mmHg using inhalation anesthetic agent and then the blood pressure was raised up to 140 mmHg by PE infusion. Hemodynamic variables were measured and arterial blood gas was analyzed at the start of one lung ventilation (control), SBP of 100 mmHg and SBP of 140 mmHg. RESULTS: The mean dose of PE infused was 5.9 +/- 3.8 microgram/kg. Infusion of PE did not increase pulmonary vascular resistant index (PVRI) significantly and did not reduce arterial PO2. There was no statistically significant difference in intrapulmonary shunt fraction (Qs/Qt) between the time of low and high blood pressures. CONCLUSION: Pulmonary vasomotor changes induced by PE are minimal and so should not affect the distribution of blood flow during one lung ventilation. On the basis of this result, PE appears to a reasonable vasoconstrictor to be used in patients undergoing thoracotomy.
Anesthesia ; Blood Pressure ; Catheters ; Dopamine ; Epinephrine ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Lung ; One-Lung Ventilation* ; Oxygen* ; Phenylephrine* ; Thoracotomy ; Vascular Resistance ; Vasoconstriction*

BACKGROUND: Both systemic inflammatory reaction and regional myocardial ischemia/reperfusion injury may elicit hypercoagulability after off-pump coronary artery bypass grafting (OPCAB). We investigated the influence of ulinastatin, which suppresses the activity of polymorphonuclear leukocyte elastase and production of pro-inflammatory cytokines, on coagulation in patients with elevated high-sensitivity C-reactive protein (hsCRP) undergoing OPCAB. METHODS: Fifty patients whose preoperative hsCRP > 3.0 mg/L were randomly allocated into the ulinastatin (600,000 U) or control group. Serum concentrations of thrombin-antithrombin complex (TAT) and prothrombin fragment 1+2 (F1+2) were measured preoperatively, immediately after surgery, and at 24 h after surgery, respectively. Secondary endpoints included platelet factor (PF)-4, amount of blood loss, and transfusion requirement. RESULTS: All baseline values of TAT, F1+2, and PF-4 were higher than the normal range in both groups. F1+2 was elevated in both groups at immediate, and at 24 h after surgery as compared to baseline value, without any significant intergroup differences. Remaining coagulation parameters, transfusion requirement and blood loss during operation and postoperative 24 h were not different between the two groups. CONCLUSIONS: Intraoperative administration of ulinastatin did not convey beneficial influence in terms of coagulation and blood loss in high-risk patients with elevated hsCRP undergoing multivessel OPCAB, who already exhibited hypercoagulability before surgery.
Antithrombin III ; Blood Platelets ; C-Reactive Protein ; Coronary Artery Bypass, Off-Pump ; Cytokines ; Glycoproteins ; Humans ; Leukocyte Elastase ; Peptide Hydrolases ; Prothrombin ; Reference Values ; Thrombophilia ; Transplants