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Results for “Extracorporeal Circulation”

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At least 253 records · Page 14Linked to original sources

PubMed1999

[Anesthetic management using extracorporeal circulation of a patient with severe tracheal stenosis by thyroid cancer].

A 64-year-old male with tracheal stenosis by thyroid cancer was scheduled for the emergency management of airway maintenance and total thyroidectomy. Dyspnea and orthopnea appeared suddenly on the admission for operation. Cervical CT and bronchial fiberscope examination revealed the trachea oppressed at the frontal neck by thyroid tumor. The trachea diameter was nearly 5 mm at the narrowest part. Therefore it seemed to be of high risk of perform tracheal intubation and tracheostomy. Extracorporeal circulation was adopted for the respiratory management at anesthesia induction. At first, the femoral artery and vein were cannulated with local anesthesia for cardiopulmonary bypass (CPB). After confirming CPB pump working, intravenous anesthetic agents were infused. Thyroid tumor was partially resected and tracheostomy was done under CPB. After the tracheostomy, a spiral tracheal tube was inserted. Anesthesia was maintained with sevoflurane and managed with controlled ventilation. Thereafter operation and anesthesia were uneventful. After the operation, pleural bloody effusion was noticed. Blood in effusion seemed to be due to the heparinization in extracorporeal circulation. We conclude that anesthetic management with extracorporeal circulation is one of useful methods for managing severe tracheal stenosis.

Anesthesia, General↗

PubMed1993

Upregulation of Mac-1 surface expression on neutrophils during simulated extracorporeal circulation.

The leukocyte integrin Mac-1 (alpha m beta 2, CD11b/18 CR3, MO1), in addition to binding iC3b, has been shown to be the receptor for the coagulation proteins fibrinogen, factor X, and high molecular weight kininogen. Mac-1 is known to be upregulated by agonists that stimulate neutrophils or monocytes. Previous studies from this laboratory have documented neutrophil activation during cardiopulmonary bypass. We therefore used an experimental model for cardiopulmonary bypass, a simulated extracorporeal circulation, to study the surface expression of Mac-1 on peripheral blood leukocytes by immunofluorescence flow cytometry. The number of Mac-1 receptors in polymorphonuclear leukocytes had increased 2.2 times and 2.9 times baseline by 2 hours at 37 degrees C and 28 degrees C, respectively (p < 0.001). Neutrophil elastase-alpha 1-proteinase inhibitor complexes (a measure of neutrophil degranulation) increased more than sixfold from 41 micrograms/L to 256 micrograms/L after 2 hours at 28 degrees C. The number of Mac-1 receptors expressed on polymorphonuclear leukocytes correlated with polymorphonuclear leukocyte elastase complexes (r = 0.93). Mac-1--bearing lymphocytes did not display any change in receptor number in the simulated extracorporeal circulation. By 2 hours, monocytes at 37 degrees C showed only insignificant increase; at 28 degrees C they displayed a 1.6 times increase (p < 0.05). By maintaining a temperature-matched standing control samples, we could prove that, unlike the Mac-1 in polymorphonuclear leukocytes, this increase in monocyte Mac-1 is not from bypass but is rather an effect of temperature. These data suggest that a receptor for procoagulant proteins on circulating polymorphonuclear leukocytes (Mac-1) is upregulated during simulated extracorporeal circulation.

Adult↗

PubMedDate not supplied

[Rocuronium (esmerone) in anesthesia during surgery under extracorporeal circulation].

