Adjustment of sweep gas flow during cardiopulmonary bypass

Perfusion ◽  
2002 ◽  
Vol 17 (5) ◽  
pp. 353-356 ◽  
Author(s):  
Hasan Karabulut ◽  
Fevzi Toraman ◽  
Sümer Tarcan ◽  
Önder Demirhisa ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Gas Flow ◽  
Surgical Techniques ◽  
Blood Gas Analysis ◽  
Carbon Dioxide Production ◽  
Gas Analysis ◽  
Lung Mechanics ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Cardiopulmonary bypass (CPB) is one of the major tools of cardiac surgery. However, no clear data are available for the ideal value of sweep gas flow to oxygenator during CPB. The aim of this study was to determine the best value for sweep gas flow during CPB. Thirty patients undergoing isolated CABG were randomly and equally allocated into three groups. Sweep gas flow to oxygenator was kept at 1.35 l/min/m2 in group 1, 1.60 l/min/m2 in group 2, and 2.0 l/min/m2 in group 3. All patients were operated on under the same anaesthetic regime and surgical techniques. Samples for blood gas analysis were collected at T1: before CPB; T2: 5 min after the initiation of CPB; T3: just before rewarming; and T4: at the end of rewarming. Five minutes after the initiation of CPB (T2), pCO2 decreased significantly in groups 2 and 3 compared to group 1 ( p < 0.02). With the addition of hypothermia (T3), the changes in the pH and pCO2 became more profound and, in this period, the levels in group 3 patients outranged the physiologic limits, with pCO2 and pH values being 28± 3 mmHg and 7.50± 0.04, respectively. At the end of the rewarming period (T4), in spite of increased carbon dioxide production, pCO2 values were below the physiologic limits in groups 2 and 3. We conclude that sweep gas flow to the oxygenator should be kept between 1.35 and 1.60 l/min/m2 during CPB to avoid hypocapnia, which results in alkalosis and has hazardous effects on lung mechanics, cerebral blood flow, and the cardiovascular system.

Adjusting Oxygen Fraction to Avoid Hyperoxemia during Cardiopulmonary Bypass

2007 ◽  
Vol 15 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Serdar Evrenkaya ◽  
Sahin Senay ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Oxygen Fraction ◽  
Wide Range ◽  
Group 3 ◽  
Group 2 ◽  
Inspired Oxygen ◽  
Group 1

Although an adverse influence of hyperoxemia during cardiopulmonary bypass is well documented, there is a wide range of oxygen settings during cardiopulmonary bypass, based mostly on trial and error. The aim of this study was to determine the optimal inspired oxygen fraction during cardiopulmonary bypass. Ninety patients undergoing isolated coronary artery bypass operations were randomly allocated to one of 3 groups of 30 each. In group 1, cardiopulmonary bypass was started with an inspired oxygen fraction of 0.40, increased to 0.60 during rewarming. These settings were 0.40 and 0.50 in group 2, and 0.35 and 0.45 in group 3. Samples for blood gas analysis were collected at defined time periods during the operation. PaO2 was significantly higher in groups 1 and 2 compared to group 3. All patients in group 1 and 88% of patients in group 2 suffered at least one episode of hyperoxemia during cardiopulmonary bypass, compared to 30% of patients in group 3. The differences were significant, and we concluded that to avoid hyperoxemia, inspired oxygen fraction should be kept at 0.35 during cardiopulmonary bypass and increased to 0.45 during rewarming.

scholarly journals Comparative Evaluation of Aortic Valve Replacement Methods in Patients Over 70 with Aortic Stenosis

2018 ◽  
Vol 7 (3) ◽  
pp. 227-233 ◽  
Author(s):  
V. V. Sokolov ◽  
M. V. Parkhomenko ◽  
A. I. Kovalyov ◽  
V. V. Vladimirov ◽  
O. L. Shiryayeva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Hospital Mortality ◽  
Heart Diseases ◽  
Surgical Techniques ◽  
Results Of Treatment ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

