ABSTRACT
This article contains analysis of retrospective and prospective studies of use of selective ultrashort Beta-blocker esmolol during intraoperative period in cardiac surgery patients in recent years. The drug is highly effective and controlled the means for prevention and treatment of tachycardia, arising as a result of the sympathoadrenal system activation during anaesthesia induction (laryngoscopy, trachea intubation) and intraoperative period (during heart and aorta manipulations). It should be considered that the use of esmolol has dose-dependent effect. For the treatment of tachycardia against the background of hypertension is recommended dose of 0.6-1.0 mg/kg, with normal blood pressure it is recommended to decrease the esmolol dose up to 0.3-0.6 mg/kg. It is possible to use esmolol-infusion in the dose of 50-200 g/kg/min prolonging adrenergic blockade during heart and aorta surgery.
Subject(s)
Adrenergic beta-1 Receptor Antagonists/therapeutic use , Aorta/surgery , Cardiac Surgical Procedures/methods , Propanolamines/therapeutic use , Tachycardia/prevention & control , Vascular Surgical Procedures/methods , Adrenergic beta-1 Receptor Antagonists/administration & dosage , Adult , Cardiac Surgical Procedures/adverse effects , Dose-Response Relationship, Drug , Echocardiography , Hemodynamics/drug effects , Humans , Intraoperative Care , Propanolamines/administration & dosage , Prospective Studies , Retrospective Studies , Tachycardia/etiology , Treatment Outcome , Vascular Surgical Procedures/adverse effectsSubject(s)
Adrenergic beta-Antagonists , Anesthesia/methods , Hemodynamics/drug effects , Propanolamines , Adrenergic beta-Antagonists/administration & dosage , Adrenergic beta-Antagonists/adverse effects , Adrenergic beta-Antagonists/therapeutic use , Humans , Propanolamines/administration & dosage , Propanolamines/adverse effects , Propanolamines/therapeutic useABSTRACT
The choice of anesthesia for a high risk operation, orthotopic transplantation of the liver (OTL), is discussed. The authors propose a protocol of anesthesia for OTL. For induction anesthesia, intravenous drugs should be preferred; the liver-free stage of the operation is carried out under anesthesia with a closed isoflurane contour, and the initial metabolic disorders of patients are corrected. When the bloodflow is let in the transplanted organ, intravenous drugs (ketamine, phentanyl, and benzodiazepines) should be administered in order to reduce the vasodilating effect of isoflurane and vasopressors for preventing relative hypovolemia. At the final stage of anesthesia, isoflurane is used. Before transporting the patient into intensive care ward, phentanyl in a dose of 1.5-3 micrograms/kg was injected, because of rapid elimination of isoflurane and awakening of the patient. This protocol maintained the hemodynamics and the major metabolic parameters at the optimal level.
Subject(s)
Anesthesia/methods , Liver Transplantation/methods , Adolescent , Adult , Cadaver , Child , Child, Preschool , Female , Hemodynamics , Humans , Infant , Liver Cirrhosis/physiopathology , Liver Cirrhosis/surgery , Liver Transplantation/physiology , Living Donors , Male , Middle Aged , Monitoring, Intraoperative/methods , Preanesthetic Medication/methodsABSTRACT
Standard technique of establishment of interatrial anastomoses allows to carry out orthotopic transplantation of the heart quickly and reliably. However the accumulation of collective experience evidences about a number of unavoidable shortcomings of such operation: rhythm disturbances, worsening of hemodynamics in discordant atrial contractions of recipient and donor, atrio-ventricular valve insufficiency, thromboembolism, coronary fistulas. Since 1990 in RRCS 25 operations were carried out with the use of standard technique and we also met with the risk of developing the above complications. In experiment on 30 mongrel dogs the technique of anatomical, truly orthotopic transplantation of the heart with six anastomoses was developed: left pulmonary veins with a common cuff, separate anastomoses of the superior and inferior caval veins, anastomoses of aorta and pulmonary artery. Particular attention was paid to developing of original surgical modes for prophylaxis of stenoses in the area of anastomoses of pulmonary and caval veins. In 1997 the anatomical technique of heart transplantation was successfully introduced by us into clinical practice. Clinical electrophysiological, echocardiographic and functional examinations have confirmed the results of the experiments and have evidenced for substantial advantages of the anatomical technique of orthotopic transplantation of the heart. By reliability the new operation is not inferior to standard method of N. Shumway.
Subject(s)
Heart Transplantation/methods , Anastomosis, Surgical/methods , Animals , Dogs , Echocardiography , Heart/anatomy & histology , Humans , Male , Middle Aged , Tissue DonorsABSTRACT
The effect of a novel ultrashort acting beta-adrenoblocker esmolol on systemic and pulmonary hemodynamics has been studied intraoperatively in 81 cardiosurgical patients. All the patients were operated under ataralgesia. Esmolol is an effective controlled agent for the treatment and prevention of supraventricular tachycardia and hyperdynamic reaction developing in cardiothoracic patients during anesthesia and surgery. Bolus injection of 100 mg esmolol exerts a negative chronotropic effect with maximum heart rate decrease by 23.3% by minute 5 and a gradual attenuation of the effect by minute 20. A parallel drop in the cardiac output by 18.5% is caused predominantly by a decrease in the heart rate and accounts for BP reduction. The above esmolol dose does not have a considerable effect on pulmonary hemodynamics and does not enhance intrapulmonary venous shunting.
