ABSTRACT
Currently, the immediate extubation in the operating room is necessary for the patients undergoing off-pump coronary artery bypass (OPCAB). To achieve UFTA, anesthesiologists should control general anesthesia. We report the case series of UFTA for the patients undergone OPCAB at our hospital. Forty patients receiving OPCAB between April 2012 and April 2014 were retrospectively analyzed. We divided the patients into those extubated in the operating room (Extubation group) and those not (Intubation group). The extubation criteria included adequate revascularization, adequate hemostasis, ratio between Pa(O2) and FI(O2) more than 250, body temperature above 36 degrees C, stable hemodynamics without noradrenaline, without IABP, and normal postoperative chest X-ray. Twenty-three patients (70% of the scheduled and 20% of the emergency patients) were included in our criteria and could be extubated in the operating room. One patient was re-intubated due to asthma attack following extubation in the operating room. The sucess rate of immediate extubation was 95.7% by our criteria. There were no significant differences in age, sex, BMI, duration of anesthesia, and amount of hemorrhage between the 2 groups. We believe that UFTA for OPCAB patients may be possible under carefull decision by extubation criteria.
Subject(s)
Anesthesia, General/methods , Coronary Artery Bypass, Off-Pump/methods , Aged , Airway Extubation , Female , Hemodynamics , Humans , Male , Middle Aged , Operating Rooms , Retrospective StudiesABSTRACT
OBJECTIVES: The aim of this study was to evaluate the intraoperative fluorescence imaging (IFI) system in the real-time assessment of graft patency during off-pump coronary artery bypass graft. BACKGROUND: Intraoperative fluorescence imaging is an intraoperative angiography-like imaging modality using fluorescent indocyanine green excited with laser light. Recently, assessment of graft patency using the IFI system was introduced into clinical use. The feasibility and efficacy of IFI technology in off-pump coronary artery bypass graft has not been systematically compared with other conventional diagnostic modalities. METHODS: Patients undergoing off-pump coronary artery bypass graft received IFI analysis, intraoperative transit time flowmetry, and postoperative X-ray angiography. In off-line IFI analysis, the graft washout was classified based on the number of heartbeats required for indocyanine green washout: fast washout (
Subject(s)
Coronary Angiography , Coronary Artery Bypass, Off-Pump , Coronary Artery Disease/surgery , Echocardiography, Doppler , Fluorescein Angiography/methods , Graft Occlusion, Vascular/diagnosis , Vascular Patency , Aged , Blood Flow Velocity , Coronary Artery Bypass, Off-Pump/adverse effects , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Coronary Circulation , Feasibility Studies , Female , Fluorescent Dyes/administration & dosage , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/physiopathology , Humans , Indocyanine Green/administration & dosage , Injections, Intravenous , Intraoperative Care , Male , Middle Aged , Pilot Projects , Predictive Value of Tests , Video RecordingABSTRACT
Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained with no need for catheterization, X-rays or iodine contrast medium. High-quality images could be obtained in all 290 grafts of 72 off-pump CABG cases (mean 4.0 grafts per patient). Four anastomoses (1.4%), including two proximal and two distal, were revised because of defects detected by SPY images. In one case, the SPY system revealed no blood flow in a radial sequential graft, although transit-time flow meter measurements showed a diastolic dominant pattern. SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPY system, technical failures could be completely resolved during surgery. The use of the SPY system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future.
ABSTRACT
Ceramics are often prepared with surface layers of different composition from the bulk, in order to impart a specific functionality to the surface or to act as a protective layer for the bulk material. Here we describe a general process by which functional surface layers with a nanometre-scale compositional gradient can be readily formed during the production of bulk ceramic components. The basis of our approach is to incorporate selected low-molecular-mass additives into either the precursor polymer from which the ceramic forms, or the binder polymer used to prepare bulk components from ceramic powders. Thermal treatment of the resulting bodies leads to controlled phase separation ('bleed out') of the additives, analogous to the normally undesirable outward loss of low-molecular-mass components from some plastics; subsequent calcination stabilizes the compositionally changed surface region, generating a functional surface layer. This approach is applicable to a wide range of materials and morphologies, and should find use in catalysts, composites and environmental barrier coatings.