Halothane for open heart surgery

Abstract

As a result of considerable changes in the techniques of cardiopulmonary by-pass at Guy's Hospital since the introduction of hypothermic perfusion, anasthetic management of these cases 1 has required alteration.In some of our earlier cases ventilation was inadequate in the immediate post-operative phase, and it was considered that the anaesthetic technique might have contributed to this state. Therefore, in order to avoid the use of large doses of tubocurarine chloride and pethidine, it was felt that a trial should be made of halothane as the main anasthetic agent.Many types of anasthesia have been used in different centres during cardio-pulmonary by-passzv 3941 536.7. Some of these21 3, emphasize the need for the deliberate production of respiratory alkalosis by overventilation in order to offset the metabolic acidosis which may result from perfusion. We do not consider this necessary or desirable, and choose a ventilatory level delivered by a mechanical ventilator to maintain normal pH and P C O~ levels.This method of anaesthesia has now been used in over 120 cases of all types of open heart surgery, without any post-operative complication directly attributable to the anasthetic technique; it is based on that described by Dawson, Theye and Kirklin 7.

A Review of the Pharmacology of Halothane

“…The use of halothane is advantageous in those operations which must be performed under hypothermia, because the vasodilatation which is produced increases the rate of heat loss and facilitates cooling, shivering being minimal (Knight, 1961). The successful use of halothane in patients undergoing open heart surgery has been reported by Bull, Ozinsky and Harrison (1960), Dawson, Theye and Kirklin (1960) and Hutton and Vale (1964). Halothane possesses the great advantage of being non-inflammable, and this together widi easy control of the level of anaesthesia and the fact that it can be administered with high concentrations of oxygen account for its suitability.…”

Tracheostomy and Open Heart Surgery

“…The anesthetic technique changed in the middle of the series; initially nitrous oxide/oxygen and relaxants were used but for the last two years halothane has been the basis of the anasthetic, relaxants being used only for intubation and intermittently if any respiratory movements occur during perfusion (Hutton & Vale 1964); this technique is used in order to avoid using atropine and neostigmine with their disagreeable action on cardiac rhythms and bronchial secretions.…”