The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

Abstract Introduction: Halting ventilation during cardiopulmonary bypass (CPB) is implemented to operate in a less bleeding setting. It sustains a better visualization of the operation area and helps to perform the operation much more comfortably. On the other hand, it may lead to a series of postoperative lung complications such as atelectasis and pleural effusion. In this study, we investigated the effects of low tidal volume ventilation on inflammatory cytokines during CPB. Methods: Twenty-eight patients undergoing cardiovascular surgery were included in the study. Operation standards and ventilation protocols were determined and patients were divided into two groups: patients ventilated with low tidal volume and non-ventilated patients. Plasma samples were taken from patients preoperatively, perioperatively from the coronary sinus and postoperatively after CPB. IL-6, IL-8, TNF-α and C5a levels in serum samples were studied with enzyme-linked immunosorbent assay (ELISA) kits. Results: C5a, IL-6, IL-8 and TNF-α were similar when compared to the low tidal volume ventilated and non-ventilated groups (P>0.05) Comparing the groups by variables, IL-6 levels were increased during CPB in both groups (P=0.021 and P=0.001), and IL-8 levels decreased in the ventilation group during CPB (P=0.018). Conclusion: Our findings suggest that low tidal volume ventilation may reduce the inflammatory response during CPB. Although the benefit of low tidal volume ventilation in CPB has been shown to decrease postoperative lung complications such as pleural effusion, atelectasis and pneumonia, we still lack more definitive and clear proofs of inflammatory cytokines encountered during CPB.

The Efficacy of Tranexamic Acid in Cardiac Surgery Requiring Cardio-Pulmonary Bypass (CPB) to Reduce Post-Operative Blood Loss and Requirement of Allogenic Blood Transfusion

Introduction: Cardiac surgery, owing to its invasiveness,need of anticoagulation, exposure to extracorporeal circulation(CPB) and relatively longer duration, is known to be associatedwith an increased risk of perioperative blood loss and allogeneicblood transfusions. Excessive bleeding requiring allogenicblood and blood components transfusion after cardiopulmonarybypass (CPB) is a common complication of cardiac surgeryimparting detrimental health and economic consequences.Many techniques like preoperative autologous blood collection(PAC), Acute normovolumic hemodilution (ANH), use ofminiaturized CPB circuit and use of ultrafiltration duringconduct of cardiopulmonary bypass (CPB) have been appliedin the past to conserve the blood during perioperative periodin cardiac surgery. Current study aimed to observe the efficacyof Tranexamic acid used during intraoperative period onpost-operative blood loss and requirement of allogenic bloodand blood products transfusion in cardiac surgical patientsrequiring cardiopulmonary bypass (CPB).Material and methods: 120 adult patients undergoingcardiac surgery requiring elective cardiopulmonary bypass(CPB) were categorized into 2 groups. Study (“TXA”) groupwas subjected to administration of tranexamic acid (20 mg/kg in divided doses). The 1st dose (10 mg/kg) was givenbefore initiation of CPB, 2nd dose (5 mg/kg) was given duringrewarming on CPB and 3rd dose (5 mg/kg) was given afterweaning off CPB along with protamine. The control (“NS”)group patients received normal saline as a placebo. Statisticalanalysis was done using “z test”.Results: “TXA” group had significantly lower post-operativebleeding and lesser requirement of allogenic blood and bloodproducts transfusion. The mean post-operative blood lossin “TXA” group was 427.42+/- 225.18 ml vs. 728.67+/-301.33ml in “NS” group. The mean PCV units transfused postoperatively in 72 hours in “TXA” group was 0.20+/-0.44 unitsvs. 0.67+/-0.60 in “NS” group. Patients in “TXA” group didnot require any FFP or platelets unit in contrast to “NS” groupwhere few patients required these products.Conclusion: The use of Tranexamic acid during intraoperative period in patient undergoing cardiac surgeryrequiring cardiopulmonary bypass circuit significantly reducesthe post-operative bleeding and requirement of allogenicblood and blood products transfusion.

Comparative analysis of myocardial protection with htk solution and hypothermic hyperkalemic blood solution in the correction of acyanogenic congenital cardiopathies - a randomized study

Abstract Objective: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. Methods: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. Results: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. Conclusion: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.