BackgroundAs life expectancy and quality of health improve, more and more people reach old age, and so does the number of heart diseases. One of the most urgent problems among elderly patients is degenerative stenosis of the aortic valve (AV). The conservative treatment of symptoms of chronic heart failure with AV stenosis improves the patient’s condition only for a while, whereas surgical treatment such as replacement of AV is recognized as the main effective method of treating a defect. Recently, alternative technologies for prosthetic AV have been developed, aimed at reducing adverse effects of artificial circulation (AC) in high-risk patients and minimizing the scope of surgical intervention.Aim of studyThe aim of the study was to evaluate the immediate results of surgical treatment of aortic stenosis using different methods in patients over 70.Material and methodsThe article presents the results of treatment of 64 patients over 70 with isolated AV stenosis, operated with different surgical techniques from July, 2016 to January, 2018. All patients were divided into three groups, differing in the severity of the initial condition and the method treatment. Group 1 (transcatheter implantation of the prosthetic AV, EuroSCORE II — 21.81%) consisted of 19 patients, Group 2 (non-suture implantation of a Perceval prosthetic valce under the AC, EuroSCORE II — 13.81%) consisted of 13 patients and Group 3 (“standard” prosthetics, EuroSCORE II — 9.89%) consisted of 32 patients.ResultsIn Group 1, two patients died, the hospital mortality was 10.5%. In Group 2 and Group 3, one patient died, the hospital mortality was 7.6 and 3.1%, respectively. Implantation of a permanent pacemaker was required in three patients (15.7%) from the TAVI group after installation of Medtronic Core Valve and two patients (15.3%) from the Perceval group.ConclusionThe obtained results of AV replacement by various methods allowed to expand indications for the management of AV stenosis in patients of the older age group with a high surgical risk of operation under AC conditions who had not previously been considered candidates for surgical treatment of aortic malformation due to the age and severity of the concomitant pathology.

scholarly journals Aortic root surgery: Early postoperative results of different surgical techniques

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 197 ◽  
Author(s):  
Rimantas Benetis ◽  
Eglė Ereminienė ◽  
Povilas Jakuška ◽  
Dainius Karčiauskas ◽  
Šarūnas Kinduris ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Postoperative Results ◽  
Aortic Root Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to evaluate early postoperative results of different surgical techniques of aortic root surgery. Material and methods. Between January 2004 and November 2007, a cohort of 83 patients underwent aortic root surgery in the Heart Center, Hospital of Kaunas University of Medicine. Patients were divided into three groups: Group 1 (18 patients) – reimplantation of the aortic valve within a vascular graft (David operation), Group 2 (48 patients) – replacement of the ascending aorta and aortic valve using a valved conduit (Bentall de Bono operation), and Group 3 (17 patients) – biological aortic root replacement. Study protocol included clinical data, operative data, and postoperative major adverse effects: reoperations for bleeding, stroke and lethal outcomes. Results. Patients undergoing biological aortic root replacement were older as compared with other groups. The mean age in the Group 1 was 50.3±3.5 years vs. 57±2.0 years in the Group 2 and 67.8±3.3 years in the Group 3 (P<0.05). The main indication for the aortic root surgery was the aneurysm of the aortic root and ascending aorta in the Group 1 and 2 patients (64.7% and 72%), while in the Group 3, the main indication was fibrocalcinosis of aortic valve, aortic annulus, and ascending aorta (61.1%). The 30-day hospital mortality rates were as follows: 5.8% (n=1), in the Group 1; 10.4% (n=5), in the Group 2; 5.5% (n=1), in the Group 3. In the early postoperative period, 11 reoperations were performed due to bleeding events: in the Group 1, after planned/emergency surgery (n=2/2), and in the Group 2 (n=1/6), respectively. The function of aortic valve improved significantly in all groups of patients early after surgery. In the Group 1, the degree of aortic regurgitation decreased from 2.5±0.8 to 1.1±0.6 (P<0.05); in the Groups 2 and 3, the mean gradient through the aortic valve decreased from 39.9±7.5 to 17.1±5.3 mm Hg and from 48.8±18.0 to 20.1±11.0 mm Hg, respectively (P<0.05). No reoperation for aortic valve failure before the discharge was required in all groups of patients, and neither thromboembolic complications nor stroke events were noted in any group. Conclusions. Different aortic root surgery techniques showed similar postoperative results. New aortic root surgery methods such as aortic root-preserving/sparing procedures and concurrent aortic valve leaflet repair or aortic root replacement with the bioprosthesis can be selected for a diverse class of aortic root pathology with low perioperative mortality rates and good early postoperative results.

