Concomitant coronary artery bypass grafting and adrenalectomy for pheochromocytoma.

We report the first case of concomitant coronary artery bypass grafting (CABG) and adrenalectomy for pheochromocytoma. Which lesion to correct first and staging of the corrective procedures are highly controversial issues. Issues concerning pre- and intraoperative control of hemodynamic instability from catecholamine release are discussed. Preoperative alpha and beta blockade permitted excellent hemodynamic control in the operating room. Operative and postoperative courses were uneventful and the patient had complete resolution of his angina and hypertension. We conclude that concomitant CABG and adrenalectomy is the preferred approach when pheochromocytoma and symptomatic coronary artery atherosclerosis coexist.

Use of Janke-Barron retractor for exposure of the arteries during bypass surgery.

The Janke-Barron heart support was used successfully on 1500 patients who required coronary artery bypass surgery to at least two vessels. The significant advantages it provided were improved exposure and access to all coronary arteries, elimination of damage caused by an assistant holding the heart, provision of a dryer operating field, and allowance for a smaller incision without compromising exposure of the heart.

Control of postcardiotomy bleeding with PEEP.

One hundred consecutive patients undergoing open-heart operation were selected for investigation of the prophylactic and therapeutic use of positive-end-expiratory pressure (PEEP) to control postoperative bleeding. Five cm of PEEP was applied after placement of sternal wires. Patients who bled more than 200 ml per hour were treated with increasing increments of PEEP until hemorrhage terminated or reoperation was required. After 8 hours, the total blood loss per patient was 281 ml for the PEEP group versus 340 ml for the controls (p greater than 0.05). Other variables showed no significant differences. Fifteen patients bled an average of 406 ml (range, 242 to 991 ml) in the first hour in the intensive care unit; they formed the PEEP treatment group. In all patients bleeding decreased to less than 60 ml per hour within 3 hours. No complications of PEEP occurred, and no patient required reoperation to control hemorrhage.

Propranolol for prevention of postoperative cardiac arrhythmias: a randomized study.

Two hundred twenty-three patients were randomly selected to receive propranolol, 10 mg orally every 6 hours, or to serve as controls after coronary artery bypass grafting. The study began at the time of discharge from the intensive care unit. Patients were ineligible if they had cardiac arrhythmias while in the intensive care unit, low cardiac output requiring catecholamine support, or bradycardia requiring a pacemaker. In the control group, cardiac arrhythmias for which treatment was necessary developed in 31 of 136 patients (23%), atrial fibrillation or flutter in 24 patients (18%), and ventricular arrhythmias in 7 (5%). In the group receiving propranolol, cardiac arrhythmias requiring treatment developed in 9 of 87 patients (10%), atrial fibrillation or flutter in 7 (8%), and ventricular arrhythmias in 2 (2%). The difference in frequency with which cardiac arrhythmias occurred between the two groups is significantly different (p less than 0.05). We conclude that propranolol is effective in the prevention of cardiac arrhythmias following coronary artery bypass grafting.