摘要:

Numerous techniques of general anaesthesia for cardiac surgery have been described. Combining general anaesthesia with a regional anaesthetic technique, or both, or the use of vasoactive drugs gives the anaesthesiologist a level of control of coronary vascular tone at least as great as that afforded by general anaesthesia alone. This control improves the ability to maintain the balance between myocardial oxygen supply and demand. This principle also holds for control of peripheral vascular tone, a critical factor in the reduction of perioperative morbidity.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Any therapy must have a benefit and a risk. The benefit of therapy with protease inhibitors, such as aprotinin and nafamostat, to reduce bleeding is well known. Data presented over the past 12 months have confirmed this efficacy and the superiority and consistency of high-dose aprotinin therapy in direct comparison with other pharmacological (desmopressin and tranexamic acid) and physical (administration of fresh platelet concentrate) interventions. Low-dose aprotinin therapy appears similar in efficacy to the lysine analogue, antifibrinolytics with a reduction in the postoperative loss collected from the thoracic and pericardial drains, and a variable effect, if any, on blood transfusions.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Haemodilution and acceptance of low haemoglobin values are important concepts to minimize allogeneic blood transfusions. Safety of moderate haemodilution could be established in patients with severe coronary artery disease, in patients with compromised myocardial function, and in patients of advanced age. The fundamental question concerning the ‘critical haemoglobin value’, however, cannot be given a general answer at present. We can only conclude that the ‘critical haemoglobin value’ is below 10 g/dl in patients with severe coronary artery disease and below 9 g/dl in elderly patients without a history of coronary disease. Advanced age and moderately reduced myocardial contractility, that is, a left ventricular ejection fraction greater than 35%, appear not to compromise the compensatory capacity during acute isovolaemic haemodilution. Drug effectiveness at various haemoglobin levels, newly discovered mechanisms responsible for the increase in cardiac output during haemodilution, potential dangers of haemodilution, and the use of injectable artificial oxygen carriers, such as haemoglobin solutions and fluorocarbon emulsions, will also be discussed.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Despite improvements in myocardial protection and in treatments, postoperative circulatory failure in adults remains with a severe prognosis of either diastolic or systolic left ventricular dysfunction. The introduction of inhaled nitric oxide in the treatment of right ventricular failure, caused by high pulmonary artery pressure, modifies the outcome.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Several cardiopulmonary bypass techniques and their influence on neuropsychological outcome after cardiac surgery are reviewed. Intermittent systemic reperfusion, selective antegrade and retrograde perfusion, as well as pharmacological cerebroprotection during deep hypothermic cardiopulmonary bypass with circulatory arrest seem to reduce postoperative neurological damage. Measurement of cerebral blood flow during bypass is still a problem. The133Xenon method was found to underestimate cerebral blood flow by 50% and there are conflicting results concerning the validity of transcranial Doppler sonography as an index of cerebral blood flow during hypothermic cardiopulmonary bypass. Monitoring of cerebral venous oxygen saturation is becoming more important because desaturation periods seem to be related to adverse neuropsychological outcome.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Inhaled nitric oxide is an interesting advance in the treatment of pulmonary arterial hypertension. In pulmonary vessels, nitric oxide bonds readily with haemoglobin resulting in immediate inactivation of the molecule and perfect maintenance of systemic blood pressure. This selective pulmonary vasodilation is fundamental to the efficacy of nitric oxide in the treatment of right ventricular failure caused by pulmonary arterial hypertension

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The immune response to cardiopulmonary bypass involves complement, neutrophil activation and cytokine release. Promising therapeutics for cardiopulmonary bypass and its associated methodological problems are discused. The major subjects addressed include: the pathophysiology and prognosis associated with cardiopulmonary bypass and the relationship of these with the techniques used; the gastrointestinal injury during cardiopulmonary bypass; the relation between reperfusion and inflammation; the immunomodulatory effects of steroids; and transfusion. Two possible mechanisms are involved in promoting the immune response to cardiopulmonary bypass: biocompatibility and intestinal translocation.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Over the past few years there has been increased understanding of the role of platelet activation and thrombosis in the pathogenesis of acute coronary ischaemia, occlusive stroke, and peripheral vascular occlusion. Advances in thrombolysis, antiplatelet, and anticoagulant therapy have reduced the incidence and morbidity of these disorders. Novel antiplatelet and anticoagulant drugs promise further improvements.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Antidysrhythmic drug research has recently focused on developing agents whose primary electrophysiological action is to selectively prolong repolarization. The major impetus for the development of these ‘pure’ class III agents was the assumption that their smaller effects on conduction velocity and contractility would make them safer drugs than class I agents. In this article, we will review some recently discovered electrophysiological properties of class III drugs that may markedly limit their clinical utility. Lastly, a novel therapeutic approach that exploits the antidysrhythmic properties of endogenous adenosine is described.

ISSN:0952-7907    

出版商:OVID    

年代:1996

数据来源: OVID