RESUMEN
The authors prospectively investigated the ability of thiopental to decrease neuropsychiatric complications as a consequence of open-ventricle operations requiring cardiopulmonary bypass. Eighty-nine randomly assigned patients received sufficient thiopental to maintain electroencephalographic silence throughout the period from before atrial cannulation to termination of bypass. These patients received an average of 39.5 mg/kg of thiopental, while 93 control patients received only fentanyl. On the first postoperative day, five thiopental (5.6%) and eight control (8.6%) patients exhibited clinical neuropsychiatric abnormalities. By the tenth postoperative day, all neuropsychiatric dysfunction had resolved in the thiopental group but persisted in seven (7.5%) control patients (P less than 0.025). The incidence of complications was significantly related to calcification of replaced valves, aortic valve replacement, advanced age, and prolonged bypass, but not to low blood pressure during perfusion. The authors believe their data are consistent with embolism as the most important cause of sensory-motor neurologic dysfunction following cardiopulmonary bypass. The data also provide evidence that thiopental in sufficient dosage can reduce the clinical consequences of these events. This is the first demonstration of cerebral protection by a barbiturate in humans.
Asunto(s)
Barbitúricos/uso terapéutico , Puente Cardiopulmonar/efectos adversos , Complicaciones Posoperatorias/psicología , Factores de Edad , Anciano , Presión Sanguínea , Calcinosis/complicaciones , Deluciones/etiología , Electroencefalografía , Femenino , Alucinaciones/etiología , Prótesis Valvulares Cardíacas , Humanos , Masculino , Trastornos de la Memoria/etiología , Persona de Mediana Edad , Contracción Miocárdica/efectos de los fármacos , Pruebas Neuropsicológicas , Complicaciones Posoperatorias/prevención & control , Fases del Sueño , Tiopental , Factores de TiempoRESUMEN
We evaluated risk of heart block after cardiopulmonary by-pass (CPB) in patients with normal conduction undergoing coronary artery bypass grafting who chronically received calcium-entry blockers, beta-blockers, or combined therapy. Before CPB, calcium-entry blockers alone produced an increase in P-R intervals but no change in heart rate; calcium-entry blocker effects were undetectable after CPB, beta-Blockers alone or with calcium-entry blockers produced lower heart rates and longer P-R intervals throughout the entire perioperative period when compared to no therapy (control) or calcium-entry blockers alone. Complete heart block did not occur; one control patient had transient second degree block after CPB. First degree block appeared transiently in 5% of the patients after anesthetic induction and in 15% on emergence from CPB, but was unrelated to drug therapy. We conclude that chronic calcium-entry blocker therapy has minimal effects on conduction perioperatively; beta-blocker effects persist for up to 10 hr after CPB; and the risk of heart block with either drug or combination is low and should not be a factor in their continued administration preoperatively.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Puente Cardiopulmonar , Bloqueo Cardíaco/prevención & control , Complicaciones Posoperatorias/prevención & control , Combinación de Medicamentos , Electrocardiografía , Electrofisiología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Periodo Intraoperatorio , Persona de Mediana Edad , Premedicación , Estudios ProspectivosRESUMEN
The frequency of complications following radial artery cannulation for monitoring purposes was determined in 1,699 cardiovascular surgical patients and in 83 patients in whom cannulation was performed in another artery after failure at the radial site. Patients were examined and radial artery flow determined by a Doppler technique 1 day and 7 days after decannulation. Although partial or complete radial artery occlusion after decannulation occurred in more than 25% of the patients, no ischemic damage to the hand or disability occurred in any patient. Neither duration of cannulation nor the size or material of the cannulas were determinants of abnormal flow. Abnormal flow was significantly related to female sex, the presence of hematoma, and to the use of extracorporeal circulation. The radial arteries of 16 patients whose results of Allen's test were abnormal were cannulated and no abnormal flow or ischemia followed. In 22 patients, the ulnar artery was cannulated after multiple punctures of the ipsilateral radial artery and no ischemia followed. We conclude that in the absence of peripheral vascular disease, the Allen's test is not a predictor of ischemia of the hand during or after radial artery cannulation, that when decreased or absent radial artery flow follows cannulation it is of no clinical consequence, and that radial artery cannulation is a low-risk high-benefit monitoring technique that deserves wide clinical use.