Search

Objective: This study was designed to assess the use of 100% oxygen or 50% oxygen in air or nitrous oxide after cardiopulmonary bypass (CPB) on atelectasis, as evidenced by the oxygenation index (PaO 2 /F I O 2 ), after coronary artery bypass graft (CABG) surgery. Design: Prospective, randomized clinical study. Setting: University teaching hospital. Participant: Thirty-six adult patients undergoing CABG surgery. Interventions: Patients either received 50% O 2 in air (50% O 2 group), 50% O 2 in N 2 O (50% N 2 O group), or 100% O 2 (100% O 2 group) after CPB. Measurements and Main Results: Apart from demographic and perioperative clinical data, extubation time, mediastinal drainage, and pulmonary complications were also recorded. After CPB, arterial blood gases done at various time points until 3 hours postextubation and oxygenation index were calculated. No significant differences were noted in demographic and perioperative data except preoperative hemoglobin and fluid use. Significant deterioration in arterial oxygenation was noted in the 100% O 2 group from the baseline value, whereas significant improvement was seen in the 50% O 2 group at 4 time points from baseline value and at all time points from the 100% O 2 group. After initial deterioration in oxygenation, no further change was evident in the 50% N 2 O group. Furthermore, there was a greater increase in the oxygenation index as compared with the 100% O 2 group. Time to extubation was also longer in the 100% O 2 group than the 50% O 2 group. Conclusion: Significant deterioration in arterial oxygenation and an increase in the extubation time occurred with the use of 100% O 2 after CPB, whereas better oxygenation was evident with the use of 50% O 2 in air.

m s t p a i i v t a t t m i t g a t 1 c o t 1 N ATRIAL SEPTAL DEFECT (ASD) is usually repaired through a midline sternotomy under general anesthesia nd cardiopulmonary bypass (CPB). Device closure of ASDs in he catheterization laboratory is another alternative; however, here are limitations.1 Presence of bilateral multiple emphyseatous bullae and chronic obstructive pulmonary disease COPD) in a patient with an ASD can pose various problems in he perioperative period including perioperative hypoxemia; ypercarbia; bronchospasm2; spontaneous rupture of bulla; neumothorax3; difficulties in separation from CPB because of ulmonary vascular disease; cor pulmonale; unfavorable pulonary mechanics; and the likelihood of postoperative respiatory failure and prolonged mechanical ventilation.2 The isues of concern to the anesthesiologist are secondary to the ecision whether to operate on the emphysematous bullae, the SD, or both lesions and whether to operate on them simultaeously or separately and in what order. A search in the iterature did not reveal any report that addresses these issues. n this report, the anesthetic management of a patient who resented for simultaneous surgical treatment of multiple emhysematous bullae and an ASD is discussed.

D S s HE OCCURRENCE OF malignant ventricular arrhythmias after aortic valve surgery may be a cause of failure to ean patients from cardiopulmonary bypass (CPB). Electrical ardioversion or defibrillation and antiarrhythmic drugs may ail to treat arrhythmias and establish sinus rhythm. Controlled aortic root perfusion with infusion of warm carioplegia has been used as a strategy for intraoperative myoardial management during cardiac surgery. In 3 patients oprated on in 2001 and 2002, aortic root perfusion was useful hen refractory ventricular arrhythmias developed after reoval of the aortic cross-clamp. All of them failed to respond o conventional treatment, but controlled aortic root perfusion ed to establishment of sinus rhythm and successful weaning ff CPB.