| 1. |
- Lindberg, Lars, et al.
(författare)
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Nitric oxide gives maximal response after coronary artery bypass surgery
- 1994
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1532-8422 .- 1053-0770. ; 8:2, s. 182-187
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Tidskriftsartikel (refereegranskat)abstract
- The dose-response to inhalation of nitric oxide (NO) after coronary artery bypass surgery was studied in seven patients with normal preoperative lung function and chest radiograms. During postoperative controlled ventilation with PEEP 5 and 10 cmH2O, the patients inhaled NO in concentrations of 2 to 25 ppm, in random order, for 6 to 10 minutes. Hemodynamic and oximetric data were analyzed before, 5 minutes after start of the NO inhalation, and 5 minutes after the cessation. The response was the same at all concentrations; mean pulmonary artery pressure decreased by 11 +/- 1% (P < 0.05) and pulmonary vascular resistance decreased by 22 +/- 2% (P < 0.05). Systemic hemodynamics did not change, but oximetric parameters tended to improve. Changes in PEEP did not affect the response. It is concluded that, in patients who have undergone coronary artery bypass grafting, inhalation of 2 to 25 ppm NO causes a dose-independent decrease in pulmonary artery pressure and pulmonary vascular resistance. In order to investigate the dose-response curve, concentrations lower than 2 ppm of NO must be used.
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| 2. |
- Ahlgren, Ewa, et al.
(författare)
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Cerebral complications after coronary artery bypass and heart valve surgery : Risk factors and onset of symptoms
- 1998
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - 1053-0770 .- 1532-8422. ; 12:3, s. 270-273
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Cerebral complications continue to be a major cause of morbidity after cardiac surgery. Earlier studies have mainly focused on intraoperative events, but symptoms may also occur later in the postoperative period. The purpose of this study was to determine the incidence and risk factors of focal neurologic complications and timing of cerebral symptoms.Design: A retrospective study.Setting: Linköping University Hospital.Participants: Two thousand four hundred eighty patients who underwent cardiac surgery from 1992 to 1995.Interventions: Standard cardiopulmonary bypass (CPB) technique was used in all patients. Anticoagulant treatment included heparin and patients with coronary artery surgery were also administered acetylsalicylic acid and valve-surgery patients received warfarin or dicumarol.Measurements and Main Results: Seventy-five patients (3%) had focal neurologic deficits and/or confusion postoperatively. In 32 patients (43%), the onset was not intraoperative but occurred later in the postoperative period. The lowest incidence of cerebral complications was found in patients who underwent single-valve replacement (1.2%) and the highest incidence was found in patients who underwent combined procedures (valve and coronary artery surgery; 7.6%). Patients greater than 70 years of age had a complication rate of 4.1% compared with 2.5% in patients aged 70 years and less (p < 0.05). The incidence of diabetes mellitus was 11.4% in the entire series, but was more common (18.7%; p < 0.05) in patients with cerebral symptoms. Also, 5.9% of all patients had a history of cerebrovascular disease compared with 14.7% (p < 0.01) of patients with cerebral complications.Conclusion: Cerebral complications may be delayed after cardiac surgery, suggesting causes of cerebral damage other than intraoperative events. Valve-surgery patients had the lowest incidence and patients with combined procedures had the highest incidence of cerebral complications. Advanced age, diabetes mellitus, and preexisting cerebrovascular disease increased the risk.
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| 3. |
- Ekbäck, Gustav, et al.
(författare)
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Sonoclot coagulation analysis : A study of test variability
- 1999
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - 1053-0770 .- 1532-8422. ; 13:4, s. 393-397
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the reproducibility of Sonoclot coagulation analysis (SCA; Sienco Inc, Morrison, CO). The authors wished to determine if the mix/release of the preloaded celite activator in standard Sono-cuvettes could be responsible for the high variation coefficients for SCA parameters with citrated whole blood and if citrated whole blood is optimal for SCA.Design: A prospective trial.Setting: A large academic teaching medical center.Participants: Eight healthy volunteers.Interventions: Repeated blood sampling was performed through indwelling radial artery catheters. Seven different Sonoclot analyzers were used to test seven different types of analysis procedures in the volunteers, involving activators of different types and amounts and in different forms, and the use of citrated or native whole blood.Measurments and Main Results: Two-way and one-way ANOVA, variance, variance analysis, and Tukey's test were used to evaluate differences in SCA methods and volunteer influence. A high variance, with SDs up to 200% of the median values of the SCA parameters with recalcified citrated blood and the standard Sono-cuvette, was confirmed. SCA with native blood and/or the use of other types of preloaded activators, ie, kaolin, significantly (p < 0.05) reduced this variance. Repeated SCAs further reduced the variance to 10% to 35% of the variance for a single analysis (standard cuvette and native blood).Conclusion: Improvement of the activator in the Sonocuvette, use of native whole blood, and repeated Sonoclot analyses reduced the previously reported high variability of this instrument.
