[Factors influencing early extubation after open heart surgery]. / Nyitott szívmútéteket követó korai extubáció kivitelezhetóségét befolyásoló tényezók.

The authors have performed a retrospective study in order to review the occurrence and the influencing factors of early extubation among their patients. Those patients who had any severe complication in the immediate postoperative period (pericardial tamponade, low cardiac output syndrome, re-operation due to excessive bleeding, postperfusion lung syndrome, pulmonary edema) preventing early extubation, have been excluded from the study. In the remaining 690 patients early extubation within 8 hours and within 4 hours could be carried out in 525 (76.1%) and 164 cases (23.8%) respectively. Late (beyond 12 hours) extubation occurred in 68 cases (9.9%). Anaesthesia was governed by two different methods. Midazolam and alfentanyl (group 1) were used in 137 cases (19.9%) whilst 553 patients (80.1%) received propofol and alfentanyl (group 2). In group 1 and 2 early extubation was possible in 50.4 and 82.5% respectively (p < 0.0001). In further investigations 27 pre- and intraoperative variables of each patient have been studied and analysed. For statistical analysis authors used the SPSS software including T-test, Mann-Whitney-test, chi-square test and multivariate logistical regression analysis. On the basis of multivariate regression analysis factors influencing early extubation were as follows: age (B = 0.0775; p < 0.001), sex (B = 1.2900; p < 0.001), method of anaesthesia (B = 1.9753; p < 0.001), duration of anaesthesia (B = 0.0053; p < 0.001), re-do operation (B = 1.0482; p = 0.0469) and preoperative congestive heart failure (B = 0.9008; p = 0.0125). Pulmonary diseases known from patient history have not had a deep impact on early extubation. On the basis of our study early extubation has not resulted in an increased number of either the postoperative complications or the occurrence of perioperative myocardial infarction.

[Hemodynamic effects of propofol induction administered with target controlled infusion pump in patients scheduled for open heart surgery]. / Célkoncentráció-vezérelt módszerrel adagolt propofol hemodinamikai hatásai a narkózis bevezetése során nyitott szívmútétre kerüló betegekben.

Target controlled infusion systems have been developed to provide improved convenience and control during intravenous anaesthesia. The anaesthetist sets and adjust the target blood concentration and depth of anaesthesia--as required on clinical grounds. Infusion rates are altered automatically according to a validated pharmacokinetic model. Haemodynamic effects during induction of anaesthesia with target controlled infusion pump have been documented in this prospective study. Twenty patients scheduled for open heart surgery. Mean age 62.2 +/- 9.93 years. The surgical procedures were: 16 coronary bypass, 2 artificial valve replacement, 2 coronary bypass combined valve replacement. Anaesthesia was induced with alfentanil, 20-40 micrograms/kg, and propofol administered with target control infusion pump, 1.5-4 micrograms/ml target concentration. Pulse contour analysis was used for haemodynamic measurements. They were repeated before induction (T0), after induction--before intubation (T1), after intubation in two minutes intervals (T2-T5). Compared with values obtained in awake patients, there was a significant decrease in mean arterial pressure (-30%), in cardiac output (-25%), in heart rate (-8%), in vascular resistance (-9%), in contractility (-37.4%), in stroke volume (-17.5%). No ECG changes were observed during that period. The haemodynamic changes observed do not differ from the published data in patients presenting for cardiac surgery and anaesthetized with manually controlled infusion techniques using propofol.

[Adult respiratory distress syndrome after open heart surgery]. / Adult respiratory distressz-szindróma nyitott szívmútétek után.

Cardiopulmonary bypass used in open heart surgery is responsible for nearly 15% of adult respiratory distress syndrome. The condition has a high mortality rate and still today we do not have a specific therapy for it. The aim of this study was to reveal the factors that are responsible for the adult respiratory distress syndrome developing after open heart operations. A retrospective statistical analysis of the database of 837 consecutive open heart operations was performed. Those patients in whom the adult respiratory distress syndrome has not developed have served as control group. chi 2 probe, Student t test and the Mann-Whitney test were used for the analysis. The authors applied logistic regression analysis for the multivariate investigation. Adult respiratory distress syndrome has developed in 10 patients (1.2%) in the postoperative period. One patient in whom the adult respiratory distress syndrome was accompanied by multiorgan failure has been lost. Between the two subgroups the authors found significant difference in the amount of blood and fresh frozen plasma transfusion, in the duration of ischaemic period and cardiopulmonary bypass, in anaesthesia time, and also in the occurrence of postoperative low cardiac output syndrome and acute myocardial infarction. Fresh frozen plasma can be a risk factor in the development of postoperative adult respiratory distress syndrome. In order to avoid the occurrence of this syndrome a great emphasis must be put on the pulmonary prevention.

[Low cardiac output following open heart surgery and catecholamine therapy]. / Nyitott szívmütéteket követö alacsony perctérfogat szindróma és katecholamin terápia.

The authors have studied the possible risk factors and complications of low cardiac output (LCO) following open heart operations. A retrospective analysis of 537 consecutive open heart operations has been performed with regards to the patients past medical and perioperative data. For statistical analysis the authors have applied the Chi-square test, T-probe, Mann-Whitney-test and logistical regression analysis by means of the SPSS software. Occurrence of various types of operations was as follows: coronary bypass (CABG): n = 266, 49.5%, combined CABG: n = 62, 11.5%, aortic valve replacement (AVR): n = 73, 13.6%, mitral valve replacement (MVR): n = 59, 11%, multiple valve replacement: n = 39, 7.3%, adult congenital surgery: n = 25, 4.7%. Aortic dissection repair: n = 6, 1.1%, miscellaneous: n = 7, 1.3%. LCO has developed in 7.3% (n = 39) of the patients. The authors have concluded that in the studied group of patients the independent risk factors of postoperative LCO are as follows: atrial fibrillation in the patient history, mitral valve disease, perioperative myocardial infarction, length of anaesthesia, NYHA stage, number of transfused units of blood, and the perioperative LDH value. Beyond these variables the cause of LCO in some cases was surely an intra or perioperative myocardial necrosis. At least a certain part of this perioperative myocardial damage must have been or might have been caused by the catecholamines given under compulsion for the treatment of LCO.