ABSTRACT
Acid-base balance and lactate concentration in the arterial blood and spinal liquor have been studied in 32 patients after air embolism of the brain vessels developed during cardiopulmonary bypass surgery. It has been shown that an increase of lactate concentration in the spinal liquor over 3.5 mmol/l after air embolism of the brain vessels is indicative of severe hypoxic brain damage, in which the prospect of stable consciousness recovery is doubtful. In lactate concentration 4.5-5 mmol/l and higher as well as in metabolic acidosis of liquor (sodium hydrocarbonate concentration less than 20 mmol/l) the intensive care procedures used were not effective. It is believed that these parameters are of prognostic value in the condition under study.
Subject(s)
Acid-Base Equilibrium , Embolism, Air/diagnosis , Intracranial Embolism and Thrombosis/diagnosis , Lactates/blood , Lactates/cerebrospinal fluid , Cardiopulmonary Bypass/adverse effects , Embolism, Air/blood , Embolism, Air/cerebrospinal fluid , Humans , Intracranial Embolism and Thrombosis/blood , Intracranial Embolism and Thrombosis/cerebrospinal fluid , PrognosisABSTRACT
Concentrations of the ingredients have been analysed in a nonstandard cardioplegia solution (CS) and CS from St. Thomas Hospital at the outset before CS introduction into the coronary vessels of patients under cardioplegia. It has been shown that the use of nonstandard CS was accompanied by undesirable variability in ingredient concentration, which to some extent may be accounted for by the use of incompletely unfrozen CS. The use of CS from St. Thomas Hospital could be accompanied by moderate hypermagnesiumemia, which did not lead to the onset of vascular insufficiency. It is stressed that plasma magnesium content should be controlled when this CS is used.
Subject(s)
Calcium/analysis , Cardioplegic Solutions/analysis , Magnesium/analysis , HumansABSTRACT
New criteria of the arterial blood oxygen transport function suggested by O. Siggaard-Andersen et al. are reviewed. The examples from clinical practice show the possibility to evaluate the capacity of the arterial blood to transport O2 during general anesthesia and intensive care.
Subject(s)
Oxygen/blood , Heart Transplantation , Humans , Hypercapnia/blood , Tetralogy of Fallot/blood , Wound Infection/bloodABSTRACT
The results of the application of a new Soviet colloid solution modegel in cardiopulmonary bypass surgery in 50 patients have been analysed. The data obtained have been compared to those of control patients who were administered gelatinol instead of modegel. Modegel ensures optimal basic plasma electrolyte content, colloid-osmotic pressure and osmolality during perfusion.
Subject(s)
Cardiac Surgical Procedures , Cardiopulmonary Bypass , Gelatin , Plasma Substitutes , Adolescent , Adult , Colloids , Female , Humans , Male , Middle AgedABSTRACT
The oxygen transport function of the blood was studied in 223 patients in the early postoperative period after open-heart surgery, which included correction of acquired cardiac valve defects and aortocoronary bypass. The studied parameters comprised central hemodynamics, pulmonary gas exchange, oxygen supply and utilization, acid-base status, blood gas and lactate content, as well as erythrocytic 2,3-diphosphoglycerate (DPG); Boehringer Mannheim reagents (FRG) were used. The venous blood P50 was calculated using a Severinghaus device. It was found, that the Bohr effect and temperature changes are the major factors controlling the Hb affinity to oxygen. No coefficient modifications in pH and T were detected. Patients with cardiac and pulmonary disorders showed, along with the Bohr effect and temperature influences, an additional shift of the oxyhemoglobin dissociation curve. A positive relationship was revealed between the 2,3-DPG level and standard P50 value. However, the coefficient was low (0.010) at 2,3-DPG and insufficiently stable. It is most probable, that 2,3-DPG mediates the buffer effect eliminating the drastic P50 deviations and is not completely responsible for additional ODC shifts in cardiopulmonary disorders. A quantitative relationship between hypoxia and Hb affinity to oxygen was revealed. The coefficient at SO2 Y varied from -0.0025 to -0.0030 by one percent of changes in the latter. Reduction in SO2 by 15 percent in cardiopulmonary patients was equivalent to the Bohr effect at a pH fall by 0.1 unit.
Subject(s)
Cardiac Surgical Procedures , Oxygen/blood , Coronary Artery Bypass , Heart Valve Diseases/surgery , Heart Valve Prosthesis , Hemodynamics , Humans , Models, Biological , Oxyhemoglobins/analysis , Postoperative Period , Prognosis , Pulmonary Gas ExchangeABSTRACT
pO2 and pCO2 were studied transcutaneously (tcpO2 and tcpCO2) in 36 patients during reconstructive surgery performed under various multicomponent balanced anesthesia techniques. The results, in the absence of hemodynamic disturbances, serve as a reliable indication of changes in arterial blood pO2 and pCO2 (PaO2 and PaCO2), however, it is impossible to identify transcutaneous PaO2 and PaCO2 values. A decrease in tcpO2 and an increase in tcpCO2 during their dynamic study may give evidence of the inadequacy of controlled lung ventilation. At the same time, with normal PaO2 and PaCO2 values, hypoxia and hypercarbia, recorded, using transcutaneous transducers, may serve as an early index of central and peripheral hemodynamic disturbances. It is advisable to use the results of transcutaneous pO2 and pCO2 measurements as additional tests, characterizing O2 and CO2 transport.
Subject(s)
Anesthesia, General , Blood Gas Monitoring, Transcutaneous , Adult , Female , Humans , Middle AgedABSTRACT
Blood heparinization was assessed, using two techniques (activated coagulation time--ACT and heparin concentration) in 31 patients during cardiopulmonary bypass surgery. It has been shown that ACT-technique, not always revealing heparin concentration, may serve as a criterion for blood heparinization adequacy during cardiopulmonary bypass, as in every case it reflects individual changes in anticoagulant blood activity.