The study was undertaken to examine the myoplegic, hemodynamic, and histamine-releasing effects of the new aminosteroidal myorelaxant Rocuronium (esmerone, Organon firm) used to maintain anesthesia in cardiac surgical patients by orienting to early tracheal extubation. Twenty two patients aged 50 +/- 3 years operated on under extracorporeal circulation were examined. At the initial stage of maintenance, the agent in a dose of 0.6 mg/kg failed to affect cardiac pump function and to elevate plasma histamine levels. A moderate vagolytic effect was shown in 45% of cases. The incidence of myoplegia reduced in patients with significant circulatory insufficiency. In the preperfusion period, Rocuronium in a dose of 10.2 +/- 0.9 micrograms/kg/min blocked neuromuscular conduction (NMC) at a level of 5.1 +/- 1.8 to 19.2 +/- 3.5%. During hypothermic extracorporeal circulation and postperfusion period, the dosage of the myorelaxant substantially decreased. After termination of Rocuronium infusion, the time of up to 95%-recovery of NMC was 63 +/- 6 min. Early tracheal extubation was conducted in 68% of the patients 69 +/- 7.6 min after the end of the operation. Residual myoplegia was absent. The predictable recovery of NMC following the use of Rocuronium creates conditions for early activation of patients operated on under extracorporeal circulation.

Androstanols↗

PubMed1985

[Fatal hypoxemia following extracorporeal circulation for aortocoronary bypass. A case].

A lethal case of acute respiratory distress syndrome of the adult following extracorporeal circulation for aorto-coronary bypass is reported. This case illustrates the two mechanisms currently thought to be responsible for this pathology: (1) the passage of blood over the synthetic fibres of the cardiopulmonary bypass machine activates the complement, and the systemic inflammatory reaction that ensues accounts for the increased permeability of the alveolar capillary membrane; (2) the haemodilution inherent in extracorporeal circulation explains the hypoproteinaemia usually observed at the end of the procedure; the resulting fall in capillary osmotic pressure upsets the equilibrium of pressures in the capillary vessels.

Coronary Artery Bypass↗

PubMed1992

[Metabolic aspects of hypothermic extracorporeal circulation].

The submitted paper is devoted to some aspects of metabolic and immunity reactions of the organism to extracorporeal circulation. The authors focused attention in particular on a correlation of the whole-body oxygen consumption and the blood sugar level. Surprising findings comprise the rise of the whole-body oxygen consumption which occurs before the tissue temperature rises. As far as toxic oxygen radicals are concerned, their release is individual. It is, however, important that during the perfusion proper the activation of the immune system is suppressed. The course of the extracorporeal circulation was satisfactory from the clinical aspect; despite that it cannot be considered physiological, as also apparent from some biochemical findings.

Blood Glucose↗

PubMed1992

Complete correction of the tetralogy of Fallot in adults using separated extracorporeal circulation to block intrathoracic collateral circulation and improve perfusion of the renal vasculature.

During the last 10 years, complete correction of the tetralogy of Fallot (TOF) has been performed on 28 adult patients using the "separated extracorporeal circulation" (separated ECC) technique developed by us. In addition to the usual ascending aortic and dual right arterial cannulations for ECC, the separated ECC also involved femoral arterial cannulation and the insertion of a catheter with two balloons via the other femoral artery. Flow via the ascending aorta and femoral artery were maintained separately during ECC. The urine output during separated ECC was significantly better than that during ordinary ECC (P < 0.01) and the operative field for intracardiac correction was clearer as a result of blocking the collateral circulation. Thus we believe separated ECC to be a superior method for total correction of TOF in adults, which may enhance the operative outcome.

Adult↗

PubMed1997

In vitro pulmonary arterial relaxation after experimental lung transplantation with extracorporeal circulation.

OBJECTIVE: In search of an agent to attenuate the increased pulmonary vascular resistance after lung transplantation with extracorporeal circulation, we investigated contractions and relaxations of isolated porcine pulmonary arterial rings in organ chambers. METHODS: Rings of arteries from three groups were studied. Rings from the heart-lung block were studied immediately after Euro-Collins flush (n = 6). Rings from the recipient's native (n = 5) and transplanted (n = 5) lung were studied after 3 h of right heart bypass following transplantation. The duration of cold ischemia of the transplanted lung was 3-4 h. Contractions to potassium chloride and phenylephrine were measured. In order to study relaxations, the rings were preconstricted with phenylephrine. Relaxations to acetylcholine, adenosine diphosphate and isoproterenol were determined in rings with endothelium, and relaxations to sodium nitroprusside in rings without endothelium. RESULTS: Sodium nitroprusside induced complete relaxations (100%) in rings of arteries from all three groups. Relaxations to acetylcholine and adenosine diphosphate were comparable among the three groups, but relaxations to isoproterenol were significantly depressed in pulmonary artery rings from the transplanted lung, compared with those from the native lung. CONCLUSIONS: Lung transplantation with extracorporeal circulation is associated with depressed beta-receptor-mediated vasodilation, but the pulmonary vascular smooth muscle cell's ability to relax is not affected.

