These observations support the belief that transesophageal echocardiographic monitoring in the intensive care unit is associated with higher interobserver agreement in diagnosing and excluding significant causes of hemodynamic instability for postoperative cardiac surgical patients.
552CAN J ANESTH 2000 / 47: 6 / pp [552][553][554][555] Purpose: To describe the effects of the combination of several therapies on the pulmonary circulation and cardiac function in a patient with severe pulmonary hypertension. Clinical features:We report the case of a female patient with chronic secondary pulmonary hypertension and cardiac failure who underwent right hemicolectomy under general anesthesia. Insertion of a pulmonary artery catheter before the operation revealed pulmonary artery pressure (PAP) of 55/24 mmHg which was lowered moderately by 40 parts per million (ppm) inhNO. During surgery, the patient presented an episode of atrial fibrillation with a slow, irregular heart rate of 45-50 min -1 and variable systemic pressure. A dipyridamole DPD (0.2 mg·kg -1 ) bolus stabilized systemic pressure and increased heart rate and cardiac output. However, PAP did not change. Nitroglycerine infusion was started at 10 mg·hr -1 shortly after the initiation of DPD. The patient responded favourably to combined inhNO, intravenous DPD and NTG therapy with a marked and sustained reduction of PAP and a systemic hemodynamic stability. Conclusion:We conclude that: 1) in combination with inhNO, DPD does not augment the inhNO-induced decrease in PAP; 2) DPD improves the hemodynamic profile and elevates cardiac output; 3) therapeutic combination (inhaled NO, NTG, DPD) has a potent effect on pulmonary pressure in cardiac failure patients.Objectif : Décrire les effets d'une combinaison de thérapies sur la circulation pulmonaire et la fonction cardiaque chez une patiente qui présente une sévère hypertension pulmonaire. ) a permis de stabiliser la pression générale et d'augmenter la fréquence et le débit cardiaques. La PAP n'a toutefois pas changé. Une perfusion de nitroglycérine a été amorcée avec 10 mg·h -1 peu après le début du DPD. La patiente a bien réagi à la thérapie combinée de NOinh, de DPD intraveineux et de NTG, ce qui a entraîné une réduction marquée et soutenue de la PAP et une stabilité hémodynamique générale. Conclusion :Nous en concluons que : 1) en combinaison avec le NOinh, le DPD n'accentue pas la baisse de PAP induite par le NOinh 2) le DPD améliore les caractéristiques hémodynamiques et augmente le débit cardiaque 3) la NTG stimule la vasodilatation pulmonaire induite par le NOinh chez les patients atteints d'insuffisance cardiaque.
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