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| 4. |
- Gannedahl, Per E., et al.
(författare)
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Vectorcardiographic changes as predictors of cardiac complications during major vascular surgery
- 1998
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Springer. - 1053-0770 .- 1532-8422. ; 12:1, s. 38-44
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To elucidate the relation of changes in computerized vectorcardiographictrend parameters indicating perioperative myocardial ischemia with perioperative cardiaccomplications.DESIGN:Prospective clinical study.SETTING:A single university hospital.PARTICIPANTS:Thirty-eight patients undergoing elective abdominal aortic surgery.INTERVENTIONS:Computerized vectorcardiography recorded during surgery and for 48 hours postoperatively.MEASUREMENTS AND MAIN RESULTS:Vectorcardiographic spatial alterations in the QRS complex (QRS-VD) and absolute (ST-VM) and spatial (STC-VM) ST-segment changes, previously used indicators of myocardial ischemia, were analyzed and related to the cardiac events detected clinically. In five patients with clearly ischemic (cardiac death, myocardial infarction, recurrent ischemia) and eight patients with possibly ischemic (congestive heart failure, arrhythmia) perioperative cardiac events, ST-VM and STC-VM were significantly increased intraoperatively. Postoperatively, these differences remained, but QRS-VD were also significantly increased. Intraoperative and postoperative changesindicating ischemia were strongly related (r = 0.83). The signs of ischemia were most pronounced during the postoperative 12 to 36 hours. The presence of 60 minutes of signs of ischemia during 2 hours revealed high sensitivity (85%), specificity (80%), and positive (69%) and negative (91%) predictive values for subsequent cardiac events. Traditional vector loop analysis showed signs of non-Q-wave infarctions in six patients, whereas only three of these were detected using standard clinical methods.CONCLUSIONS:Vectorcardiographic signs of myocardial ischemia were significantly increased intraoperatively, but most pronounced postoperatively in the patients subsequently suffering cardiac events. The changes could be related to the individual cardiac morbidity with acceptable precision. Thus, continuous vectorcardiographicmonitoring may be beneficial for patients at risk of developing perioperative ischemia.
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| 5. |
- Arbeus, Mikael, et al.
(författare)
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Milrinone Increases Flow in Coronary Artery Bypass Grafts After Cardiopulmonary Bypass : A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
- 2009
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1053-0770 .- 1532-8422. ; 23:1, s. 48-53
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effects of a bolus of milrinone, 50 mu g/kg, versus placebo on flow in coronary artery bypass grafts after cardiopulmonary bypass (CPB). Design: A prospective, randomized, double-blind study. Setting: A university hospital. Participants: Forty-four patients with stable angina and left ventricular ejection fraction > 30% scheduled for elective coronary artery bypass graft (CABG) surgery were included. Intervention: Patients were randomized to receive 50 mu g/kg of milrinone (n = 22) or placebo (n = 22) after aortic declamping. Measurements and Main Results: The flow in coronary artery bypass grafts was measured with a transit time flow meter at 10 minutes and 30 minutes after termination of CPB. The hemodynamic evaluation included transesophageal echocardiography, mean arterial pressure (MAP), heart rate, and intracavitary measurement of left ventricular end-diastolic pressure (LVEDP). The flow in the saphenous vein grafts was significantly higher in the milrinone group when compared with the placebo group both at 10 and 30 minutes after termination of CPB (p < 0.001). At 10 minutes, the flow was 64.5 +/- 37.4 mL/min (mean +/- standard deviation) and 43.6 +/- 25.7 mL/min in nonsequential vein grafts for milrinone and placebo, respectively. Corresponding values at 30 minutes were 54.8 +/- 29.9 mL/min and 35.3 +/- 22.4 mL/min. The left internal thoracic artery (LITA) flow was higher in the milrinone group but did not reach statistical significance. The fractional area change was higher, and the MAP and calculated pressure gradient (MAP-LVEDP) were lower at 10 minutes in the milrinone group. Conclusion: Milrinone significantly increases the flow in anastomosed saphenous vein grafts after CPB, and has beneficial effects on left ventricular function.
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| 6. |
- Axelsson, Birger, et al.
