Anaesthetic management of high-risk cardiac patients undergoing thoracic surgery with the support of intra-aortic balloon pump

Abstract

The duration of diffusion hypoxia has to be shorter than SGE, as a limited amount of N 2 O is washed out with a high concentration gradient between blood and alveolar space, especially when ventilation is with an open circuit. Interestingly, we found greater changes in arterial Pa O 2 between the first gas mixture and AIRs, independent of whether it had been nitrous oxide/oxygen or AIRc/oxygen (Fig. 1). By altering from AIRs to AIRc or nitrous oxide, much less effect on the Pa O 2 was produced compared with the above sequence. Obviously, the withdrawal of the low nitric oxide concentrations induces a mismatching in the lungs that cannot be reversed by similar concentrations of nitric oxide. Sometimes new results raise more questions than answers.

Successful Anesthetic Management of Coronary Artery Bypass Graft Patients with Very Low Ejection Fraction: Two Case Reports

“…The functioning of IABP involves inflation during diastole leading to increased diastolic pressure and reduced afterload during systole because of deflation of balloon. This improves myocardial perfusion and cardiac output along with decreased myocardial oxygen consumption [6]. Role of preoperative insertion of IABP in reducing hospital mortality and low cardiac output syndrome has already been proved by metaanalysis of randomized controlled trials [7,8,9].…”

Mechanical circulatory support devices in noncardiac surgery

“…7 Case reports describe a subset of high-risk cardiac patients managed with IABPs for NCS either in an emergency situation or to help maintain perioperative stability for an elective yet time-sensitive operation. [8][9][10][11] These patients are described as unable to be revascularized, too high risk to take antiplatelet agents following revascularization, or did not have adequate time for revascularization before NCS. While these case reports are promising, it is important to note that no clinical trial has proven a morbidity/ mortality benefit as of yet.…”

“…It is also used perioperatively in patients with critical coronary artery disease undergoing coronary artery bypass grafting to support hemodynamics 7. Case reports describe a subset of high-risk cardiac patients managed with IABPs for NCS either in an emergency situation or to help maintain perioperative stability for an elective yet time-sensitive operation 8–11. These patients are described as unable to be revascularized, too high risk to take antiplatelet agents following revascularization, or did not have adequate time for revascularization before NCS.…”

Surgical treatment of lung cancer combined with advanced atherosclerosis under intra-aortic balloon counterpulsation

“…За последние 10 лет среди больных, которые были госпитализированы в отделения торакальной хирургии для планового хирургического лечения, около 18% признаны неоперабельными из-за тяжелых конкурирующих заболеваний и неудовлетворительных параметров газообмена и гемодинамики [4]. Главной причиной отказа от оперативного вмешательства или вынужденного ограничения объема резекции легочной ткани в ущерб онкологической радикальности операции является наличие сопутствующих сердечно-сосудистых заболеваний, особенно распространенного атеросклероза с поражением коронарных артерий, сонных артерий и других ветвей аорты [7].…”