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1. Abstracts

Author

Michèle, Saiah, Alain, Borgeat, Oliver, Wilder-Smith, Hung, Orlando R., Hope, Charles E., Laney, Geoffrey, Whynot, Sara C., Coonan, Thomas J., Malloy, David S., Patterson, S., Gelb, A., Manninen, P., Strum, D., Glosten, B., Spellman, M. J., Eger, E. I., Craen, R. A., Gelb, A. W., Murkin, J. M., Chong, K. Y., Penning, D. H., El-Behairy, H., Brien, J. F., Coh, J. W., Arellano, R., Correa, J., Fedorko, L., Arellano, R., Liu, Z., Boylan, J. F., Sandler, A. N., Nierenberg, H., Sheiner, P. A., Greig, P. D., O’Leary, G. M., Teasdale, S. J., Glynn, M. F. X., Orser, B. A., Wang, L. -Y., MacDonald, J. F., Loomis, C. W., Arunachalam, K. D., Vyas, D., Milne, B., Gagnon, Daniel, Lavoie, Josée, Dupuis, Jean-Yves, Miller, D. R., Martineau, R. J., Greenway, D., Olivaris, L., Hull, K., Tierney, R. N. M., Wynands, J. E., Martineau, R., St-Jean, B., Kitts, J., Miller, D., Lindsay, P., Curran, M., Allen, G. C., Crossan, M. L., Wise, Richard, Donati, François, Bevan, David R., Hardy, J. F., Desroches, J., Perrault, J., Carrier, M., Robitaille, D., Ansley, D. M., O’Connor, J. P., Dolman, J., Townsend, G. E., Ricci, D., Liepert, D. J., Browne, P. M., Hertz, T., Rooney, M., Yip, R. W., Code, W., Phillips, A. A., McLean, R. F., Devitt, J. H., Harrington, E. M., Byrick, R. J., Wong, P. Y., Wigglesworth, D., Kay, J. C., Sinclair, L. A., Koch, J. P., Deemar, K. A., Christakis, G. K., Belo, S., Angle, P., Cheng, D., Boylan, J., Sandler, A., Feindel, C., Carmichael, F., Boylen, P., Boylen, P., DeLima, L. G. R., Nathan, H. J., Hynes, M. S., Bourke, M. E., Russell, G. N., Seyone C., Chung F., Chartrand, Daniel, Roux, Lucie, Dain, S. L., Smith, B. D., Webster, A. C., Wigglesworth, D. F., Rose, D. K., Caskennette, G., Mechetuk, C., Doyle, D. John, DeMajo, Wilfred, van den Bosch, Frank, Lee, Mark, McClenaghan, K. M., Mazer, C. D., Preston, R., Crosby, E. T., Kotarba, D., Dudas, H., Elliott, R. D., Enns, J., Manninen, P. H., Farrar, J. K., Huzyka, David L., Lin, L. Philip, Fossey, Susan, Finucane, Brendan T., Stockwell, M., Lozanoff, S., Lang, S., Hyssen, J., Campbell, D. C., Douglas, M. J., Pavy, T. J. G., Flanagan, M. L., McMorland, G. H., Bands, Colin, Ffaracs, Ch. B., Lipsett, Catherine, Drover, David, Stafford-Smith, Mark, Stevens, Sarah, Shields, Kate, MacSween, Michael J., McAllister, J. D., Morley-Forster, P. K., White, A. K., Taylor, M. D., Vandenberghe, H. M., Knoppert, D., Reimer, H., Duke, P. C., Kehler, C. H., Kepron, M. W., Taraska, V. A., Carstoniu, J., Norman, P., Katz, J., Hannallah, Medhat, Cooney, C. M., Lyons, J. B., Hennigan, A., Blunnie, W. P., Moriarty, D. C., Dobkowski, W. B., Prato, F. S., Shannon, N. A., Drost, D. J., Arya, B., Wills, J. M., Bond, D., Morley-Forester, P., JB, Mullen, Spahr-Schopfer, I., Lerman, J., Cutz, E., Dolovich, M., Kowalski, S., Ong, B., Bell, D., Ostryzniuk, T., Serrette, C., Wasylak, T., Coke, S., Tsuda, Takako, Nakagawa, Takashi, Mabuchi, Norifumi, Ando, Hiroshi, Nishida, Osamu, Azami, Takafumi, Katsuya, Hirotada, Goto, Yukio, Searle, N., Roy, M., R. R. T., Smith, Charles