Abstract:
OBJECTIVE:Pulmonary resection may be associated with considerable alterations of the cardiorespiratory system. The ideal anesthetic regimen for these patients is not yet definitely determined. DESIGN:Prospective, randomized study. SETTING:Single-institutional, clinical investigation in a thoracic anesthesia department of a university hospital. PARTICIPANTS:Fifty consecutive patients scheduled for elective thoracic surgery for lung cancer. INTERVENTIONS:In 20 patients undergoing lobectomy, fentanyl/propofol/nitrous oxide/vecuronium anesthesia was used, and extubation was planned immediately after surgery (group 1A, early extubation). Another 20 patients with lobectomy were anesthetized during fentanyl/midazolam/vecuronium, and they were extubated in the intensive care unit (ICU) (group 1B, late extubation). Ten patients underwent pneumonectomy (extubation planned in the ICU) (group 2, pneumonectomy). Patients of groups 1A and 1B were selected according to a randomized sequence. MEASUREMENTS AND MAIN RESULTS:Extensive hemodynamic monitoring was performed using a pulmonary artery catheter by which right ventricular hemodynamics (right ventricular ejection fraction [RVEF], right ventricular end-systolic, and end-diastolic volumes) were additionally measured. Measurements were performed after induction of anesthesia (supine position, baseline values), before surgery (lateral position), 30 minutes after one-lung ventilation (OLV) was induced, at the end of surgery (supine position), 2 hours after surgery (in ICU), and on the morning of the first postoperative day. Pneumonectomy resulted in an increase in the pulmonary wedge pressure (from 12.2 +/- 2.9 to 18.3 +/- 3.8 mmHg) and a deterioration in right ventricular hemodynamics with a decrease in RVEF from 40.6 +/- 3.4% to 28.8 +/- 4.3% at the end of surgery. These changes were also seen on the morning of the first postoperative day. PaO2/FI02, Qs/Qt, VO2I, and DO2I were also significantly different between pneumonectomy and lobectomy patients. Intraoperatively, patients of group 1A and 1B showed almost similar cardiorespiratory data. During OLV, PaO2/FIO2 was significantly less reduced in group 1A (to 292 +/- 98 mmHg) than in group 1B (to 200 +/- 120 mmHg). Postoperatively, patients of group 1A were orientated, and physiotherapy could be started early. No relevant differences with regard to cardiorespiratory parameters were observed between group 1A and group 1B in the postoperative period until the first postoperative day. CONCLUSIONS:In comparison with lobectomy patients, pneumonectomy resulted in more pronounced and sustained deterioration in right ventricular hemodynamics. The kind of anesthesia regimen did not influence most of the cardiorespiratory parameters intraoperatively, except for Qs/Qt, which was least compromised in the propofol patients during OLV. Early extubation could safely be performed in the lobectomy patients anesthetized with propofol without showing any negative cardiorespiratory effects.
journal_name
J Cardiothorac Vasc Anesthjournal_title
Journal of cardiothoracic and vascular anesthesiaauthors
Boldt J,Müller M,Uphus D,Padberg W,Hempelmann Gdoi
10.1016/s1053-0770(96)80045-0subject
Has Abstractpub_date
1996-12-01 00:00:00pages
854-9issue
7eissn
1053-0770issn
1532-8422pii
S1053-0770(96)80045-0journal_volume
10pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:The aim of this study was to investigate the effect of systemic CPB temperature on the production of the key mediators of the systemic inflammatory response to coronary artery bypass graft (CABG) surgery. DESIGN:Randomized clinical study. SETTING:University hospital. PARTICIPANTS:Thirty patients undergoing...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2006.02.030
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN:A retrospective analysis of prospectively collected clinical data. SETTING:Cardiothoracic surgery and an intensive care...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2010.07.002
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate whether isoflurane, a known negative lusitropic agent, exacerbates diastolic dysfunction in patients with preexisting impaired relaxation. DESIGN:Prospective, experimental study. SETTING:Single-institution, university hospital. PARTICIPANTS:Twenty-five patients ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2006.01.018
更新日期:2006-08-01 00:00:00
abstract::Appropriate anesthesia for LVAD placement needs to incorporate an understanding of the surgical procedure and LVAD physiology, the altered physiology and pharmacology of the cardiac failure patient, and a knowledge of the interaction of anesthesia with the potent cardiac drugs used in end-stage heart failure therapy. ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:
更新日期:2000-06-01 00:00:00
abstract::Cardiopulmonary bypass has been shown to activate various inflammatory cascades in the body, resulting in pathophysiological changes that may affect patient outcome after cardiac surgery. Many of these inflammatory cascades are enzyme mediated, involving serine proteases. This report reviews the mechanisms of bypass-m...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s1053-0770(97)80006-7
