Perioperative management for placement of tracheobronchial stents.

Tracheobronchial stenting was performed under general anesthesia, with (six patients) or without (two patients) muscle relaxant, in eight patients suffering from carcinoma. All patients had presented preoperatively with dyspnea, exhibiting Hugh-Jones grade 4 or 5. Three patients had been mechanically ventilated before the procedure. The procedure was performed under general anesthesia with flexible bronchoscopic guidance. Stent placement was performed either through an orotracheal tube (four patients) or through a transtracheal tube (two patients) in those who had no upper tracheal stenosis, while it was performed through a laryngeal mask airway in two patients with upper tracheal stenosis. During the procedure, arterial hemoglobin oxygen saturation (Sp(O(2)) decreased in all patients, despite fraction of inspired oxygen (FI(O(2)) being maintained at 1.0. Except for two patients, one of whom developed superior vena cava syndrome and one, tension pneumothorax after stent placement, there were no complications resulting from stent placement. Six patients were weaned from mechanical ventilation (0-24 days after the procedure). Two of the three patients who had been on mechanical ventilation preoperatively could not be weaned. Stent insertion is an effective treatment for tracheobronchial stenosis, but its indications in patients with malignancy who have been mechanically ventilated prior to stenting should further be evaluated.

Normothermic cardiopulmonary bypass and cardioplegia reduce inotropic requirements and creatine kinase-MB after coronary artery bypass graft surgery.

PURPOSE: To determine whether normothermic cardiopulmonary bypass (CPB) and cardioplegia preserve myocardial function, reduce inotropic requirements, and reduce markers of myocardial ischemia following coronary artery bypass graft surgery (CABG). METHODS: We retrospectively reviewed the charts of 171 consecutive patients undergoing elective CABG by a single surgeon from April 1994 to December 1995. Hypothermic CPB with intermittent cold cardioplegia was used in 83 patients and normothermic CPB with intermittent warm cardioplegia in 88 patients. Demographic, surgical, hemodynamic, and inotropic requirements and laboratory data were reviewed. RESULTS: The duration of CPB was significantly shorter in the normothermic group (113±27vs 90±21 min;P<0.0001). After CPB the cardiac index was similar between groups, but significantly larger doses of both dopamine and dobutamine were required (8vs 5µg·kg-1·min-1,P<0.0001), and significantly more patients required norepinephrine administration in the hypothermic group (18%vs 6%;P=0.01). Postoperative peak values of creatine kinase MB fraction (CK-MB) were significantly lower in the normothermic group (80±60vs 55±54 IU·I-1;P<0.0001). CONCLUSION: Normothermic CPB and cardioplegia reduce inotropic requirements and CK-MB following CABG.