A Comparative Study of Nonpulsatile and Pulsatile Perfusion on Hemodynamics and Renal Function Centered on the patients undergoing coronary artery bypass grafting with cardiopulmonary bypass / 대한마취과학회지

BACKGROUND: It has been widely believed that pulsatile flow was better than nonpulsatile flow. However it remains uncertain whether pulsatile perfusion has shown substantive clinical improvement compared to standard, nonpulsatile perfusion. The purpose of this study was to compare nonpulsatile perfusion with pulsatile perfusion on hemodynamic and renal function during and after cardiopulmonary bypass (CPB) in the patients undergoing coronary artery bypass grafting (CABG). METHODS: Twenty patients undergoing CABG were divided into two groups, nonpulsatile perfusion group (NP) and pulsatile perfusion group (PP). Hemodynamic data was measured at preinduction, postinduction, immediately after aorta cross clamping (ACC on), and 60 minutes after the start of CPB (CPB 60'). Hemodynamic variables included mean arterial pressure (MAP), peripheral vascular resistance (PVR), plasma catecholamine (epinephrine, norepinephrine), and dosage of the vasodilator (sodium nitroprusside). Renal parameters were urine output, and serum BUN and creatinine. They were measured at preCPB, during CPB, postCPB, and POD 1. RESULTS: MAP was significantly higher in NP at CPB 60'. At CPB 60, PVR returned to preinduction level in NP, but was still decreased in PP. The dosage of vasodilator (sodium nitroprusside) infusionwas significantly higher in NP than in PP. In both groups, plasma epinephrines were increased significantly during CPB but there was no difference between the groups. Plasma norepinephrine was significantly higher in NP than in PP during CPB. At postCPB, urine output was higher than preCPB only in PP. At POD 1, serum BUN increased to the preCPB level in NP but was still decreased in PP. After CPB, serum creatinine was decreased significantly in PP. There was no significant difference in renal parameters between both groups. Conclusion: It was suggested that pulsatile perfusion, compared with nonpulsatile perfusion, can attenuate hemodynamic changes by decreasing release of plasma norepinephrine, peripheral vascular resistance, mean arterial pressure and dosage of vasodilator during cardiopulmonary bypass. Pulsatile perfusion didn't show substantive clinical difference of renal outcome in patients without preoperative renal dysfunction.

Effects of Amrinone on Systemic and Pulmonary Arterial Pressure in Infants with Intracardiac Left to Right Shunt / 대한마취과학회지

BACKGROUND: Amrinone is a nonglycosidic noncatecholamine with both vasodilator and positive inotropic effects that has not been evaluated widely in pediatric patients with intracardiac left to right shunts. The present study was performed to evaluate the hemodynamic effects of amrinone in infants and children with intracardiac left to right shunts. METHODS: Twenty patients (aged 2 months to 24 months) who underwent open heart surgery to correct one or more intracardiac left to right shunts were evaluated. Before cardiopulmonary bypass, a 22 gauge angiocatheter was placed at the main pulmonary artery by surgeons to measure pulmonary arterial pressure. Patients with a mean pulmonary arterial pressure or = 25 mmHg were assigned to Group B (n = 10). Mean systemic arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP) and heart rate (HR) were measured before loading of amrinone (3 mg/kg), 5 minutes, and 15 minutes after continuous infusion of amrinone (10 microgram/kg). The mean pulmonary arterial pressure to mean systemic arterial pressure ratio (MPAP/MAP) and rates of changes of mean arterial pressure (delta MAP) and mean pulmonary arterial pressure (delta MPAP) were calculated. RESULTS: Amrinone reduced MAP, MPAP, CVP and increased HR. MPAP/MAP increased in Group A but decreased in Group B (P < 0.05). In Group A, delta MAP was significantly greater than that of Group B (P < 0.005). In Group B, delta MPAP was significantly greater than that of Group A (P < 0.005). CONCLUSION: In infants with intracardiac left to right shunts, amrinone reduces MAP, MPAP, CVP and increases HR. Amrinone appears to have a potent vasodilating effect on the pulmonary artery in infants with pulmonary hypertension. However, more hemodynamic measurements such as cardiac output, vascular resistance and doppler echocardiographic study are necessary to evaluate the hemodynamic effects of amrinone precisely.