(författare)
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Milrinone improves diastolic function in coronary artery bypass surgery as assessed by acoustic quantification and peak filling rate : a prospective randomized study
- 2010
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1053-0770 .- 1532-8422. ; 24:2, s. 244-249
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the effects of a bolus dose of milrinone, 50 microg/kg, to placebo on diastolic function (active relaxation) in patients undergoing on-pump coronary artery bypass grafting (CABG).DESIGN: Prospective, randomized, double-blind, placebo-controlled study.SETTING: University hospital.PARTICIPANTS: Twenty-four patients with stable angina and left ventricular ejection fraction >30%, scheduled for elective CABG using cardiopulmonary bypass (CPB), were included.INTERVENTION: Patients were randomized to receive either 50 microg/kg of milrinone (n = 12) or placebo (n = 12) after aortic declamping.MEASUREMENTS AND MAIN RESULTS: The diastolic function of the left ventricle (LV) was measured as peak filling rate (dA/dt [maximal diastolic area change over time]) with transesophageal echocardiography (TEE) using acoustic quantification (AQ) before CPB and 10 minutes after termination of CPB. The normalized peak filling rate (dA/dt)/EDA was also calculated. Active relaxation was statistically significantly increased in the milrinone group compared with the placebo group after CPB.CONCLUSION: Patients undergoing CABG surgery and treated with milrinone after aortic declamping had better diastolic function following cardiopulmonary bypass.
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| 7. |
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| 8. |
- Bergman, ASF, et al.
(författare)
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Diltiazem infusion for renal protection in cardiac surgical patients with preexisting renal dysfunction
- 2002
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1532-8422 .- 1053-0770. ; 16:3, s. 294-299
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate if the calcium channel blocker diltiazem protects postoperatively renal function in cardiac surgical patients with preexisting mild-to-moderate renal dysfunction. Design: Prospective, randomized, placebo-controlled, double-blind, clinical study. Setting: Cardiothoracic anesthesia department at a university hospital. Participants: Adult patients undergoing elective cardiac surgery using cardiopulmonary bypass, with a preoperatively elevated serum creatinine level (n = 24). Interventions: Randomized infusions of diltiazem (bolus 0.25 mg/kg followed by a continuous infusion of 1.7 pg/kg/min) (DTZ, n = 12) or placebo (C, n = 12) were started 30 minutes before induction of anesthesia and continued for 24 hours. Measurements and Main Results: Median plasma concentrations of diltiazem (DTZ group) were 79 mug/L before cardiopulmonary bypass, 67 mug/L at the end of cardiopulmonary bypass, and 164 mug/L at 24 hours postoperatively. Serum creatinine levels; on postoperative days 1, 3, and 5; and 3 weeks postoperatively were similar between groups. lohexol clearance did not differ between the groups on day 5 but was higher in the DTZ group than in the placebo group 3 weeks after surgery (median, 51 v 40 mL/min/1.73 m(2); p < 0.05). Urinary N-acetyl-β-glucosamidase concentrations were similar between the groups during the study but were increased from baseline on days 2 and 4 and 3 weeks postoperatively. Conclusion: Diltiazem can be safely used in patients who have mild-to-moderate renal dysfunction and undergo cardiac surgery using cardiopulmonary bypass. Within the limits of this study, the data suggest that addition of prophylactic diltiazem may prevent further glomerular damage resulting from cardiopulmonary bypass and may improve glomerular function 3 weeks after cardiac surgery.
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| 9. |
- Biancari, Fausto, et al.
(författare)
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Gender and the Outcome of Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation
- 2022
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1053-0770 .- 1532-8422. ; 36:6, s. 1678-1685
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Tidskriftsartikel (refereegranskat)abstract
- Objective: There is a paucity of sex-specific data on patients’ postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO). The present study sought to assess this issue in a multicenter study. Design: Retrospective, propensity score–matched analysis of an international registry. Setting: Multicenter study, tertiary university hospitals. Participants: Data on adult patients undergoing postcardiotomy VA-ECMO. Measurements and Main Results: Between January 2010 and March 2018, patients treated with postcardiotomy VA-ECMO at 17 cardiac surgery centers were analyzed. Index procedures considered were coronary artery bypass graft surgery, isolated valve surgery, their combination, and proximal aortic root surgery. Hospital and five-year mortality constituted the endpoints of interest. Propensity score matching was adopted with logistic regression. A total of 358 patients (mean age: 63.3 ± 12.3 years; 29.6% female) were identified. Among 94 propensity score–matched pairs, women had a higher hospital mortality (70.5% v 56.4%, p = 0.049) compared with men. Logistic regression analysis showed that women (odds ratio [OR], 1.87; 95% confidence interval [CI] 1.10-3.16), age (OR, 1.06; 95%CI 1.04-1.08) and pre-ECMO arterial lactate (OR, 1.09; 95%CI 1.04-1.16) were independent predictors of hospital mortality. No differences between female and male patients were observed for other outcomes. Among propensity score–matched pairs, one-, three-, and five-year mortality were 60.6%, 65.0%, and 65.0% among men, and 71.3%, 71.3%, and 74.0% among women, respectively (p = 0.110, adjusted hazard ratio, 1.27; 95%CI 0.96-1.66). Conclusions: In postcardiotomy VA-ECMO, female patients demonstrated higher hospital mortality than men. Morbidity and late mortality were similar between the two groups.
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| 10. |
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