Improved cardiac performance and reduced pulmonary vascular constriction by epinephrine administration via a left atrial catheter in cardiac surgical patients

Haider, W.; Zwölfer, W.; Hiesmayr, Michael; Keznickl, P.; Heilinger, D.; Coraim, F.; Gabriel, A; Grubhofer, G.; Hrska, F.

doi:10.1016/1053-0770(93)90053-n

Cited by 8 publications

(2 citation statements)

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“…The LAP monitoring is a valuable method for managing therapy during the weaning off of the cardiopulmonary bypass and postoperative period after surgical correction of complex congenital cardiac malformations, ischaemic heart disease with left ventricular dysfunction and repair procedures for the mitral valve [Gold 1986;Mondejar 1988;Haider 1993].…”

Section: Discussionmentioning

confidence: 99%

Monitoring Left Atrial Pressure With a Useful Epidural Catheter

Arnaz

Altun

2018

HSF

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Background: Left atrial pressure (LAP) monitoring provides a valuable option for management of hemodynamic status in pediatric congenital heart surgery during the postoperative period.Methods: We used a Perifix Soft Tip 701 filter set catheter (B. Braun Melsungen AG 34209 Melsungen, Germany), which is commonly used for continuous epidural anesthesia. The catheter was placed into the left atrium to provide LAP monitoring. The study included 33 children, who needed LAP monitoring during and post-surgery between January 2016 and September 2017. Patients retrospectively were reviewed for ease of catheter placement, effectivity, accurate LAP, postoperative stability, and complications after removal of the catheter, including bleeding, air embolism, or thromboembolic events.Results: Patients ranged in age from 2 days to 131.27 months (Mean 11.80 days ± 25.76 days). Fifteen patients were newborn. Of the newborn patients, 39.4% (N = 13) were female. Catheters successfully were implanted in all patients, and there were no procedural complications. Left atrial catheters were removed between 1 to 12 days, with an average of 3.55 days ± 3.39 days before chest tube removal. During follow-up, patients did not suffer complications, such as thrombus formation, catheter-related infection, systemic embolism or stroke. Also, after the catheter was withdrawn, patients did not suffer from bleeding, haemodynamic deterioration, catheter retention, or require the need for intervention. During the stay in ICU, catheter nonfunction was the most frequent complication at 12.1 percent (N = 4). Conclusion: This is a simple, easy, and safe technique for wide use in congenital cardiac surgery patients.

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Section: Discussionmentioning

confidence: 99%

Monitoring Left Atrial Pressure With a Useful Epidural Catheter

Arnaz

Altun

2018

HSF

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“…Experience from the author's institution, in which 47 HLTx, 88 SLTx, and 82 BSLTx have been performed since 1989, is typical of those with a high caseload (Table 1). Most patients awaiting lung transplan- tation have undergone extensive workups to assess their clinical status and suitability for transplantation.…”

Section: Preoperative Evaluationmentioning

confidence: 97%

Aspects of Anesthesia for Lung Transplantation

Myles

1998

Semin Cardiothorac Vasc Anesth

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Anesthesia for lung transplantation is both a demanding and rewarding experience. Success requires teamwork, experience, knowledge of cardiorespiratory pathophysiology and its anesthetic implications, appropriate use of noninvasive and invasive monitoring, and the ability to respond quickly and effectively to lifethreatening perioperative events. Specific issues include management of a patient with end-stage lung and heart disease, lung isolation and one-lung ventilation, perioperative respiratory failure, pulmonary hypertension, and acute right ventricular failure. Recent advances include greater understanding of dynamic hyperinflation ("gas-trapping") during mechanical ventilation, perioperative use of inhaled nitric oxide and treatment of acute right ventricular failure. Successful anesthetic management leads to greater hemodynamic stability, improvement in gas exchange and a reduction in need for cardiopulmonary bypass, all of which should lead to improved patient outcome.Copyright@ 1998 by IIV. B. Saunders Company.Anesthesia for lung transplantation is one of the most complicated and demanding procedures that anesthesiologists are confronted with in their practice. Issues that arise include management of a patient with end-stage lung and heart disease, lung isolation and one-lung ventilation (OLV), perioperative respiratory failure, pulmonary hypertension and right ventricular (RV) failure, pathophysiology of cardiopulmonary bypass (CPB), coagulopathy and multiple blood product transfusion, maintenance of other vital organ function (especially brain and kidneys), and postoperative pain management.1&dquo;21 Critical incidents during the procedure are common and often life-threateningB-11 ,14,19,20; they demand rapid assessment and intervention. This can be compromised by anesthesiologist fatigue because most lung transplantation procedures take 6 to 10 hours and usually occur at night, often after a busy cardiothoracic operating scheduse.1,2,4 Successful management demands both knowledge and experience, and this is best optimized by concentrating clinical exposure to lung transplantation among a small number of dedicated anesthesiologists at any one institution. Although this increases individual work load, it does enhance expertise and consistency of practice. Work schedules the day after transplantation can be reorganized, and this is most efficiently achieved with a cohesive cardiothoracic anesthetic team. As with other types of specialized surgery, 22 outcome after lung transplantation may be affected by caseload, with larger units having more favorable results.5 Accumulating experience within an institution is also associated with improved outcome'5 ; at the author's institution, a 50% reduction from 20% to 10% in early (<90 days) postoperative mortality rate over the first 7 years of the program (G. Snell, personal communication, May 20, 1997) has been observed.Ideally, clinical practice should be evidencebased, guided by clinical trials showing superiority of one treatment over another.23,24 However, i...

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