Avoiding intra-arterial placement of the introducer sheath. II.
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Arteries↗
Biomedical subjects
J V Roth
Publications and source records attributed to J V Roth.
Catastrophic cardiopulmonary bypass accident.
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Anesthesia, Inhalation↗
Temporary transmyocardial pacing using epicardial pacing wires and pacing pulmonary artery catheters.
This study investigated the feasibility of transmyocardially pacing the heart using one temporary epicardial pacing lead and one endocardial lead of a pacing pulmonary artery catheter. Twenty patients undergoing cardiopulmonary bypass with cardioplegic arrest were studied 10 to 45 minutes and 18 to 30 hours after discontinuation of cardiopulmonary bypass. The Swan-Ganz Flow-Directed Pacing TD Catheter (Baxter Healthcare Corporation) was inserted in one group of 10 patients, and the Swan-Ganz Thermodilution A-V Paceport Catheter (Baxter Healthcare Corporation, Irvine, CA) was used in another group of 10 patients. Using the Pacing TD Catheter, transmyocardial atrial (TMA) pacing was successful in 14 of 16 attempts (87.5%), and transmyocardial ventricular (TMV) pacing was successful in 15 of 16 attempts (93.8%). With the AV Paceport Catheter, TMA pacing was successful in 16 of 18 attempts (88.9%), and TMV pacing was successful in 17 of 19 attempts (89.5%). Transmyocardial atrial-ventricular sequential pacing was achieved in all cases when both TMA and TMV pacing were independently successful. There were no significant differences between catheters in the success rates of either TMA or TMV. It is concluded that transmyocardial pacing is feasible using one temporary epicardial pacing lead and one endocardial lead of a pacing pulmonary artery catheter.
Cardiac Pacing, Artificial↗
Transcutaneous pacing in patients undergoing coronary artery bypass grafting: effect of previous cardiac surgery.
Temporary transcutaneous pacing thresholds were measured in 10 patients undergoing primary coronary artery bypass grafting (CABG) operations and 10 patients having reoperative CABG operations 7 months to 14 years after their previous cardiac surgery. All surgeries were performed via median sternotomy. After anesthetic induction using either fentanyl or sufentanil in combination with enflurane, the pacing stimulation thresholds were determined. There was no significant difference (P less than 0.05) between the pacing thresholds of the reoperative group and the primary procedure group (78.2 +/- 6.2 v 79.2 +/- 4.8 mA, respectively). Transcutaneous pacing was successful in all 20 patients. Therefore, transcutaneous pacing thresholds appear unaffected by previous cardiac surgery.
Aged↗
Automated control of postoperative hypertension: a prospective, randomized multicenter study.
Hypertension after a cardiac operation is a frequent phenomenon. Complications resulting from this include bleeding, disruption of vascular suture lines, subendocardial ischemia, and possible cerebrovascular accidents. Treatment with sodium nitroprusside has become accepted practice to prevent these complications. To improve control of arterial blood pressure, a closed-loop system for sodium nitroprusside administration was developed. A prospective, randomized multicenter study was carried out postoperatively in 180 cardiac surgical patients to evaluate the performance of this system compared with manual control of infusion. Adherence of mean arterial blood pressure to +/- 10% of the target blood pressure occurred 85% of the time with the automatic system and 61% of the time with manual regulation (p less than 0.0001). With the automatic system, there was less hypertension (9% versus 22%; p less than 0.0001) and hypotension (6% versus 22%; p less than 0.0001). The superior control of hypertension was achieved more rapidly with less requirement for nurse regulation of infusion rate. The superior control of blood pressure resulted in less chest tube drainage in the automatic mode (720 mL versus 840 mL; p less than 0.05).
Aged↗
Use of the pacing pulmonary arterial catheter to detect endocardial electrical activity during hypothermic cardioplegic arrest.
The pacing Swan-Ganz catheter was evaluated for its ability to monitor atrial and ventricular electrical activity during cardioplegic arrest on cardiopulmonary bypass. This endocardial electrical activity was compared with the activity found on the standard electrocardiogram (ECG). The atrial electrodes detected activity that was noted also by visual inspection. The ventricular electrodes detected recurring electrical activity in 7 of 18 patients. Three of these 7 patients did not have simultaneous standard ECG activity, indicating that, in the usual monitoring circumstances, this ventricular electrical activity would not have been treated with repeat cardioplegia. If the pacing Swan-Ganz catheter is used for clinical care, it can be used also to monitor myocardial electrical activity during cardioplegic arrest.
Catheterization, Swan-Ganz↗
Esmolol attenuates hemodynamic responses during fentanyl-pancuronium anesthesia for aortocoronary bypass surgery.
We evaluated the effects of esmolol, a short acting (t1/2 beta = 9 min) beta-blocker on hemodynamics during noxious stimulation associated with aortocoronary bypass surgery. Group E (n = 10) and P (n = 10) patients had their morning dose of beta- or calcium blockers withheld except for nifedipine, and were given infusions of esmolol (E) or placebo (P) beginning prior to anesthetic induction and continuing until mediastinal dissection. Group S (n = 10) patients received their usual medication the morning of surgery and received neither esmolol nor placebo. All patients received fentanyl infusions for anesthesia and pancuronium for relaxation. Esmolol patients had no changes in heart rate throughout the study. In contrast, significant increases in heart rate occurred during induction, intubation, and surgical stimulation in Groups P and S. Esmolol patients had a statistically significant but transient increase in pulmonary capillary wedge pressure (PCWP) after intubation, which did not require treatment. There were no significant changes in PCWP in Group S and a decrease in PCWP in Group P patients. We conclude that esmolol was effective in attenuating potentially deleterious responses to noxious stimulation during fentanyl-pancuronium anesthesia.
Adult↗