The hazardous effects of alveolar hypocapnia on lung mechanics during weaning from cardiopulmonary bypass

Perfusion ◽  
2000 ◽  
Vol 15 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Osman Bayindir ◽  
Belhhan Akpinar ◽  
Ug'ur Özbek ◽  
Emine Cakali ◽  
Ülkü Pekcan ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Airway Pressure ◽  
Venous Pressure ◽  
Lung Mechanics ◽  
Pressure Measurements ◽  
Coronary Artery Revascularization ◽  
Vascular Bed ◽  
Group 2 ◽  
Group 1 ◽  
Pulmonary Vascular Bed

The bronchoconstrictive effects of alveolar hypocapnia during weaning from cardiopulmonary bypass (CPB) were investigated in patients undergoing elective coronary artery revascularization. Thirty patients were randomly assigned into two equal groups. In both groups, mechanical ventilation was initiated for 3 min prior to weaning from CPB with the venous pressure low. This kept the pulmonary vascular bed empty, resulting in alveolar hypocapnia (ETCO2 < 2 kPa). Peak airway pressure ( Ppeak) and plateau pressures ( Pplateau) were recorded. In group 1, 5% CO2 was added to the inspiratory gas mixture and the ETCO2 allowed to rise (ETCO2 > 3.3 kPa). The ventilation pressure measurements were recorded again after 3 min stabilization. In group 2, the venous pressure was increased to allow the pulmonary venous bed to fill and the ventilation pressures recorded after a 3 min period of stabilization. In group 1, the ventilatory pressures dropped significantly ( p < 0.001) when the alveolar hypocapnia was reversed with added CO2 ( Ppeak 19.71 ± 5.7 to 12.31 ± 2.8 cmH2O and Pplateau 13.15 ± 3.28 to 9.15 ± 2.23 cmH2O). In group 2, a similar effect was achieved by allowing filling of the pulmonary vascular bed ( Ppeak 17.46 ± 4.72 to 11.92 ± 3.03 cmH2O and Pplateau 13.93 ± 4.10 to 9.37 ± 3.00 cmH2O). These results suggest that filling the pulmonary vascular bed prior to initiating ventilation, when weaning from CPB, prevents the otherwise deleterious effects of alveolar hypocapnia, resulting in raised bronchomotor tonus and raised airway pressures.

Hypomagnesemia and low alkaline phosphatase activity in patients' serum after cardiac surgery.

1989 ◽  
Vol 35 (4) ◽  
pp. 664-667 ◽  
Author(s):  
G Lum ◽  
C Marquardt ◽  
S F Khuri
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
General Anesthesia Group ◽  
Alp Activity ◽  
Anesthesia Group ◽  
Group 3 ◽  
Group 2 ◽  
Post Cardiac Surgery ◽  
Group 1

Abstract Significant decreases in magnesium (Mg) concentration and alkaline phosphatase (ALP, EC 3.1.3.1) activity in serum were seen in patients after cardiac surgery with cardiopulmonary bypass (Group 1), as compared with non-cardiac-surgery patients after general anesthesia (Group 2) or only spinal anesthesia (Group 3). Mean changes for Mg and ALP by the first postoperative day, compared with pre-operative baseline values, were as follows: Group 1: Mg -7.5 mg/L (-38.3%), ALP -46U/L (-48.4%); Group 2: Mg -3.3 mg/L (-17.4%), ALP -17 U/L (-16.5%); and Group 3: Mg -1.9 mg/L (-10.0%), ALP -15 U/L (-14.0%). The decreases in Mg and ALP observed in post-cardiac-surgery patients appear to be a consequence of the cardiac surgery and the cardiopulmonary bypass pump. Measurement of Mg and ALP in a subgroup of 10 cardiac-surgery patients for 10 days postoperatively showed initial decreases, with gradual recovery to near-normal values by the 10th day. That the changes in Mg and ALP seen postoperatively were not attributable to hemodilution alone was confirmed by measuring total-protein concentrations before and after operation. ALP requires Mg ion in vitro for optimal activity, but addition of Mg in the appropriate amounts to sera with low ALP activity did not restore ALP activity. The low ALP activity seen in post-cardiac surgery patients in vivo may perhaps be related to factors other than Mg that were removed by the cardiopulmonary bypass pump.

scholarly journals The scintigraphic evaluation of the pulmonary perfusion pattern of dogs hospitalised with babesiosis

2008 ◽  
Vol 79 (2) ◽  
Author(s):  
L. Sweers ◽  
R.M. Kirberger ◽  
A.L. Leisewitz ◽  
I.C. Dormehl ◽  
E. Killian ◽  
...  
Keyword(s):  
Pulmonary Thromboembolism ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Control Group ◽  
Pulmonary Perfusion ◽  
Perfusion Scintigraphy ◽  
Perfusion Defects ◽  
Group 2 ◽  
Minimal Work ◽  
Group 1

The possibility of coagulopathy in Babesia canis rossi infections in the canine patient has been suggested in the literature, but minimal work has been done to evaluate the clinicopathological nature of it in further detail. Pulmonary thromboembolism (PTE) has not yet been implicated in canine babesiosis (CB), but may also be one of the causes of the sudden dyspnoea and tachypnoea that are frequently seen in complicated CB patients. The objective of this study was to prospectively evaluate the scintigraphic pulmonary perfusion pattern in hospitalised dogs with babesiosis in an attempt to ascertain whether a scintigraphic pattern consistent with clinically relevant PTE does indeed occur in these patients. The study consisted of a normal control group of 9 mature healthy Beagle dogs (group 1) and a Babesia group with 14 dogs of a variety of breeds that were naturally infected with Babesia (group 2). Pulmonary perfusion scintigraphy was performed after making thoracic radiographs and performing a blood gas analysis in both groups. The scintigraphic images were visually inspected for changes suggestive of PTE, but not a single dog in group 2 had pleural-based, wedge-shaped perfusion defects which would have resulted in a high probability for clinically relevant PTE. The scintigraphic pulmonary perfusion pattern demonstrated was not significantly different between the 2 groups (P = 1.00).

A Comparison of Different Surgical Techniques in Treating Degenerative Arthrosis of the Carpometacarpal Joint of the Thumb

1995 ◽  
Vol 20 (1) ◽  
pp. 105-110 ◽  
Author(s):  
M. LANZETTA ◽  
G. FOUCHER
Keyword(s):  
Soft Tissue ◽  
Surgical Techniques ◽  
Silicone Implants ◽  
Carpometacarpal Joint ◽  
Degenerative Arthrosis ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Between March 1977 and December 1991, 98 surgical procedures on 85 patients were performed at SOS Main Strasbourg for osteoarthrosis of the carpometacarpal joint of the thumb. The mean age was 56 and 90% were female; 13 were operated on bilaterally. 40% had Swanson arthroplasties (group 1), 15% Ashworth-Blatt hemiarthroplasties (group 2), and 45% had soft tissue arthroplasties (group 3). 62 cases were reviewed at an average follow-up of 5 years. Normal thumb range of motion was obtained in all cases, regardless of the technique used. Complete pain relief was achieved in 77% of the cases in group 1, 37.5% in group 2 and 71% in group 3. 15% of group 1 and 50% of group 2 required surgical revision, either for displacement or fracture of the implants. No revision was necessary in group 3. One case of silicone synovitis requiring secondary surgery was noted 6 years after surgery, accounting for 2.9% of the total number of silicone implants reviewed, but radiological signs of silicone synovitis were much more common (56%). Proximal metacarpal migration in group 3 averaged 38% of the initial arthroplasty space, and was not related to the type of ligamentoplasty used, or presence or absence of an “anchovy”. The migration increased to 68% of the space if an associated MP joint arthrodesis was carried out at the same time. Complications included reflex sympathetic dystrophy (4% in group 1 and 14% in group 3). The Ashworth-Blatt hemiarthroplasty failed to gain satisfactory results, but both silicone arthroplasty and soft tissue arthroplasty proved to be useful procedures. However, due to the risk of synovitis the present treatment of choice is soft tissue arthroplasty.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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