Perioperative management of a patient with double orifice mitral valve with supramitral ring with subaortic membrane with ventricular septal defect and severe pulmonary hypertension: Report of a rare case

Double-orifice mitral valve (DOMV) is an unusual congenital anomaly characterized by a mitral valve with a single fibrous annulus with two orifices or rarely two orifices with two separate mitral annuli opening into the left ventricle. We present a first report of a patient with a DOMV with supramitral ring (SMR), subaortic membrane (SAM), a large ventricular septal defect (VSD) with more than 50% aortic override, and severe pulmonary arterial hypertrophy (PAH). This patient underwent excision of the SAM, and SMR, with closure of the VSD together under cardiopulmonary bypass (CPB). However postoperatively, the patient developed an irreversible fatal pulmonary hypertensive crisis (PHC), immediately after transferring the patient to the cardiac intensive care unit from the operating room (OR). The PHC was refractory to intravenous and inhaled milrinone and nitroglycerine and intravenous adrenaline, dobutamine, norepinephrine, vasopressin, patent foramen oval (PFO), and CPB support. The management of DOMV and perioperative pulmonary hypertension is discussed.

A survey of practices during cardiopulmonary bypass in India: An Indian association of cardiovascular and thoracic anesthesiologist endeavor

Context: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. Aims: The aim of this survey is to gather information on variations during the conduct of CPB in India. Settings and Design: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. Subjects and Methods: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. Results: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. Conclusions: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes.

Aplicação de planejamento baseado na estrutura do receptor na busca de inibidores de cisteíno-proteases parasitárias (cruzaína (T. cruzi) e PCB (Leishmanioses) / Structure-based virtual screening in the search of parasitic cysteine-proteases inhibitors

Doenças causadas por agentes infecciosos e parasitários são chamadas negligenciadas por não despertarem interesse das indústrias farmacêuticas para o desenvolvimento de novas alternativas terapêuticas. Essas doenças são responsáveis por levar milhões de pessoas à morte todos os anos e afetam principalmente os países pobres e em desenvolvimento. Dentre estas, a doença de Chagas e as leishmanioses, parasitoses causadas por parasitas flagelados pertencentes à família Trypanosomatidae, T. cruzi e Leishmaina sp., respectivamente, se apresentam como um sério problema de saúde pública mundial. Endêmicas em vários países e causando milhões de mortes anualmente, ainda hoje não existem fármacos eficientes e seguros para o tratamento dessas doenças. Este panorama torna eminente a necessidade de pesquisa e desenvolvimento de novos fármacos para essas parasitoses. A busca por agentes quimioterápicos envolve a seleção de vias metabólicas essenciais à sobrevivência dos parasitas. Dentre estas, destacamse cisteíno-proteases presentes nesses tripanossomatídeos, deste modo a cruzaína no T. cruzi, e a CPB2.8 na Leishmania mexicana, se mostram como alvos bioquímicos promissores. A disponibilidade de estruturas cristalográficas da cruzaína e do sequenciamento genômico da CPB2.8, nos permite utilizar estratégias de planejamento de fármacos baseado no receptor (SBDD) na identificação de candidatos a fármacos para essas doenças. Entre as técnicas modernas de SBDD utilizadas, a triagem virtual possibilita identificar promissores candidatos a novos fármacos. Assim neste trabalho, obteve-se por meio da técnica de modelagem comparativa o modelo da enzima CPB2.8 de L. mexicana, visto a indisponibilidade da estrutura cristalográfica no Protein Data Bank (PDB). De modo a refinar o modelo construído realizou-se a simulação por dinâmica molecular de 100ns, apresentando estabilização a partir de 80ns. A simulação por dinâmica molecular foi validada por meio do gráfico de Ramachandran, gráfico de raio de giro, RMSD, gráfico de superfície hidrofóbica. Foram calculados os mapas de interação molecular no programa GRID das seguintes proteínas: cruzaína, CPB2.8, catepsina B e catepsina L, e, posteriormente, foi construído um modelo farmacofórico baseado no sítio ativo das enzimas cruzaína e CPB2.8. O modelo farmacofórico da cruzaína foi validado por curva ROC apresentando valor de AUC 61%. A triagem virtual foi realizada para ambas as proteínas e foram obtidos 369 compostos para a cuzaína e 225 compostos para a CPB2.8. Foi realizado o ancoramento molecular desses compostos obtidos pela triagem virtual a fim de diminuir a quantidade de compostos a serem avaliados experimentalmente

