Abstracts of papers presented at the annual meeting, canadian anaesthetists’ society, june 13-17, 1981 (original) (raw)
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Journal of …, 2008
The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase.
Can J Anaesth, 2002
Purpose: This study was designed to examine the efficacy of low-dose intrathecal morphine (ITM) on extubation times and pain control after cardiac surgery. Methods: 43 patients undergoing elective cardiac surgery were enrolled in this prospective, randomized, double-blind placebo controlled trial. Patients were given a pre-induction dose of ITM (6 µg•kg-1 per ideal body weight in 5 mL normal saline, group ITM) or 5 mL of intrathecal normal saline (group ITS). Anesthesia was induced with thiopental (3 mg•kg-1), sufentanil, midazolam and rocuronium. The total allowable doses of sufentanil and midazolam for the entire case were limited to 0.5 µg•kg-1 and 0.045 mg•kg-1 respectively. Anesthesia was maintained with isoflurane before and during cardiopulmonary bypass (CPB), and with propofol after CPB. In the postanesthesia care unit, patients received nurse-administered morphine followed by patient-controlled analgesia morphine. Serial visual analogue scale pain scores, morphine use, mini-mental state examinations and pulmonary function tests were measured for 48 hr. Patient satisfaction questionnaires were completed at the time of discharge. Results: Mean times to extubation from the application of dressings were short and did not differ between groups (ITM = 41.4 ± 33.0 min, ITS = 39.2 ± 37.1 min). During the first 24 hr postoperatively, the ITM group had improved pain control and a lower iv morphine requirement than the control group, both at rest and during deep breathing. Both forced expiratory volume in one second and forced vital capacity were improved in the ITM group. There were no differences in spinal-related side effects or in the overall complication rates. Patient satisfaction was high in both groups. Conclusion: Low-dose ITM for cardiac surgery did not delay early extubation, but it improved postoperative analgesia and pulmonary function. Objectif : Vérifier l'efficacité d'une faible dose de morphine intrathécale (MIT) sur le temps d'extubation précoce et le contrôle de la douleur après une opération en cardiochirurgie. Méthode : L'étude prospective, randomisée et à double insu contre placebo a été menée auprès de 43 patients de cardiochirurgie élective. Les patients ont reçu une dose de MIT avant l'induction (6 µg•kg-1 par poids corporel idéal dans 5 mL de solution salée, groupe MIT) ou 5 mL de solution salée intrathécale (groupe SIT). L'anesthésie a été induite avec du thiopental (3 mg•kg-1), du sufentanil, du midazolam et du rocuronium. Les doses totales permises de sufentanil et de midazolam pour toute l'opération ont été respectivement limitées à 0,5 µg•kg-1 et à 0,045 mg•kg-1. L'anesthésie a été maintenue avec de l'isoflurane avant et pendant la circulation extracorporelle (CEC), et avec du propofol après la CEC. À la salle de réveil, les patients ont reçu de la morphine administrée par une infirmière, puis par injection auto-contrôlée. Les séries de scores de douleur de l'échelle visuelle analogique, la consommation de morphine, les mini-examens de l'état mental et l'exploration respiratoire fonctionnelle ont été mesurés pendant 48 h. Des questionnaires sur la satisfaction des patients ont été remplis au moment du départ.
Anesthesia for elective cardioversion: a comparison of four anesthetic agents
Journal of Cardiothoracic and Vascular Anesthesia, 1991
Elective cardioversion is a short procedure performed under drugs provided satisfactory anesthesia for cardioversion and general anesthesia for the treatment of cardiac dysrhyth-there were no major complications. Midazolam produced a mias. Selection of the anesthetic agent is important, because more prolonged duration of effect and more interindividual a short duration of action and hemodynamic stability are variability. Propofol was associated with hypotension and a required. Forty-four patients scheduled for elective cardiover-higher incidence of apnea, and its duration of action was sion in the coronary care unit were studied prospectively. All similar to that of etomidate or thiopental. Etomidate propatients were randomly assigned, according to the last digit duced myoclonus and pain on injection; however, it was the of their clinical record number, to receive one of the four only agent that did not decrease arterial blood pressure, anesthetic agents studied: group 1,12 patients who received Thiopental reduced blood pressure but otherwise seemed an 3 mg/kg of sodium thiopental; group 2, 10 patients who appropriate anesthetic for this procedure. In conclusion, all received 0.15 mgl kg of etomidate; group 3. 12 patients who four anesthetic agents were acceptable for cardioversion, received 1.5 mgl kg of propofol; and group 4,lO patients who although their pharmacological differences suggest specific received 0.15 mg/ kg of midazolam. All patients also received indications for individual patients.
