Cardiac Surgeries without Transfusion / 대한마취과학회지

BACKGROUND: Jehovah's Witnesses are well known for their refusal of blood transfusions which, challenges the safety of performing cardiac surgeries. Their stand regarding blood transfusions has garnered criticism from some medical and legal sources, but has also added incentive for the development of many bloodless surgery techniques. To assess the impact on the continuing progress of blood saving protocols and increasing operative risk; herein our results in this specific population are reported. METHODS: The medical records of Jehovah's Witnesses, who underwent cardiac surgeries without blood transfusions, between Feb 1996 and Sep 2005, were retrospectively reviewed. RESULTS: 103 surgical procedures were performed on 102 patients. The age of patients varied from 2 months to 78 years, with a sex ratio of 60:42 (Male:Female). Cardiopulmonary bypass (CPB) was used in 81 cases. The mean hemoglobin (Hb) and hematocrit (Hct) levels were 13.2 g/dl (8.1-17.3), and 39.2% (24.3-52.5) before surgery, and 11.8 g/dl (8.0-16.5), and 35.3% (24-49) after surgery, respectively. Recombinant human erythropoietin (rHuEPO) and iron were used in 95 and 69 cases before and after surgery, respectively. High dose aprotinin (2 million KIU IV loading dose, 2 million KIU into the pump prime volume and 500,000 KIU per hour of surgery as a continuous intravenous infusion) was used in 67 cases. Acute normovolemic hemodilutions were performed in 7 cases. Cell saver was used in all procedures. Re-operations were needed in two cases due to wound infections and one patient died-of arrhythmias on the 2nd post-operative day. CONCLUSIONS: Bloodless cardiac surgery can be performed on Jehovah's Witnesses, but effective care of such patients requires close collaborative team efforts and advance planning to ensure favorable outcomes. At our hospital, preoperative iron and rHuEPO, as well as high dose aprotinin and cell saver are routinely used where indicated.

The Effects of Dexmedetomidine on Hemodynamics and Plasma Catecholamine Concentrations during Coronary Artery Bypass Graft Surgery / 대한마취과학회지

BACKGROUND: Alpha-2 adrenergic agonists decrease the sympathetic tones of hemodynamic and endocrine responses to surgical stimuli. The goal of this study was to evaluate the hemodynamic and endocrinologic effects of intraoperatively administered dexmedetomidine, a highly selective alpha-2 adrenergic agonist, in patients undergoing coronary artery bypass graft surgery. METHODS: Fifty coronary artery bypass graft patients, in a double-blind, randomized manner, received a continuous infusion of normal saline placebo or dexmedetomidine, 10 ng/kg/min for 1 hr from 5 minutes after sternotomy. All patients received standardized anesthesia. Plasma catecholamine was measured at 5 minutes after sternotomy (T1), 30 minutes after drug infusion (T2), and 30 minutes after drug cessation (T3). Heart rate, blood pressure, pulmonary artery pressure and cardiac output were monitored. RESULTS: Compared with the placebo group, plasma norepinephrine concentrations decreased in the dexmedetomidine group Dexmedetomidine attenuated increased blood pressure on surgical stimuli and induced more hypotension. CONCLUSIONS: The intraoperative infusion of dexmedetomidine to patients undergoing coronary artery bypass graft surgery reduced sympathetic tone and attenuated hemodynamic responses to surgical stimuli.

Effects of Nicardipine on Changes of Blood Pressure and Heart Rate during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngoscopy, tracheal intubation and the suspension laryngoscopy often provoke an undesirable increase in blood pressure and/or heart rate during laryngeal microscopic surgery. Thus, the anesthesiologist's objectives are to maintain sufficient anesthetic depth and to promote rapid awakening. Nicardipine, a direct arterial dilator, can be used to attenuate increasing blood pressure. We investigated the effects of nicardipine on changes of blood pressure and heart rate during laryngeal microscopic surgery. METHODS: Eighty patients of ASA class 1 or 2 scheduled for laryngeal microscopic surgery were randomly allocated into 4 groups. For anesthetic induction, IV propofol 1.5 mg/kg, rocuronium 0.4 mg/kg, and glycopyrrolate 0.2 mg were administered followed by mask ventilation for 5 minutes with isoflurane. One minute before tracheal intubation and suspension laryngoscopy saline, nicardipine 10, 20, or 30microgram/kg was injected in each group. Thereafter we measured blood pressure and heart rate one minute after each procedure. RESULTS: Increases in blood pressure were blunted in the nicardipine 20 and 30microgram/kg group. In the nicardipine 30microgram/kg group, heart rates were significantly increased and facial flushing was observed in two patients. CONCLUSIONS: We suggest that nicardipine 20microgram/kg can alleviate blood pressure increases with little effect on heart rate during laryngeal microscopic surgery. However, although nicardipine 30microgram/kg could blunt blood pressure increases, it produces tachycardia and perhaps overdose.