Immediate or early extubation: where do we start?
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Coronary Artery Bypass↗
Biomedical subjects
C Royse
Publications and source records attributed to C Royse.
Lung function following cardiac surgery is not affected by postoperative ventilation time.
We investigated the effect of postoperative ventilation time on lung function following cardiac surgery. A prospective observational study of 100 elective patients. Anaesthetic technique and postoperative ventilation times reflected the routine of participating anaesthetists. Group I (n = 29) patients were extubated prior to leaving the operating room, Group II (n = 37) within 8 hours and Group III (n = 28) after 8 hours. Oxygen saturation on air, spirometry and chest x-rays were performed preoperatively and on postoperative days 2, 3 and 4. No demographic differences were detected between groups. There was no mortality, perioperative myocardial infarction or reintubation in any group. Lung function significantly declined following surgery in all groups (p<0.0001) for all endpoints, but was not different between groups. Chest x-ray changes were common in all groups but not significantly different between groups. Immediate extubation does not worsen lung function compared to early or late extubation.
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Assessment of thoracic aortic atheroma by echocardiography: a new classification and estimation of risk of dislodging atheroma during three surgical techniques.
A new classification is described to improve precision of thoracic atheroma reporting. In 68 patients, the thoracic aorta was screened with epiaortic and transesophageal echocardiography. The thoracic aorta is divided into 6 zones corresponding to sites of aortic manipulation. Zones 1-3, proximal, mid and distal ascending aorta, Zones 4-5, proximal and distal arch and Zone 6, proximal descending aorta. Each zone is further sub-divided into anterior, left lateral, posterior and right lateral quadrants. There is a marked increase in moderate and severe atheroma between Zones 1-3 and Zone 4-6 (p<0. 001). There is a difference in atheroma by quadrant with the anterior the most frequent. (p<0.001) Once the grade and location of atheroma was classified, a comparison of the estimation of risk of dislodging atheroma during three surgical methods for care, was performed. Of 50 quadrants of atheroma, the composite arterial pedicle Y graft CABG would manipulate 5, Aortocoronary CABG with single aorta cross clamp, 16, and Aortocoronary CABG with aortic partial occlusion clamp, 21. This classification of 6 zones and 4 quadrants within each zone will increase the precision of atheroma reporting and allow better comparison of stroke reduction interventions.
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Screening the thoracic aorta for atheroma: a comparison of manual palpation, transesophageal and epiaortic ultrasonography.
UNLABELLED: Accurate detection of atheroma within the thoracic aorta is an important part of most stroke prevention strategies in cardiac surgery. The thoracic aorta was divided into six zones corresponding to sites of surgical manipulation. Zones 1-3, proximal, mid and distal ascending aorta, zones 4-5, proximal and distal arch and zone 6, proximal descending aorta. This study compares the accuracy of atheroma detection by manual palpation, epiaortic (EPI) and transesophageal (TEE) ultrasonography in 70 patients. RESULTS: Using EPI as the reference method for zones 1-4, 14/70 patients were identified with moderate or severe atheroma. The frequency of atheroma was age related with the youngest at 55 years. Compared with EPI, manual palpation correctly detected moderate or severe atheroma in 7/14 patients (p=0.0058) and TEE in only 4/14 patients (p= 0.0002). For TEE, adequate imaging was only obtained in 41/70 in zone 3 and 30/70 in zone 4. Adequate imaging of zones 5-6 was obtained in all patients using TEE. Of 68 patients with adequate imaging of all zones, 36 had moderate or severe atheroma in zones 5-6. The positive predictive value for zones 1-4 based on atheroma in zones 5-6 was 39%. Of 32 patients with nil or mild atheroma in zones 5-6, only 1 had moderate or severe atheroma in zones 1-4 (negative predictive value 94%). CONCLUSION: Manual palpation and TEE are inaccurate methods of atheroma detection in zones 1-4. Epiaortic ultrasonography is recommended for all patients undergoing cardiac surgery, although the yield will be low for patients < 50 years of age or if there is nil or mild atheroma detected by TEE in zones 5-6.
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