Prospective randomised double-blind comparative study of rocuronium and pancuronium in adult patients scheduled for elective ‘fast-track’ cardiac surgery involving hypothermic cardiopulmonary bypass

Anaesthesia ◽  
2003 ◽  
Vol 58 (3) ◽  
pp. 265-271 ◽  
Author(s):  
R. Thomas ◽  
D. Smith ◽  
P. Strike
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Comparative Study ◽  
Fast Track ◽  
Adult Patients ◽  
Double Blind ◽  
Hypothermic Cardiopulmonary Bypass

scholarly journals Spindle Activity in Children During Cardiac Surgery and Hypothermic Cardiopulmonary Bypass

2002 ◽  
Vol 19 (6) ◽  
pp. 547-552 ◽  
Author(s):  
Bernhard Schmitt ◽  
Oskar G. Jenni ◽  
Urs Bauersfeld ◽  
Rolf Schüpbach ◽  
Edith R. Schmid
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hypothermic Cardiopulmonary Bypass ◽  
Spindle Activity

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Annalisa Franco ◽  
Chiara Gerli ◽  
Monica De Luca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Troponin T ◽  
Mechanical Activity ◽  
Double Blind ◽  
Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

scholarly journals Impact of Bispectral Index Monitoring on Propofol Administration in Patients Undergoing Cardiopulmonary Bypass

2007 ◽  
Vol 35 (3) ◽  
pp. 342-347 ◽  
Author(s):  
C. L. Chiu ◽  
G. Ong ◽  
A. A. Majid
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Standard Dose ◽  
Controlled Trial ◽  
Target Concentration ◽  
Hypothermic Cardiopulmonary Bypass ◽  
Bispectral Index Monitoring ◽  
Group B ◽  
Index Value

Propofol anaesthesia using target control infusion during cardiac surgery has become more popular recently. However, without depth of anaesthesia monitoring, the standard target concentration used may be higher than necessary to maintain adequate hypnosis during hypothermic cardiopulmonary bypass. The purpose of this study was to evaluate the effect of bispectral index monitoring on propofol administration during hypothermic cardiopulmonary bypass. After ethics committee approval and written informed consent, 20 New York Heart Association class I-III patients scheduled for elective cardiac surgery requiring hypothermic cardiopulmonary bypass were studied in this prospective randomised controlled trial. In group C, routine anaesthesia was practised, where patients received propofol at target concentration between 1.5 to 2.5 μ/ml during cardiopulmonary bypass. In group B, the target concentration was titrated to a bispectral index value of 40 to 50. Mean arterial pressure and bispectral index were recorded at various time intervals. The use of propofol, phenylephrine, sodium nitroprusside and adrenaline were recorded. The median propofol administration in group B was significantly less than that in group C (2.9 mg/kg/h compared to 6.0 mg/kg/h). The bispectral index value during bypass was significantly lower in group C than in group B, reflecting a deeper state of anaesthesia. There was no difference in the use of inotropes, vasoconstrictors or vasodilators. Bispectral index monitoring enables a 50% reduction in propofol administration at this standard dose during hypothermic cardiopulmonary bypass.

A Phase II, Double-Blind, Placebo-Controlled, Ascending-Dose Study of Eritoran (E5564), a Lipid A Antagonist, in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

2007 ◽  
Vol 104 (2) ◽  
pp. 378-383 ◽  
Author(s):  
Elliott Bennett-Guerrero ◽  
Hilary P. Grocott ◽  
Jerrold H. Levy ◽  
Kevin A. Stierer ◽  
Charles W. Hogue ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Phase Ii ◽  
Lipid A ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Dose Study

Propofol requirement titrated to bispectral index: a comparison between hypothermic and normothermic cardiopulmonary bypass

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 27-32 ◽  
Author(s):  
PJ Mathew ◽  
GD Puri ◽  
RS Dhaliwal
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Adult Patients ◽  
Study Group ◽  
Factors Affecting ◽  
Inter Quartile Range ◽  
Elective Cardiac Surgery ◽  
Quartile Range ◽  
Hypothermic Group

Though propofol requirement is expected to decrease during cardiopulmonary bypass (CPB), a few studies have failed to demonstrate this. The factors affecting pharmacokinetics of propofol and, therefore, the requirement, are different during hypothermic and normothermic CPB. We evaluated and compared the requirement of propofol during hypothermic and normothermic CPB. Fifty adult patients scheduled for elective cardiac surgery on CPB were recruited and randomly allocated into hypothermic CPB (28–300 C) (Group H) and normothermic CPB (35–370 C) (Group N) groups. Patients were induced and maintained with propofol titrated to maintain a target bispectral index (BIS) of 50 ± 10. Propofol requirement (mean ± SD) was similar in normothermic and hypothermic groups, both before CPB (4.9 ± 1.5 mg.kg−1hr−1 in Group N, 4.6 ± 1.5 mg.kg−1hr−1 in Group H) and after cessation of bypass (p > 0.05) (4.6 ± 1.8 mg.kg−1hr−1 in Group N and 4.3 ± 1.7 mg.kg−1hr−1 in Group H). CPB significantly reduced (p < 0.001) propofol requirements in both arms of the study (Group N: 2.9 ± 1.4 mg.kg−1hr−1and Group H: 1.3 ± 0.7 mg.kg−1hr−1). This reduction was more pronounced in the hypothermic group (p < 0.001). The BIS (median ± inter quartile range) remained constant during normothermic CPB (50 ± 8.8), but declined significantly during hypothermic CPB (41 ± 5.6) despite decreased usage of propofol during hypothermia. No patient had recall of intra-operative events. CPB decreases the magnitude of propofol requirements and the effect of hypothermic CPB is significantly more than that of normothermic CPB.

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