The Management of the Severely Ill Patient After Open-Heart Surgery

Dammann, J. Francis; Thung, Nalda; Christlieb, Ignacio Y.; Littlefield, James B.; Muller, William H.

doi:10.1097/00132586-196308000-00051

Cited by 7 publications

(6 citation statements)

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“…Cardiac output and left ventricular function can improve after valve replacement (Kloster et al, 1966) and also, in some patients, after myocardial revascularisation (Moran et al, 1973). Peripheral resistance usually increases after the use of nonpulsatile flow during cardiopulmonary bypass, particularly in the first few hours after operation (Dammann et al, 1963). These haemodynamic sequelae would result in a rise in systemic arterial pressure because of the increase in both output and resistance.…”

Section: Discussionmentioning

confidence: 99%

Arterial hypertension in immediate postoperative period after valve replacement.

Estafanous¹,

Tarazi²,

Buckley³

et al. 1978

Heart

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suMMARY Paroxysmal hypertension occurred during the first 8 hours after cardiac valve replacement in 15 of 186 consecutive patients. The clinical characteristics of this hypertension were similar to those of hypertension after myocardial revascularisation, except that this complication occurred much less frequently after valve replacement (8-1%) than after myocardial revascularisation (33%) (P < 0.001).Hypertension resulting from hypoxia, hypercapnia, shivering, or arousal from anaesthesia was excluded from consideration.The (Estafanous et al., 1973;Estafanous, 1975;Chaptal et al., 1975). It occurs after both coronary bypass surgery (Estafanous et al., 1973;Estafanous, 1975;Chaptal et al., 1975) and cardiac valve replacement (Cleland et al., 1969; BraimbridgeandBranthwaite, 1972;McQueen et al., 1972), but has been said to be much less frequent in the latter situation (Estafanous et al., 1973). However, our initial report dealt with fewer cases of valve replacement (38) than of coronary bypass (76). Other reports were concerned only with hypertension after valve replacement and did not include coronary bypass cases (Cleland et al., 1969;Braimbridge and Branthwaite, 1972;McQueen et al., 1972). Further, the numbers involved in the latter series were also relatively small and the criteria for hypertension and the time of its occurrence differed in these reports. It still is not clear, therefore, whether postoperative hypertension is more frequent after myocardial revascularisation than after other Received for publication 12 September 1977 types of open heart surgery. More important, it has yet to be established whether the clinical picture and associated haemodynamic changes were the same in both circumstances. To that end a clinical study by the same group of investigators applying the same criteria was appropriate.We have, therefore, investigated 186 patients who have had valve replacement operations; the results were compared with our experience in over 5000 myocardial revascularisation procedures (Estafanous et al., 1972(Estafanous et al., , 1973Estafanous, 1975). MethodsThe postoperative records of 186 consecutive patients who had had an operation for cardiac valve replacement were reviewed. Of these, 85 patients had had mitral valve replacement, 83 aortic valve replacement, and 18 patients had had both valves replaced.Premedication consisted of Pantopon (0 3 mg/kg body weight) intramuscularly and promethazine hydrochloride (0-25 mg/kg body weight). Anaesthesia was induced with sodium thiopentone (3 to 5 mg/kg body weight), and a muscle relaxant was 718 on 7 June 2019 by guest. Protected by copyright.http://heart.bmj.com/ Br Heart J: first published as 10.1136/hrt.40.7.718 on 1 July 1978. Downloaded from

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Section: Discussionmentioning

confidence: 99%

Arterial hypertension in immediate postoperative period after valve replacement.

Estafanous¹,

Tarazi²,

Buckley³

et al. 1978

Heart

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“…Controlled ventilation for administration of anesthetics and long-term treatment of patients with cardiorespiratory insufficiency occurs in an increasing number of patients (Norlander et al, 1960;Dammann et al, 1963). A fundamental prerequisite of ventilators must be that they supply the patient with an adequate ventilation under such circumstances that unfavorable effects on circulation or the lungs and the airways are not created.…”

Section: Discussionmentioning

confidence: 99%

Volume‐controlled Respirators

Norlander

Engström

1965

Annals of the New York Academy of Sciences

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Equipment used for automatic ventilation of the lungs can be classified in different ways. Commonly used methods are mostly based on the process of cycling or triggering or the way the insufflated volume is controlled. In that respect a common division is made of referring to the final, end-inspiratory pressure as measured in the upper airways of the patient-pressure-controlled machines or to the final insufflated volume where the pressures will be a function of the mechanical characteristics of the lung and the airways and the ventilator itself-volume-controlled machines. Such divisions usually explain only some simple factors of the action but provide little information regarding fundamental mechanical properties of the device which are of great importance for the possibility of the equipment to administer an adequate ventilation even under unfavorable mechanical conditions of the lungs and airways.For such information it is necessary to know the qualities of the driving force on the insufflated gas and the flow, pressure and power characteristics of the device.Examples of different types of force generators and their principle pressureflow characteristics have been given by Mushin, Rendell-Baker, and Thompson ( 1959), Mapleson ( 1962), and Holaday and Rattenborg ( 1962). Recently, a slightly different approach to the analysis of function of ventilators has been used by Engstrom and Norlander (1962), Engstrom (1963), and by Norlander (1964). Their approach was based on the power demand on the ventilator during different clinical conditions of intermittent positive pressure ventilation. The power is equal to the product of flow and pressure. The integrated power gives the work, i.e. :This gives a simple method for determination of the future distribution of the respiratory work as it develops in the lungs and the airways during spontaneous breathing or respirator treatment, and the power demand on the force generator of the ventilator.The product of flow and pressure is easily computed with current electronic techniques. We have utilized a multiplier based on the Hall effect which was developed in our department . Three different volume-controlled ventilators are presented here. They have been analyzed with respect to force, power and gas flow in the generator circuit at conditions similar to those occurring clinically.The force generators have been classified according to the force available for action on the respiratory gas during the inspiratory period. (1) Constant force generator with a nonadjustable flow; and (2) increasing force generators with: ( a ) direct action, and (b) indirect action of the patient circuit.The ventilators were connected to a simulated patient circuit, consisting of a 40-liter glass bottle and with an adjustable flow resistance. The ventilators were adjusted to deliver approximately equal tidal volumes at equal respiratory frequencies. The flow resistance in the "patient" circuit was adjusted so that the peak airway pressure amounted to 40 to 50 cm. of water at a maximum load. This p...

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“…The proportion rises as high as 50% if the work of breathing is increased (Cherniack & Cherniack, 1961). Dammann, Thung & Littlefield (1963) introduced controlled respiration after surgery to reduce respiratory work, and while fully controlled respiration may not be necessary following operation, assisted respiration triggered by the patient can be beneficial in such cases. The endo-tracheal tube is left in place after surgery and removed 24 hr later if the patient's condition warrants.…”

Section: Acid-base Statusmentioning

confidence: 99%

Intensive care of the surgical patient

Lawson¹

1967

Postgraduate Medical Journal

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The Management of the Severely Ill Patient After Open-Heart Surgery

Cited by 7 publications

References 0 publications

Arterial hypertension in immediate postoperative period after valve replacement.

Arterial hypertension in immediate postoperative period after valve replacement.

Volume‐controlled Respirators

Intensive care of the surgical patient

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