E., Pinchak, Alfred C., Hagen, Joan F., Hancock, Donald, Krassioukov, Andrei V., Weaver, Lynne C., Sutton, I. R., Mutch, W. A. C., Teskey, J. M., Thomson, I. R., Rosenbloom, M., Thiessen, D., Teasdale S., Corbin H., Graham, M. R., Lang, S. A., Chang, P., Gerard, M., Tetzlaff, J. E., Walsh, M., Yoon, H., Warriner, Brian, Fancourt-Smith, Peter, McEwen, Jim, Crane, Judy, Badner, N. H., Bhandari, R., Komar, W. E., Ganapathy, S., Warriner, C. B., McCormack, J. P., Levine, M., Glick, N., Chan, V. W. S., McQuestion, M., Gomez, M., Cruise, C., Evana, D., Shumka, D., Smyth, R. J., Graham, M., Halpenny, David, Goresky, Gerald V., Zaretski, J. Eldon, Kavanagh, B., Roger, S., Davies, A., Friedlander, M., Cohen M. M., Duncan P. G., Pope W. D. B., Biehl D., Merchant R., Tweed, W. A., Tessler, Michael J., Angle, Mark, Kleiman, Simcha, Kavanagh, B. P., Doak, G. J., Li, G., Hall, R. I., Sulliyan, J. A., Yee, I., Halpern, S., Pittini, R., Huh, C., Bryson, G. L., Gverzdys, R., Perreault, C., Ferland, L., Gobeil, F., Girard, D., Smyth, R., Asokumar, B., Glynn, M., Silveira, Sandra, Clark, Jeff, Milgram, Paul, Splinter, W. M., MacNeill, H. B., Ménard, E. A., Rhine, E. J., Roberts, D. J., Gould, G. M., Johnson, G. G., Quance, Daniel, Wiesel, Saul, Easdown, Jane, Truong, N. Tien, Miller, Normand, Sheiner, Nathan, Welborn, L., Norden, J., Hannallah, R., Broadman, L., Seiden, N., Iwai, M., Iwai, R., Horigome, H., Yamashita, M., Wood, Catherine E., Klassen, Kim, Kleinman, S., Yentis, S., Sikich, N., Yemen, T. A., Mascik, B., Nelson, W., Ghantous, H., Gandolfi, J., Wood, Gordon, Ali, Mohamed, Inman, Kevin, Karski, J. M., Carroll, J., Brooks, D., Oakley, P. A., Webster, P. M., Karski, J., Yao, T., Ivanov, J., Young, P., Carson, S., Weisel, R. D., Cooper, Richard M., Wong, David T., Wagner, Douglas P., Knaus, William A., Munshi, Charul A., Kampine, John P., Soutter, I. D., Mathieu, A., Gafni, A., Dauphin, A., Torsher, L., Tierney, M., Hopkins, H. S., Baylon, G. J., Peter, Elizabeth A., Bellhouse, C. P., Dore, Caroline, Rachwal, T. W., Lanigan, D. T., Yip, Raymond, Derdemezi, J. B., Britt, B. A., Withington, D. E., Reynolds, F., Patrick, A., Man, W., Searle, N. R., Ste-Marie, H., Kostash, Mark A., Johnston, Richard, Bailey, R. J., Sharpe, M. D., Woda, R. P., Haug, M., Slugg, P., Lockrem, J., Barnett, G., Finegan, B. A., Robertson, M., Taylor, D., Frost, G., Koshal, A., Rodney, Grant E., Reichert, Clayton C., O’Regan, Desmond N., Blackstock, Derek, Steward, David J., Wenstone, Richard, Harrington, Ellen, Wong, A., Braude, B., Fear, D., Bissonnette, B., Reid, Craig W., Hull, Kathryn A., Yogendran, S., McGuire, G., Chan, V., Hartley, E., Van Kessel, K., Weisel, R., Takla, N., Tremblay, N. A., Ralley, F. E., Ramsay, J. G., Robbins, G. R., Salevsky, F. C., Gandhi, S., Nimphius, N., Dionne, Bernard, Jodoin, Christian, Lorange, Michel, Lapointe, Alain, Hawboldt, Geoffrey, Volgyesi, G. A., Tousignant, Guy, Barnett, R., and Gallant, B.