Neglected diseases are caused by parasites and infectious agents and affect mainly people in poor areas being prevalent in 149 countries and causing 534,000 deaths per year. Among neglected diseases we can highlight Chagas Disease and Leishmaniasis, both have a high rate of morbidity and mortality and both are addressed in this project in the search of new drugs against a NTD. Nowadays, the search for new drugs involves the selection of biological pathways essential for parasite survival, in this class of parasites we can suggest the cysteine proteases, a proteases family present in Trypanosoma cruzi and and Leishmania ssp. In order to obtain a new agent against Neglected Disease in this work was obtained the model of the enzyme CPB2.8 of L. mexicana using the comparative modeling technique, due to the unavailability of the crystallographic structure in the Protein Data Bank (PDB). In order to refine the constructed model was performed the molecular dynamics simulation of 100ns, stabilization was achieved from 80ns. Molecular dynamics simulation was validated using the Ramachandran graph, radius of rotation graph, RMSD, hydrophobic surface area graph. The molecular interaction fields were calculated in the GRID program to cruzain, CPB2.8, cathepsin B and cathepsin L. Based on molecular interaction fields generated pharmacophoric models were constructed using information about the active site of the enzymes cruzain and CPB2.8. The pharmacophoric model of cruzain was validated by ROC curve presenting AUC value of 61%. Virtual screening was performed for both proteins and 369 compounds were obtained for cuzain and 225 compounds for CPB2.8. Docking studies of these compounds was performed in order to decrease the amount of compounds to be evaluated experimentally

Cerebral protection of dexmedetomidine in patients with heart valve replacement under CPB / 药物评价研究

Objective To investigate the cerebral protection of dexmedetomidine in patients with heart valve replacement under CPB.Methods Totally 80 cases of patients with heart valve replacement under CPB in Seventh people's hospital of Zhengzhou city from January 2015 to December 2015 were selected and divided into observation group and control group,40 cases in each group.Patients in observation group were treated with dexmedetomidine before anesthetic induction and during the operation,and patients in control group were treated with same dose of saline solution.The arterio-venous oxygen content difference (Da-jvO2),jugular venous oxygen saturation (SjvO2),cerebral oxygen extraction rate (CERO2),serum myelin basic protein (MBP),serum neuron-specific enolase (NSE),and S1003 protein content before anesthetic induction (T0) and when the ascending aorta open (T1),After 10 min of CPB (T2) and postoperative 6 h (T3) were compared between two groups,and occurring rates of MMSE and POCD were also compared.Results SjvO2 values of two groups at T1 were significant higher than T0 (P ＜ 0.05),Da-jvO2,and CERO2 were significant lower than T0 (P ＜ 0.05),SjvO2 values of observation group at T1 and T2 were significant higher than those of control group and Da-jvO2 and CERO2 were significant lower than those of control group (P ＜ 0.05);At T2 and T3,MBP levels of observation group and control group were significant higher than T0 (P ＜ 0.05),and those in observation group were significant lower than control group (P ＜ 0.05);At T1,T2,and T3 of observation group and control group were significant higher than T0 (P ＜0.05),and NSE levels of observation group at T1,T2,T3 were significant lower than those of control group (P ＜ 0.05),S-100β levels of observation group at T2 and T3 were significant lower than those of control group (P ＜ 0.05).After 7 d,MMSE score of observation group was significant higher than that of control group and POCD occurring rate was lower (P ＜ 0.05).Conclusion Dexmedetornidine can improve cerebral ischemia hypoxia state and reduce brain damage in patients with heart valve replacement under CPB.

Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass.

Introduction: The concerns for induction of anaesthesia in patients undergoing cardiac surgery include hemodynamic stability, attenuation of stress response and maintenance of balance between myocardial oxygen demand and supply. Various Intravenous anaesthetic agents like Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used for anesthetizing patients for cardiac surgeries. However, many authors have expressed concerns regarding induction with thiopentone, midazolam and ketamine. Hence, Propofol and Etomidate are preferred for induction in these patients. However, these two drugs have different characteristics. Etomidate is preferred for patients with poor left ventricular (LV) function as it provides stable cardiovascular profile. But there are concerns about reduction in adrenal suppression and serum cortisol levels. Propofol, on the other hand may cause a reduction in systemic vascular resistance and subsequent hypotension. Thus, this study was conducted to compare induction with these two agents in cardiac surgeries. Methods: Baseline categorical and continuous variables were compared using Fisher’s exact test and student’s t test respectively. Hemodynamic variables were compared using student’s t test for independent samples. The primary outcome (serum cortisol and blood sugar) of the study was compared using Wilcoxon Rank Sum test. The P value less than 0.05 was considered significant. Results: Etomidate provides more stable hemodynamic parameters as compared to Propofol. Propofol causes vasodilation and may result in drop of systematic BP. Etomidate can therefore be safely used for induction in patients with good LV function for CABG/MVR/AVR on CPB without serious cortisol suppression lasting more than twenty-four hours.

