SummaryAtelectasis occurs during general anaesthesia. This is partly responsible for the impairment of gas exchange that occurs peri-operatively. During cardiopulmonary bypass, this atelectasis is exacerbated by the physical collapse of the lungs. As a result, poor arterial oxygenation is often seen postoperatively. We tested the effect of an Ôalveolar recruitment strategyÕ on arterial oxygenation in a prospective randomised study of 78 patients undergoing cardiopulmonary bypass. Patients were divided equally into three groups of 26. Group Ôno PEEPÕ received a standard post bypass manual lung inflation, and no positive end-expiratory pressure was applied until arrival at intensive care unit. Group Ô5 PEEPÕ received a standard post bypass manual inflation, and then 5 cmH 2 O of positive end-expiratory pressure was applied and maintained until extubation on intensive care. The third group, Ôrecruitment groupÕ, received a pressure-controlled stepwise increase in positive end-expiratory pressure up to 15 cmH 2 O and tidal volumes of up to 18 ml.kg )1 until a peak inspiratory pressure of 40 cmH 2 O was reached. This was maintained for 10 cycles; the positive end-expiratory pressure of 5 cmH 2 O was maintained until extubation on intensive care. There was a significantly better oxygenation in the recruitment group at 30 min and 1 h post bypass when compared with the no PEEP and 5 PEEP groups. There was no significant difference in any of the groups beyond 1 h. Application of 5 cmH 2 O positive end-expiratory pressure alone had no significant effect on oxygenation. No complications due to the alveolar recruitment manoeuvre occurred. We conclude that the application of an alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass surgery.

We reviewed the prevalence and severity of pruritus in 85 patients after cardiac surgery. EloHAES, a long-lasting hydroxyethylated starch, was given to 59 of these patients. None of the patients who did not receive EloHAES developed pruritus, compared with 22% of those who did (P = 0.007). The timing of onset, duration and severity of the pruritus are similar to those found previously for other hydroxyethylated starches, and the cause of this pruritus is likely to be similar. Hydroxyethyl starch can cause long-term pruritus.

No abstract

No abstract

No abstract