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVES:Mesenteric ischemia is still a fatal event after cardiac procedures. No adequate intraoperative methods are available to monitor the gastrointestinal mucosal microcirculation in real-time conditions. The aim of the study was to assess a newly designed microprobe using laser Doppler flowmetry and remission sp...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2014.07.003
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVES:Bleeding into the chest is a major cause of blood transfusion and adverse outcomes following cardiac surgery. The authors investigated predictors of bleeding following cardiac surgery to identify potentially correctable factors. DESIGN:Data were retrieved from the medical records of patients undergoing card...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2013.09.010
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:The present study was designed to evaluate the effects of the nitric oxide synthesis inhibitor NG-nitro-L-arginine methyl ester (L-NAME) on right ventricular (RV) contractility, both pulsatile and nonpulsatile contributions to afterload, and relate any changes to alterations in performance of the RV as a pum...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(96)80055-3
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVES:Octogenarians considered for cardiac surgery encounter more complications than other patients. Postoperative complications raise the question of continuation of high-cost care for patients with limited life expectancy. Duration of hospitalization in intensive care after cardiac surgery may differ between oct...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2016.07.029
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the pretreatment effect of simvastatin on spinal cord ischemia-reperfusion injury. DESIGN:Prospective, interventional study. SETTING:University research laboratory. PARTICIPANTS:Forty-five male Sprague-Dawley rats. INTERVENTIONS:Rats were treated with oral simvastatin...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2012.01.025
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:Because of the lack of data regarding the impact of obesity on propofol pharmacokinetics in patients undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), the authors sought to explore propofol pharmacokinetics and develop a predictive pharmacokinetic model that characterizes and predicts...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2016.02.003
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:The present study examined the feasibility and efficacy of continuous bilateral erector spinae blocks for post-sternotomy pain in pediatric cardiac surgery. DESIGN:Prospective cohort study; patients were retrospectively matched 1:2 to control patients. Conditional logistic regression was used to compare dich...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.10.009
更新日期:2020-10-12 00:00:00
abstract:OBJECTIVES:During cardiac surgery, circulating red blood cells (RBCs) are at risk of exposure to environmental factors during extracorporeal circulation and transfusion of stored RBCs. For this study, the authors observed morphological differences, deformability, density distribution, and erythrocyte indices of RBCs du...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.03.030
更新日期:2019-11-01 00:00:00
abstract::This study examined the effects of global normothermic hypoperfusion on the compressed spectral array (CSA) processed electroencephalogram (EEG) during high-dose narcotic anesthesia. Fifteen patients undergoing cardiac electrophysiologic surgery were studied. The patients were anesthetized with a standard high-dose na...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(91)90276-y
更新日期:1991-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the safety and efficacy of ketamine in pediatric patients undergoing interventional cardiac procedures. DESIGN:A retrospective clinical study. SETTING:A single, tertiary referral center. PARTICIPANTS:Patients (n = 107) undergoing interventional cardiac procedures between July 1996 and July 1998...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(00)90053-3
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVES:Use of viscoelastic testing, such as thromboelastography (TEG), is recommended in cardiac surgery to monitor coagulation and to guide the transfusion of blood products. The Quantra QPlus System is a novel point-of-care platform that uses ultrasonic pulses to characterize dynamic changes in viscoelastic prope...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.11.058
更新日期:2020-12-08 00:00:00
abstract:OBJECTIVE:To determine whether patients receiving pegorgotein preoperatively would be less likely than patients receiving placebo to demonstrate postoperative cerebral or myocardial dysfunction and thus would be less likely to (1) demonstrate a decline in neuropsychologic testing after cardiopulmonary bypass, (2) recei...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1053-0770(99)90121-0