Effect of dexmedetomidine on patients′ inflammation during the CPB and the effect on patients′ renal and hepatic function / 实用医学杂志

Objective To observe the effect of dexmedetomidine on patients′ inflammation during CPB and protective effect on kidney and liver. Methods 60 cases undergoing cardiac valve replacement under CPB were randomly divided into NS group and Dex group. Blood samples were taken before induction , before ascending aorta blocked, end of CPB, 24, 48 and 72 hours after operation. The serum level of HMGB-1, TNF-α, IL-6, BUN, Cr and ALT are tested. Blood WBC and N% are also counted. Results WBC, N% and HMGB-1, TNF-α, IL-6, BUN, Cr in Dex group significantly decreased at time point T2 ~ T6 (P < 0.05) compared with NS group. But ALT in Dex group only decreased at time point T 2 and T5 compared with NS group (P < 0.05). Conclusion Dexmedetomidine can significantly decrease inflammatory factor during CPB and improve renal function after surgery.

Molecular detection and characterization of cpb2 gene in Clostridium perfringens isolates from healthy and diseased chickens

Clostridium perfringens is an important pathogen in both human and veterinary medicine. Necrotic enteritis (NE) is the most clinically dramatic bacterial enteric disease of poultry induced by C. perfringens. The pathogenicity of this bacterium is associated with the production of extracellular toxins produced by some of its strains, such as beta2 toxin. The exact role of beta2 toxin in NE pathogenesis is still controversial. In the present study, C. perfringens isolates from healthy and diseased poultry flocks from different parts of Iran were analyzed by PCR assay to determine the presence of all variants of the beta2 toxin gene (cpb2). The products of two positive cpb2 PCR reactions were sequenced, compared to each other and to the cpb2 sequences published in GenBank (by multiple alignment and phylogenetic analysis). The current work represents the first study of cpb2 in poultry C. perfringens isolates in Asia, and reports the highest percentage of cpb2-positive isolates in both apparently healthy chickens (97.7%) and those afflicted with NE (94.4 %). The sequenced isolates were classified as atypical. This study did not show a direct correlation between NE occurrence and cpb2 presence.(AU)

La lactatemia cmmo pronostico inmediato de supevivencia en la cirugia cardiovaascular pediatrica a corazon abierto / Lactathemia as an immediate prognosis value of survival in open heart pediatric surgery

El ácido láctico ha sido considerado en los últimos años, como un indicador temprano de supervivencia y/o mortalidad en pacientes sometidos a cirugía cardíaca a corazón abierto para la corrección quirúrgica de sus cardiopatías congénitas. La apreciación de la oxigenación tisular durante la anemia aguda que se desarrolla durante la circulación extracorpórea de nuestros pacientes pediátricos con cardiopatías congénitas constituye la razón principal para evaluar si un paciente está o no adecuadamente perfundido, por lo que la evaluación seriada del ácido láctico en sangre arterial debe ser estimada en este tipo de cirugía. Teniendo en cuenta esto, decidimos realizar esta revisión sobre la lactatemia, en pacientes que van a ser sometidos a circulación extracorpórea,y garantizarles un mejor pronóstico. Se considera hiperlactatemia cuando su valor en sangre supera los 3 mmol/L.

The lactic acid has been considered in the last years, as an early indicator of survival and/or mortality in subjected patients to heart surgery to open heart for the surgical correction of its congenital cardiopathies. The appreciation of the tissular oxygenation during the anemia sharp normovolémica that is developed during the circulation extracorpórea of our pediatric patients with congenital cardiopathies constitutes the main reason to evaluate if a patient this or not appropriately perfused, for that the evaluation of the lactic acid in blood arterial debit side to be estimated in this surgery type. Keeping in mind this decides to carry out this revision on the lactatemia, in patients that will be subjected to circulation extracorpórea, guaranteeing them a better presage. It is considered hiperlactatemia when its value in blood overcomes the 3 mmol/L.