Anaesthesia for myocardial revascularisation
Anaesthesia, 1992
We studied the eflects on mycurdial performance and metabolism of,fentanyl/propofol and fentanyl/enJurane anaesthesia in 20 patients befilre coronarjl urtery bypass grafting. Anaesthesia was induced with fentanyl 20 pg.kg-' und pancuronium 0.15 mg.kg-'. Patients received, by random allocation, either propofol by infusion, 6 mg.kg-'.h-' reduced by half after 10 min then adjusted as necessary (mean rate 2.8 mg.kg-'.h-') ~ or enjurane 0.8% inspired concentration ,for 10 min reduced to 0.6% and adjusted as required (mean 0.7%). Measurements were made bef)re induction, after tracheal intubation, after skin incision and after sternotomy. There were no significant diflerences between the groups in any haemodynamic variables during the study.
Haemodynamic effects of rocuronium bromide in adult cardiac surgical patients
Canadian Journal of Anaesthesia, 1998
Haemodynamic effects of rocuronium bromide in adult cardiac surgical patients I'urpose: To measure the haemodynamic effects of rocuronium in adults undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: Twenty patients undergoing elective cardiac surgical procedures with moderate hypothermic nonpulsatile bypass participated in this prospective, observational study. After anaesthetic induction, recovery from succinylcholine, and achievement of baseline haemodynamic stability, patients received 0.6 mg'kg-I rocuronium as an initial rapid intravenous bolus. Maintenance dosing of 0.2 mg'kg-I was continued for the remainder of the procedure. Haemodynamic measurements (heart rate, systemic artedal systolic, diastolic, and mean arterial pressure, pulmonary artedal systolic, diastolic, and mean pressure, pulmonary capillary wedge pressure, central venous pressure, and thermodilution cardiac output measurements) were obtained for the fi~ tire minutes after rocurenium administration, and subjects were observed for histamine-related symptoms. Results: Central venous pressure decreased from baseline at two and five minutes after the rocuronium bolus, and mean pulmonary artery pressure decreased at five minutes. No changes were observed in hearL rate, mean systemic arterial pressure, pulmonary capillary wedge pressure, cardiac index, stroke volume, systemic vascular resistance, or pulmonary vascular resistance, nor did any patient manifest any other histamine-related symptoms. Conclusion: The haemodynamic profile for a 0.6 mg-kg-' bolus of rocuronium is acceptable for patients with cardiovascular disease. Objectif : Mesurer les effets h~modynamiques du rocuronium chez des adultes subissant une chirurgie cardiaque sous CEC. M&hodes : Vingt patients subissant une chirurgie cardiaque sous CEC ~ riot non pulsatile et sous hypothermie mod4r4e ont particil~ ~ cette ~tude d'observation prospective. Apr~s I'inductian de I'anesth&ie, r~cup~ration de I'effet de la succinylcholine et obtention d'une stabilit~ h~modynamique de base, les patients ont regu par voie IV rapide un bolus initial de 0,6 mg-kE "l de rocuronium suivi de doses de malntien de 0,2 mg.kg-~ durant route la dur6e de la procfidure. Durant les premi&es cinq minutes apr~s radministration de rocuronium, les mesures h~modynamiques suivantes ont ~t4 obtenues : rythme cardiaque, pression art&ielle syst~mique et pulmonaire, systolique, diastolique et moyenne, pression capillaire bloqu~e, pression veineuse centrale et mesures du d~bit cardiaque par thermodilution. On a aussi recherch6 chez les patients de sympt6mes li~s ~ la lib&ation d'histamine. R~sultats : Apr& un bolus de rocuronium, on a observ~ une diminution de la pression veineuse centrale apr~s deux et cinq minutes. Les autres variables, rythme cardJaque, pression art&ielle moyenne, pression capillaire bloqu6e, index cardiaque, volume d'~jection, r&istance vasculaire pulmonaire et syst~mique, n'ont pr&ent~ aucun changement. Aucun patJent n'a d~montr~ de sympt6mes li& ~ la lib6ration d'histamine. Conclusion : Une dose bolus de 0,6 mg-kg "l de racuronium poss~de un profil h4modynamique acceptable pour des patients pr&entant maJadie cardiovasculaire.
organ dysfunctions or simply hospital survival; but a healthy, productive long-term survivor (Murphy et al,2009). Anesthetic protocols in cardiac surgery are investigated and analized in terms of their effect on postoperative mortality and incidence of myocardial infarction following cardiac surgery, postoperative cardiac troponin release, need for inotropic support, time on mechanical ventilation, ICU and hospital stay (Landoni et al,2009). How to reference In order to correctly reference this scholarly work, feel free to copy and paste the following: