Evaluation of Left Ventricular Ejection Fraction before Mitral Valve Replacement in Patients with Chronic Mitral Regurgitation / 대한마취과학회지

BACKGROUND: Left ventricular ejection fraction (LVEF) is considered to be an index of LV function. However, LVEF in chronic mitral regurgitation (MR) is overestimated due to a "systolic unloading effect" into the left atrium and leads to underestimation of the degree of LV dysfunction preoperatively. The purpose of this study was to evaluate the exact degree of preoperative LV dysfunction by LVEF, according to the MR grade. METHODS: Transesophageal echocardiography (on transgastric short axis view) was performed to compare LVEF at the Pre- and Post-MVR periods, in 39 patients with chronic MR: group I, MR grade III (n = 16) and group II, MR grade IV (n = 23). RESULTS: LVEF at Pre- and Post-MVR were 63.8 +/- 6.1% and 54.8 +/- 6.0%, respectively, and the LVEF difference between Pre- and Post-MVR was 9.0 +/- 3.5 by number (14.1 +/- 5.3% by ratio) in group I. LVEF at Pre- and Post-MVR were 68.1 +/- 7.2% and 51.7 +/- 6.0%, respectively, and the LVEF difference between Pre- and Post-MVR was 16.4 +/- 4.2 by number (24.0 +/- 5.2% by ratio) in group II. CONCLUSIONS: For the exact evaluation of preoperative LV function in patients with chronic MR, we have to subtract 9.0 by number (14.1% by ratio) from the preoperative LVEF in MR grade III and 16.4 by number (24.0% by ratio) from the preoperative LVEF in MR grade IV.

Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery / 대한구급학회지

BACKGROUND: Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery. METHODS: 30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups. RESULTS: Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1. CONCLUSIONS: Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.