Relationship between some coagulation indices with hemorrhage complication in patients undergoing cardiac surgery with cardiopulmonary bypass

Background: Cardiac surgery with cardiopulmonary bypass (CPB) can cause haemostatic abnormalities that increase the risk of postoperative hemorrhage. Objectives: (1) To study changes of coagulation in cardiac patients undergoing surgery with CPB. (2) To research the relationship between duration of cardiopulmonary bypass, coagulation tests and postoperative hemorrhage complications. Subjects and methods: A cross sectional descriptive study was carried out on 252 patients (105 women, 147 men) undergoing cardiac surgery with CPB due to congenital heart disease and acquired heart disease at Viet Duc Hospital from December 2005 to August 2006. Results: After surgery, 54 patients had to transfuse the blood products, accounting for 21.4% rate. 21 cases had abnormal bleeding (8.3%). 12 patients assigned to re-operate due to bleeding (4.8%). There was an inverse correlation between platelet counts after surgery with duration of CPB and duration of aortic clamping. Relationship between rate of prothrombin, APTT, fibrinogen after surgery and duration of CPB and duration of aortic clamping was not seen. Duration of CPB prolonging over 120 minutes related to postoperative hemorrhage complication (OR=2.69 (p<0.5)). Reduced platelet count increased the risk of postoperative hemorrhage but not statistically significant (OR=1.36; p>0.05). Prothrombin ratio of less than 50% associated with the risk of postoperative hemorrhage (OR=4.83; p<0.01). Conclusion: The routine coagulation tests can help monitor clotting in patients after cardiac surgery

The effect of low dose TP-5 after CPB operation / 医学研究生学报

Objectives:To investigate the effect of TP 5 on the immune function and infection rate in patients undergoing cardiopulmonary bypass(CPB) operation. Methods:Ninety four patients were divided into two groups to observe the effect of TP 5 on the immune function and infection rate. Results:The immunological parameters in the TP 5 group was better than the control group, and postoperative infection was prevented. Conclusions:TP 5 can improve patients' cell mediated immunity and reduce infection rate.

The Effect of Deep Anesthesia on the Postoperative Complications with CPB / 中国医师杂志

Objective Retrospectively discuss the effect of deep anesthesia on the post-operative complications with CPB. Methods All of the chosen patients including anesthesia group (30 cases) and deep anesthesia (30 cases) had the heart surgery under general anesthesia and CPB with the age of (56?6.4), the time of CPB (148?23.6) minutes, Medtronic membrane oxygenator, 4:1 cold blood cardioplegia, the flo of 2.0～2.4L?min -1 ?m -2 .The relative markers: operatively, the mean artery pressure (MAP), end tip oxygen saturation (SpO_2),the mean quantity of regitine (Regitine);postoperatively, the mean base-excess (BEpost), the mean quantity of 5% sodium bicarbonate per kilogram (NaHCO_3post),oxygen index, the level of blood glucose ,the duration of mechanical ventilation and intensive care unit stay , wound healing up, and the mortality. Results With deep anesthesia, the patients had more stable hemodynamic reserve operatively and significant improvements in the balance of acid-base, the lung function, the blood sugar , the wound recovery and the mortality. Conclusion The complication of postoperation with CPB is affected by the degree of anesthetic depth, and the proper depth of anesthesia can reduce the post-operative morbidity and mortality.

Role of Apoptosis in the Gut Mucosal Barrier Dysfunction in Rats with Cardiopulmonary Bypass / 中国医师杂志

Objective To investigate the role of cell apoptosis in the gut mucosal barrier dysfunction in rats undergoing cardiopulmonary bypass(CPB) . Methods The rat model of CPB was set up. The rats were divided into CPB group, sham operation(SO) group and normal control group. The morphological changes of ileum mucosal tissues were observed by microscope and electron microscope at 3h, 6h, 12h and 24h after operation, respectively. The apoptotic index of gut mucosal epithelial cells was measured with TUNEL method. Results Gut mucosal morphology was normal in CPB group at 3h, 6h and 12h after operation, but gut mucosal epithelial desquamation occurred at 24h after operation. Typical apoptotic cells could be seen with electron microscope in CPB group at every time point. Apoptotic index of gut mucosal epithelial cells significantly increased in CPB group at every time point compared with SO group, and peaked at 6h after operation. Apoptotic cells were mostly located in the gut crypt. Conclusion The data suggested that the apoptosis of intestinal epithelial cells significantly increased at early stage of post-CPB in rats, which might contribute to gut mucosal barrier dysfunction.