Published
1992
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2. Erratum

Author

Michèle, Saiah, Alain, Borgeat, Oliver, Wilder-Smith, Hung, Orlando R., Hope, Charles E., Laney, Geoffrey, Whynot, Sara C., Coonan, Thomas J., Malloy, David S., Patterson, S., Gelb, A., Manninen, P., Strum, D., Glosten, B., Spellman, M. J., Eger, E. I., Craen, R. A., Gelb, A. W., Murkin, J. M., Chong, K. Y., Penning, D. H., El-Behairy, H., Brien, J. F., Coh, J. W., Arellano, R., Correa, J., Fedorko, L., Arellano, R., Liu, Z., Boylan, J. F., Sandler, A. N., Nierenberg, H., Sheiner, P. A., Greig, P. D., O’Leary, G. M., Teasdale, S. J., Glynn, M. F. X., Orser, B. A., Wang, L. -Y., MacDonald, J. F., Loomis, C. W., Arunachalam, K. D., Vyas, D., Milne, B., Gagnon, Daniel, Lavoie, Josée, Dupuis, Jean-Yves, Miller, D. R., Martineau, R. J., Greenway, D., Olivaris, L., Hull, K., Tierney, R. N. M., Wynands, J. E., Martineau, R., St-Jean, B., Kitts, J., Miller, D., Lindsay, P., Curran, M., Allen, G. C., Crossan, M. L., Wise, Richard, Donati, François, Bevan, David R., Hardy, J. F., Desroches, J., Perrault, J., Carrier, M., Robitaille, D., Ansley, D. M., O’Connor, J. P., Dolman, J., Townsend, G. E., Ricci, D., Liepert, D. J., Browne, P. M., Hertz, T., Rooney, M., Yip, R. W., Code, W., Phillips, A. A., McLean, R. F., Devitt, J. H., Harrington, E. M., Byrick, R. J., Wong, P. Y., Wigglesworth, D., Kay, J. C., Sinclair, L. A., Koch, J. P., Deemar, K. A., Christakis, G. K., Belo, S., Angle, P., Cheng, D., Boylan, J., Sandler, A., Feindel, C., Carmichael, F., Boylen, P., Boylen, P., DeLima, L. G. R., Nathan, H. J., Hynes, M. S., Bourke, M. E., Russell, G. N., Seyone C., Chung F., Chartrand, Daniel, Roux, Lucie, Dain, S. L., Smith, B. D., Webster, A. C., Wigglesworth, D. F., Rose, D. K., Caskennette, G., Mechetuk, C., Doyle, D. John, DeMajo, Wilfred, van den Bosch, Frank, Lee, Mark, McClenaghan, K. M., Mazer, C. D., Preston, R., Crosby, E. T., Kotarba, D., Dudas, H., Elliott, R. D., Enns, J., Manninen, P. H., Farrar, J. K., Huzyka, David L., Lin, L. Philip, Fossey, Susan, Finucane, Brendan T., Stockwell, M., Lozanoff, S., Lang, S., Hyssen, J., Campbell, D. C., Douglas, M. J., Pavy, T. J. G., Flanagan, M. L., McMorland, G. H., Bands, Colin, Ffaracs, Ch. B., Lipsett, Catherine, Drover, David, Stafford-Smith, Mark, Stevens, Sarah, Shields, Kate, MacSween, Michael