Animals↗

PubMed1991

[Endocrine response to extracorporeal circulation].

The authors analyze the results of measuring the content of vasopressin, renin, angiotensin II and aldosterone coupled with the results of studying hemodynamics, acid-base state, and lactate in the arterial blood during operations on the heart in 32 patients with different acquired heart diseases. The main attention was concentrated on studies into the nature of humoral changes during extracorporeal circulation in three types of anesthesia. In group I, anesthesia was maintained by fentanyl given in a dose of 5-6 micrograms/kg/h, diazepam (0.1 mg/kg/h), and arduan (0.02 mg/kg/h). In the second observation group, at the beginning of perfusion the patients were administered trimetotan (artonad) (0.2 mg/kg), and in group III, the dose of fentanyl was raised during perfusion to 10-12 micrograms/kg/h. It is concluded that during extracorporeal circulation, it is desirable that the dose of fentanyl be increased to attain more adequate anesthesia in that period of heart surgery. The magnitude of humoral changes occurring in the body during extracorporeal circulation served as a criterion for anesthesia adequacy.

Adult↗

PubMed1990

[Miniaturized extracorporeal circulation for infants].

By using the smallest commercially available oxygenator and our own modification of an apparatus for extracorporeal circulation we achieved minimal filling. By placing the apparatus close to the operating table the set can be miniaturized and the length of the tubes can be maximally reduced, while a satisfactory overview is ensured. The authors compared a group of 10 children operated by using this miniature apparatus with a control group of 20 children where the standard set up was used. The filling of the apparatus incl. added solutions was significantly smaller in the group with the mini-apparatus--on average 420 ml, as compared with the control group (671 ml). Despite the substantially larger amount of transfused blood in the control group with the greater volume (500 ml/patient), the resulting packed cell volume was the same in both groups. The other common postoperative parameters did not differ significantly in the two groups. The minimal filling of the apparatus for extracorporeal circulation in the described set up makes possible in the majority of children and infants with an elevated packed cell volume perfusion without the use of donor blood which is consistent with contemporary trends.

Extracorporeal Circulation↗

PubMed1989

[Combined resection of the aortic wall using extracorporeal circulation in lung cancer patients].

Two cases of lung cancer performed combined resection of the aortic wall using extracorporeal circulation were discussed in this paper. One was 59-year old male and another was 63-year old male. Both had squamous cell carcinoma of the left upper lobe. CAT scan suggested the tumor invaded into the aortic wall, main pulmonary artery and left atrium in either patients. For the first case, separated perfusion to the upper half and lower half of his body, and for the second case, perfusion only to the lower half of the body were employed to resect and repair the aortic wall, using Dacron patch. For the first case, the left main pulmonary artery and the left atrial wall were resected in advance under the regular extracorporeal circulation. The first case died of the recurrence of the tumor 1 year and 7 months post-operatively, resulting the hemorrhage into the thoracic cavity. The second case died of empyema resulting massive hemorrhage from the anastomotic site of the patch 3 months post operatively. We think some managements such as the coverage of the synthetic graft with the omentum would be needed.

Aorta↗

PubMed1997

Application of argatroban, direct thrombin inhibitor, in heparin-intolerant patients requiring extracorporeal circulation.

