Correlation between myocardial ischemia and changes in arterial resistance during coronary artery bypass surgery.

The arterial resistometer provides continuous on-line monitoring of changes in arterial resistance. Resistance index (Ri), which bears a direct relationship to systemic vascular resistance (SVR), is defined by the equation Ri = P'/(dP'/dt), where dP'/dt is the peak dP/dt of the arterial waveform, and P' is the pressure at dP'/dt. In 42 patients with unstable angina, changes in Ri were studied at six periods during aortocoronary bypass surgery before tracheal intubation, during tracheal intubation, leg elevation, presternotomy, sternotomy, and dissection of the internal mammary artery. Thirty-four episodes of ischemia (0.1 mV ST segment changes) were observed in 26 patients. All ischemic episodes were associated with increased Ri (mean increase, 102 +/- 52%). Elevation of the pulmonary capillary wedge pressure correlated with ischemia during the preintubation, intubation, and sternotomy periods, but not in the remaining periods. Changes in arterial pressure and heart rate were not good predictors of ischemia. The prevalence of ST segment changes increased markedly during all periods of anesthesia with increase in Ri (P less than 0.05). Ninety-one percent of ST segment changes were associated with a 25% increase from the baseline Ri. Raising the cutoff point to a greater than or equal to 75% increase in Ri improved the specificity of Ri in ischemia detection from 61% to 92%. An increase of greater than or equal to 75% in Ri occurred in only 8% of cases without ST segment changes. It was found that an increase in Ri as depicted by the arterial resistometer was the best hemodynamic correlate of myocardial ischemia.

Prostacyclin and prostaglandin E2 mediate reduction of increased mean arterial pressure during cardiopulmonary bypass by aspiration of shed pulmonary venous blood.

Increased mean arterial pressure during the aortic crossclamp period while on cardiopulmonary bypass was usually treated by us with hypotensive drugs. We noticed, however, that aspirating shed excess pulmonary venous blood from the open pleural cavities causes an immediate reduction in mean arterial pressure, obviating the need for any further pharmaceutical intervention. In this study we investigated the relationship between the reduction in mean arterial pressure and the levels of prostacyclin and prostaglandin E2 in the peripheral and pulmonary venous blood. Ten men undergoing coronary bypass operations had 21 episodes of increased mean arterial pressure (106.9 +/- 11.4 mm Hg) during aortic crossclamping, which was reduced to 67.4 +/- 11.4 mm Hg (p less than 0.001) only by aspirating a mean of 490 ml (range 150 to 1100 ml) of pulmonary venous blood from the pleurae back into the circulation. Mean peripheral prostacyclin level, measured as 6-keto-prostaglandin F1 alpha, and prostaglandin E2 level, both measured by radioimmunoassay technique, were significantly lower at peak mean arterial pressure (419 +/- 180 and 59.5 +/- 21.2 pg/ml) than at lowest mean arterial pressure (632 +/- 271 and 96.7 +/- 52.4 pg/ml for 6-keto-prostaglandin F1 alpha and prostaglandin E2, respectively; p less than 0.001). Prostaglandin F1 alpha and prostaglandin E2 levels in the aspirated pulmonary venous blood were 2309 +/- 3098 pg/ml and 749 +/- 909 pg/ml, respectively. The hypotensive effect of shed pulmonary venous blood that is aspirated back from the pleurae into the circulation seems to be mediated by the high levels of prostacyclin and prostaglandin E2, both powerful vasodilators.

Biocuff--a new pressure device for infusion bags.

The Biocuff is a new pressure device designed to overcome the problems associated with use of pneumatic cuffs and spring-driven devices. It consists of three modular elements: a sleeve, an air sac, and a booster. The sleeve has a rigid back, which reduces the air volume required to compress the infusion bag. The booster applies constant air pressure until the bag is empty. The Biocuff is easy to handle and is quickly put into operation. It is most advantageous in situations requiring rapid infusion of large volumes of blood.