Changes of respiratory function before and after cardiopulmonary bypass in children with pulmonary hypertension / 中华麻醉学杂志

Changes in respiratory function before and after CPB in 40 children with state of left-to-right shunt of VSD were studied. Among the cases, 20 of them were with pulmonary hypertension (PH group ) and 20 without PH (control group). Before CPB, resist ante of inspira tion (RI) and resistance of expiration (RE)in PH group (23.87?7.53,42.98?12.1) were significantly higher than those of control group(RI 17.95?7.53,RE 34.95?5.13);compliance of lung-thorax(CLT) in PH group(11.58?4.87) was significantly lower than that of control group(14.32?1.99). After CPB. both RI (30.94?11.89) and RE(46.43?9.9) in PH group were greatly higher than those in control group (28.00?9.29,46.43?9.9);CLT (10.98?4.6) was lower than that of control group (12.3?2.68). In PH group,the PaO_2 decreased and the magnitude of A-aDO2 increased much more than those in control group. The results suggest that respiratory function in the children with PH might not be improved immediately after CPB separation.

Effect of Intravenous Anesthetics on Systemic Vascular Resistance during Cardiopulmanary Bypass / 대한마취과학회지

We have studied the effect of thiopental sodium, propofol, midazolam and ketamine on systemic vascular resistance(SVR) during cardiopulmonary bypass with constant pump flow in 20 patients undergoing elective open heart surgery. SVR decreased about 13(+/-3.42)% of control values after thiopental sodium 4 mg/kg, about 10 (+/-5.30)% of control after propofol 2 mg/kg and about 8(+/-3.72)% of control after midazolam 0.2 mg/kg; it returned to control values about 2 min 30 sec(+/-1 min 20 sec) after administration of thiopental sodium and about 4 min 30 sec(+/-2 min 15 sec) after administration of propofol. It remained under control values after 10 min after administration of midazolam. Ketamine showed no significant changes on SVR. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups. Change of SVR after administration of thiopental sodium did not have statistical significance(P< 0.05).

The Effect of Component Transfusion on Perioperative Change of Hemoglobin , Hematocrit and Platelet Count / 대한마취과학회지

In order to study the changes of blood sugar and electrolyte during cardiopulmonary bypass(CPB) in open heart surgery, 28 patients were selected and observed. The results are as follows: 1) The levels of blood sugar were increased significantly(p<0.01) in all patients compared to the controls as the operation advanced to the end of the CPB. But there was no significant correlation the with the CPB. 2) The increase in blood sugar level was greater in the TOF group and it was at significantly increased(p<0.01) after the CPB and was maintained higher at the end of the CPB. 3) The changes of electrolyte and arterial blood gas values during CPB were not remarkable.

Repair of ventricular septal defect through subaxillary minithoractomy / 重庆医科大学学报

Objective:To introduce the clinical experiences of repairing ventricular septal defect through right subaxillary minithoracotomy and to evaluate it's clinical effect.Methods:46 cases of VSD were repaired through right subaxillary minithoracotomy.The sizes of the defects varied from 0.4～0.8cm in diameter and all of them were membranous or conventricular defects.The average age was 7.1 ys.Results:There was no operative death or complication.The lenth of incision varied from 5～10cm.Cardiopulmonary bypass time were 21～42 minutes.Postoperative hospitalized time were 6 to 10 days.Conclusion:Repairing of ventricular septal defect through subaxillary minithoracotomy have the advantages of minimal trauma,hidden incision and quicker recovery.

Effect of autogenous oxygenator cardiopulmonary bypass on lung protection at cardiac surgery / 重庆医科大学学报

Objective:To investigate lung injury and protective effect of autogenous oxygenator cardiopulmonary bypass(CPB) on lung after CPB.Methods:24 adult mongrels (weight 15?1kg) were randomly divided into two groups,12 for experimental group,in which the dog's own lung was used as oxygenator;12 for control group,in which the artificial lung (bubble oxygenator) was used as oxygenator.Leukocyte count of right atrium and left atrium,difference of transpulmonary leukocyte,the pulmonary artery pressure,and the oxygen pressure of artery were measured during the perioperative period.And lung biopsies were obtained before and after CPB in both groups for microscope pathological examination.Results:Autogenous oxygenator CPB technique could provide satisfactory oxygenation during CPB.The oxygen pressure after CPB was significantly higher in the experimental group than that in the control group at different time points( P