This study describes the present knowledge regarding the clinical application of argatroban, a direct competitive thrombin inhibitor for heparin-intolerant patients, including those with congenital and acquired antithrombin III deficiencies, those with heparin-induced thrombocytopenia, and those with high levels of polymorphonuclear granulocyte elastase. These patients are often associated with intracircuit clot formation with heparin anticoagulation during extracorporeal circulation. Therefore, argatroban may be chosen as one of the alternate anticoagulants. Because the anticoagulant effect of argatroban is reflected in the prolongation of activated thromboplastin time, monitoring is easy, similar to that for heparin. Because argatroban has a fast acting anticoagulant effect without any cofactors such as antithrombin III, this drug is a favorable anticoagulant for heparin-intolerant patients with antithrombin III deficiencies requiring extracorporeal circulation. In adverse reactions to heparin, heparin acts as an antigen after complexing with platelet factor 4, which leads to life-threatening heparin-induced thrombocytopenia. As argatroban prevents heparin-induced platelet aggregation, it is effective for use as a therapeutic anticoagulant. In other clinical applications, heparin decreases antithrombin activity and causes intracircuit clot formation during extracorporeal circulation when the polymorphonuclear granulocyte elastase level is very high. The antithrombin activity shows less decrease when argatroban is substituted for heparin. These findings indicate that argatroban is a useful alternative anticoagulant in these heparin-intolerant patients.

Anticoagulants↗

PubMedDate not supplied

Leukocytes-depleting filters preferentially remove activated leukocytes and reduce the expression of surface adhesion molecules during the simulated extracorporeal circulation of human blood.

The effect of leukocyte-depleting filters on the total and activated leukocyte counts and the expression of surface adhesion molecules CD11b, CD18, and CD62L during the in vitro extracorporeal circulation of human blood was studied. A 200 ml blood sample was taken from 10 patients undergoing CABG surgery. The blood was circulated for 60 minutes within an experimental extracorporeal circuit. A leukocyte-depleting filter was attached in five circuits (filtered group). In five other circuits, no filter was used (controls). Total leukocyte counts were determined manually. Activated leukocytes were identified using nitroblue tetrazolium staining. The expression of CD11b, CD18, and CD62L was measured with flow cytometry. At 60 minutes, total leukocyte counts were reduced by 49% from the baseline values in the filtered group and 10% in the control group (p < 0.0001). Activated leukocyte counts decreased by 86% in the filtered group and increased by 116% in the control group (p < 0.0001). In the filtered group, the expression of CD11b, CD18, and CD612L decreased by 60%, 21%, and 79%, respectively, and in the control group it increased by 24%, 6%, and 28% (p < 0.0001). Leukocyte-depleting filters preferentially remove activated leukocytes and reduce the expression of CD11b, CD18, and CD62L during the in vitro extracorporeal circulation of human blood.

Aged↗

PubMed1975

[Studies on extracorporeal circulation with large volume hemodilution using lactate ringer's solution and low molecular weight dextran: alterations of acid-base balance associated with intentional hemodilution (author's transl)].

Twenty mongrel dogs, weighing between 7.5 and 13.0 kg were used to investigate the percentage limits permissible for hemodilution using a double-helical reservoir heart-lung machine which has a 1,100 ml of priming volume. In both 40 and 50 per cent groups of intentional hemodilution by 30 minute extracorporeal circulation, remarkable anemia was inevitable and recovery was extremely slow, especially in the 50 per cent dilution group. In both 40 and 50 per cent groups of intentional hemodilutions by 30 minute extracorporeal circulation, metabolic acidosis was observed. In 50 per cent group of intentional hemodilution, no improvement of metabolic acidosis was observed even after perfusion. When sodium bicarbonate was administered to 40 per cent hemodilution group, minimum alterations of acid-base balance and of serum electrolytes were observed during and after extracorporeal perfusion. When sodium bicarbonate was administered to 50 per cent hemodilution group, metabolic acidosis was more evident than in 40 per cent hemodilution group accompanied with an increase in serum sodium concentration and a decrease in serum chloride concentration. These data qualify the use of 40 per cent intentional hemodilution using Lactate Ringer's solution or low molecular weight dextran for 30 minute extracorporeal circulation when sodium bicarbonate is administered in adequate amounts.