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:To delineate associations between preoperative risk factors and clinical processes of care and perioperative glucose tolerance in patients managed on a fast-track cardiac surgery clinical pathway with prebypass methylprednisolone administration. DESIGN:Retrospective sequential cohort study. SETTING:Universi...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2000.18298
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to assess the feasibility and effects on perioperative management of a focused transthoracic echocardiogram performed by anesthesiologists. DESIGN:A prospective observational study of all patients having a focused cardiovascular ultrasound (FoCUS). SETTING:A single tertiary referr...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2009.01.018
更新日期:2009-08-01 00:00:00
abstract::This study was designed to compare the cardiovascular effects of pipecuronium bromide (PIP) to vecuronium (V) when combined with sufentanil (SF) in patients undergoing coronary artery bypass surgery. Eighty-two patients were studied; 40 were normotensive and 42 had hypertension currently controlled by pharmacological ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/1053-0770(91)90321-j
更新日期:1991-04-01 00:00:00
abstract:OBJECTIVE:The authors aimed to assess the hemodynamic effects and demonstrate the feasibility of inhaled nitric oxide (iNO) in hemodynamically unstable patients with acute right ventricular (RV) dysfunction and to explore the safety profile of this approach. DESIGN:Retrospective cohort study. SETTING:Intensive care u...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.08.004
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVES:Recent studies have demonstrated that perioperative myocardial ischemia, detected by electrocardiography, is a risk factor for myocardial infarction. ST-segment analyzers and hemodynamic monitors may be useful for on-line detection in perioperative and critical care environments. However, independent perform...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(05)80230-7
更新日期:1995-12-01 00:00:00
abstract::Aprotinin has been reported to reduce bleeding in cardiac surgery patients. Its mechanisms of action on coagulation have not been fully elucidated. In a prospectively randomized study of 40 patients undergoing elective aortocoronary bypass grafting, the influence of high-dose aprotinin (2 million IU of aprotinin befor...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/1053-0770(94)90164-3
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVES:There is still controversy about whether an infant should have cardiac surgery concomitant with ongoing persistent pneumonia. This study analyzes the outcome of surgical treatment for infants with left-to-right shunt congenital heart disease accompanied with persistent pneumonia and discusses the perioperati...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.05.039
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To determine the effect of cardiopulmonary bypass (CPB) on hepatic blood flow (HBF) and the hepatic venous flow pattern. DESIGN:Single-arm prospective study. SETTING:University hospital operating room and intensive care unit. PARTICIPANTS:Eight patients ranging in age from 57 to 73 years undergoing cardiac...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(96)80090-5
更新日期:1996-04-01 00:00:00
abstract:OBJECTIVES:This study was conducted to compare continuous cardiac output (CCO) with bolus thermodilution cardiac output (BTD) at steady state, and to compare the response time of STAT CCO with that of trend CCO, mean arterial pressure, and mixed venous oxygen saturation [SvO2] during an acute hemodynamic change. DESIG...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(97)90050-1
更新日期:1997-06-01 00:00:00
abstract:OBJECTIVES:The authors performed a meta-analysis to evaluate whether levosimendan is associated with improved survival in patients undergoing cardiac surgery. DESIGN:A meta-analysis. SETTING:Hospitals. PARTICIPANTS:A total of 440 patients from 10 randomized controlled studies were included in the analysis. INTERVEN...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1053/j.jvca.2009.05.031
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decrease...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.09.012
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To identify patients with poor tissue factor pathway inhibitor (TFPI) response to heparin and observe any association with increased risk of excessive coagulation activation, morbidity, or mortality. DESIGN:Prospective, observational cohort study. SETTING:University hospital. PARTICIPANTS:Patients (n = 96)...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2002.29677
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVES:To determine whether individualized selection of double-lumen tubes or alternatives based on three-dimensional reconstruction of the tracheobronchial image from routine preoperative computed tomography (CT) scans leads to clinically appropriate choices. DESIGN:Prospective observational study; comparison to ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(99)90003-4
更新日期:1999-10-01 00:00:00