ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Minimally invasive bypass grafting of the internal thoracic artery to the left anterior descending artery has become routine in many institutions. Currently, indications for single vessel revascularization are expanding to those patients not suitable to be operated upon using extracorporeal circulation, but surgeons remain rather reluctant when multivessel disease is concerned. In such cases, the ‘hybrid technique’, i.e. single vessel bypass grafting followed by percutaneous transluminal coronary angioplasty at a different site, seems to be a more appropriate alternative. Despite the merits of minimally invasive surgery, the majority of surgeons do not believe that it is possible to achieve the same quality of anastomosis on a beating heart as on an arrested heart.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

There is no conclusive evidence that any pharmacological intervention is able to offer effective protection for the kidneys during cardiac surgery. More research is needed into the underlying mechanisms of postoperative renal failure, specifically with regard to the possible role played by endothelial factors and inflammatory response.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Homeostatic control of the balance of pro- and anti-inflammatory cytokines is important for the maintenance of health. Cardiac surgery, with its intense pro-inflammatory stimulus, constitutes a major challenge to the patient's ability to maintain this balance. Pre- and intraoperative factors influencing the maintenance of cytokine balance are discussed.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Several recent articles have examined the effect of anesthetic technique on outcome in patients undergoing peripheral vascular surgery. This review examines the recent literature and evaluates the role of new data in advancing current understanding of the impact of anesthetic management on outcome in this high-risk population.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Perioperative hypertension is a very frequent occurrence and requires the anaesthetist to make clinical decisions regarding antihypertensive therapy, evaluation of risk, cancellation of surgery and treatment of high and low blood pressure. Perioperative management of hypertensive patients must take into account the possible consequences of left ventricular diastolic dysfunction and reduced coronary reserve.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The blood-gas barrier must be extremely thin because oxygen and carbon dioxide cross the alveolar-capillary membrane by passive diffusion, and the diffusion resistance is proportional to thickness. Despite its remarkable size (harmonic mean thickness ∼0.6 μm) the membrane must be immensely strong, because maintenance of its integrity is fundamental for pulmonary gas exchange. The basement membrane is probably the principal anatomical structure providing the strength of the blood-gas barrier. Experimental studies have demonstrated that wall stress of the capillaries can become very high when perfusion pressure is increased to 5.2 kPa (39 mmHg) or more, which was associated with breaks of the capillary endothelium, the alveolar epithelium, or both. These values are potentially reached or exceeded in different cardiac or pulmonary diseases, or in healthy humans subjected to heavy exercise. Stress failure of pulmonary capillaries may play a role in neurogenic pulmonary oedema, high-altitude pulmonary oedema, re-expansion pulmonary oedema, and some forms of the adult respiratory distress syndrome. Increased alveolar pressure due to lung inflation potentiates damage of the blood-gas barrier, suggesting that increases in capillary transmural pressure and transpulmonary pressure are equivalent in terms of their effects on capillary wall stress. These data may have importance for the management of patients with acute respiratory failure requiring mechanical ventilation.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To date, only a few published studies have been concerned with the anaesthesiological aspects of lung volume reduction surgery. This review summarizes the different anaesthetic concepts and offers a general strategy to meet specific requirements. Limitation of peak inspiratory pressure, tolerance of hypercapnia and avoidance of hypoxia during one-lung ventilation, and the immediate postoperative tracheal extubation of these patients, are considered to be crucial. However, many aspects of the procedure and of anaesthesiological management remain to be elucidated.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This review focuses on recent developments in the perioperative management of patients undergoing lung transplantation. Relevant current literature and the experience of the Munich Lung Transplant Group were taken into consideration. Recent advances include the use of inhalational nitric oxide for the treatment of early graft dysfunction and the use of aerosolized cyclosporine for the treatment of recurrent and steroid-resistant acute rejection. Opportunistic infections remain a major source of morbidity and mortality in lung transplant recipients.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Further insight into the inflammatory process of asthma has accumulated during the past few years. New inhalational anaesthetics seem to have a better bronchorelaxant effect, and prophylactic treatment with β2-agonists and local anaesthetics may also be an alternative. Bronchospasm during anaesthesia appears to be less common now, but persons with asthma should still be considered to be at an increased risk of severe morbidity.

ISSN:0952-7907    

出版商:OVID    

年代:1998

数据来源: OVID