Acid-Base Equilibrium↗

PubMed1997

[Microembolizatoins during heart surgery under extracorporeal circulation].

OBJECTIVE: By means of transcranial Doppler sonography (TCD), microembolic signals (MES) representing embolic events can be registered during cardiac surgery and extracorporeal circulation in a considerable number of patients. We conducted the present study to determine the neuro-psychiatric consequences of MES. METHODS: 25 patients scheduled for elective aorto-coronary bypass grafting (ACBG; n = 10) or aortic valve replacement (AVR; n = 15) were studied pre- and postoperatively with neuropsychiatric testing. Results were related to the number of MES noted intraoperatively. In addition, we registered the intraoperative changes of middle cerebral artery blood flow velocity, mean arterial pressure, arterial blood gases, haemoglobin and haematocrit. Statistics included t-test, two-way analysis of variance, Mann-Whitney-U-test and Spearman correlation with p < 0.05 considered significant. RESULTS: Regarding demographic data and intraoperative parameters, both study groups (ACBG vs. AVR) were comparable except for age. AVR patients showed significantly more MES than those undergoing ACBG (p < 0.012) which was most pronounced in the late state of surgery (aortic clamp off; p < 0.0003). However, MES counts did not correlate with neuropsychiatric test results. CONCLUSIONS: In contrast to recent reports, we were unable to show a deterioration of postoperative neuropsychiatric state related to high intraoperative MES count in our patients. Future TCD studies should focus on the differentiation between gaseous emboli and particles even in the clinical setting, as the latter may well play a major role for the development of cerebral dysfunction following cardiac surgery and extracorporeal circulation.

Analysis of Variance↗

PubMed2001

[Ventricular assist support of the failing heart after surgery with extracorporeal circulation].

OBJECTIVE: To communicate our experience implanting ventricular assist devices; we report the incidence of refractory heart failure after extracorporeal circulatory support and discuss clinical course after support. PATIENTS AND METHOD: Retrospective study of 14 cases of ventricular assistance required when refractory heart failure developed after extracorporeal circulation. The patients were 10 males and 4 females aged between 12 and 70 years. Four underwent coronary revascularization, 2 required valve replacement, and 8 received heart transplants. Two left, 2 right and 6 bilateral ventricular assist devices were implanted. RESULTS: The incidence of refractory heart failure after extracorporeal mechanical circulation requiring ventricular assist devices among our patients was 0.48%, with left ventricular failure occurring in 21.42%, right ventricular failure in 42.85% and biventricular failure in 35.71%. The main complications were infection, renal insufficiency, coagulation disorder, hemorrhage with repeated surgery. One patient received a second transplant. The device was successfully withdrawn from 35.7% of the patients. Survival upon discharge was 7.1%. CONCLUSION: Refractory heart failure after extracorporeal circulation is a life-threatening event requiring rapid response and resolution. The decision to implant a ventricular assist device is a difficult one, requiring immediate assessment of the causes of heart failure, its reversibility and the possibility of performing a heart transplant. The study of large series of patients experiencing this event and implanted with ventricular assist devices would facilitate decision making.

Adolescent↗

PubMed2003

Myocardial protective effect of hypothermia during extracorporeal circulation -- by quantitative measurement of myocardial oxygen consumption -.

OBJECTIVE: To evaluate the effect of systemic temperature on myocardial protection during extracorporeal circulation, we quantitatively evaluated the relationship between myocardial oxygen consumption and rectal temperature. MATERIALS AND METHODS: Myocardial oxygen consumption during cardiac arrest was calculated via blood gas analysis of venous blood samples collected from the coronary sinus. The rectal temperatures of the patients during extracorporeal circulation ranged from 16.0 degrees C to 33.5 degrees C. The patients were classified into three groups according to their rectal temperature: group I (n=10; rectal temperature: 20.3+/-1.80 degrees C), group II (n=24; rectal temperature: 29.4+/-0.97 degrees C), and group III (n=29; rectal temperature: 31.7+/-0.72 degrees C). The myocardial oxygen consumption of each group was then compared. RESULTS: The average of the myocardial oxygen consumption of all cases was 62.5+/-64.0 O(2) ml/min/100 mm(3) left ventricle volume, and the averages of the individual groups were 26.9+/-28.8 in group I, 72.2+/-71.8 in group II, and 69.3+/-62.6 in group III. There was a significant difference in the oxygen consumption between group I and the other two groups. There was a positive correlation between the rectal temperature and myocardial oxygen consumption, as reflected in the following formula: Y=-0.3 x X +1.10 x X(2)-0.02 x X(3) (Y, myocardial oxygen consumption; X, rectal temperature; R(2)=0.533; P<0.0001). CONCLUSION: This study suggested that rectal temperature below 22.5 degrees C is advantageous due to the resultant myocardial protection such hypothermia affords.

Aged↗

PubMed1995

Influence of different flow modi during extracorporeal circulation on endothelial-derived vasoactive substances.

Influences of shear stress on endothelin (ET) as well as prostacyclin (PGF) levels are common findings in different experimental settings. Thus, plasma levels of both substances seem to be a good tool to verify if different flow modi can be produced in blood vessels by generating pulsatile flow with a roller pump. In the present study, 20 patients scheduled for elective aortocoronary bypass operation were divided into two groups at random. One group was perfused with nonpulsatile (CON-group) and the other with pulsatile flow (PULS-group) during extracorporeal circulation. ET and PGF plasma levels were monitored perioperatively together with parameters of renal function and haemodynamic data. ET values were only slightly elevated at the end of extracorporeal circulation (mean baseline value; CON 3.1 pg/ml and PULS 3.2 pg/ml; mean maximal values at the end of cardiopulmonary bypass (CPB) 4.0 pg/ml and 3.9 pg/ml respectively). Prostacylin values (median baseline values: CON 56.7 pg/ml and PULS 57.1 pg/ml) peaked at the end of operation (median CON 117.8 pg/ml and PULS 137.5 pg/ml respectively) with a subsequent small decrease. No differences between the groups could be observed at any time point with respect to vasoactive substances, urine output (CON 6.5 ml/min and PULS 6.2 ml/min) or haemodynamics during CPB. This confirms studies emphasizing that no effective microvascular pulsatile flow is generated by conventional pulsatile flow-generating devices. In the present study, normothermia and a constant flow rate were maintained during CPB. Aortic cannulae (body-surface-related not maximal large diameters) were inserted. Altering these procedures may have led to more pronounced differences between the groups. All patients had an uneventful course after the operation. Similar to other reports, the present study was not able to demonstrate any benefit of pulsatile perfusion during extracorporeal circulation.

Aged↗

PubMed1981

Blood trauma during extracorporeal circulation: a comparison between two bubble and two membrane oxygenators in a standardized dog model.

Determination of blood traumatization by extracorporeal circulation systems (ECC) in clinical trials may be interfered with by the underlying heart disease, by priming the circuit with blood or plasma expanders and by different operation techniques requiring a variable amount of coronary suction. Therefore, in this study a standardized animal model was used to compare blood traumatization in 2 bubble and 2 membrane oxygenators. After 2 hours of extracorporeal circulation, there was no advantage of the membrane over the bubble oxygenators concerning hemolysis, platelet preservation and induction of clotting factors. Red cells and platelets were traumatized in membrane oxygenators during the first 30 minutes without a significant further increase, whereas blood trauma in bubble oxygenators increased until bypass was disconnected. Therefore bubble oxygenators appear better suited for shorter perfusions, whereas membrane oxygenators are the superior choice in perfusions lasting longer than 2 hours.

Animals↗