J., McAllister, J. D., Morley-Forster, P. K., White, A. K., Taylor, M. D., Vandenberghe, H. M., Knoppert, D., Reimer, H., Duke, P. C., Kehler, C. H., Kepron, M. W., Taraska, V. A., Carstoniu, J., Norman, P., Katz, J., Hannallah, Medhat, Cooney, C. M., Lyons, J. B., Hennigan, A., Blunnie, W. P., Moriarty, D. C., Dobkowski, W. B., Prato, F. S., Shannon, N. A., Drost, D. J., Arya, B., Wills, J. M., Bond, D., Morley-Forester, P., JB, Mullen, Spahr-Schopfer, I., Lerman, J., Cutz, E., Dolovich, M., Kowalski, S., Ong, B., Bell, D., Ostryzniuk, T., Serrette, C., Wasylak, T., Coke, S., Tsuda, Takako, Nakagawa, Takashi, Mabuchi, Norifumi, Ando, Hiroshi, Nishida, Osamu, Azami, Takafumi, Katsuya, Hirotada, Goto, Yukio, Searle, N., Roy, M., R. R. T., Smith, Charles E., Pinchak, Alfred C., Hagen, Joan F., Hancock, Donald, Krassioukov, Andrei V., Weaver, Lynne C., Sutton, I. R., Mutch, W. A. C., Teskey, J. M., Thomson, I. R., Rosenbloom, M., Thiessen, D., Teasdale S., Corbin H., Graham, M. R., Lang, S. A., Chang, P., Gerard, M., Tetzlaff, J. E., Walsh, M., Yoon, H., Warriner, Brian, Fancourt-Smith, Peter, McEwen, Jim, Crane, Judy, Badner, N. H., Bhandari, R., Komar, W. E., Ganapathy, S., Warriner, C. B., McCormack, J. P., Levine, M., Glick, N., Chan, V. W. S., McQuestion, M., Gomez, M., Cruise, C., Evana, D., Shumka, D., Smyth, R. J., Graham, M., Halpenny, David, Goresky, Gerald V., Zaretski, J. Eldon, Kavanagh, B., Roger, S., Davies, A., Friedlander, M., Cohen M. M., Duncan P. G., Pope W. D. B., Biehl D., Merchant R., Tweed, W. A., Tessler, Michael J., Angle, Mark, Kleiman, Simcha, Kavanagh, B. P., Doak, G. J., Li, G., Hall, R. I., Sulliyan, J. A., Yee, I., Halpern, S., Pittini, R., Huh, C., Bryson, G. L., Gverzdys, R., Perreault, C., Ferland, L., Gobeil, F., Girard, D., Smyth, R., Asokumar, B., Glynn, M., Silveira, Sandra, Clark, Jeff, Milgram, Paul, Splinter, W. M., MacNeill, H. B., Ménard, E. A., Rhine, E. J., Roberts, D. J., Gould, G. M., Johnson, G. G., Quance, Daniel, Wiesel, Saul, Easdown, Jane, Truong, N. Tien, Miller, Normand, Sheiner, Nathan, Welborn, L., Norden, J., Hannallah, R., Broadman, L., Seiden, N., Iwai, M., Iwai, R., Horigome, H., Yamashita, M., Wood, Catherine E., Klassen, Kim, Kleinman, S., Yentis, S., Sikich, N., Yemen, T. A., Mascik, B., Nelson, W., Ghantous, H., Gandolfi, J., Wood, Gordon, Ali, Mohamed, Inman, Kevin, Karski, J. M., Carroll, J., Brooks, D., Oakley, P. A., Webster, P. M., Karski, J., Yao, T., Ivanov, J., Young, P., Carson, S., Weisel, R. D., Cooper, Richard M., Wong, David T., Wagner, Douglas P., Knaus, William A., Munshi, Charul A., Kampine, John P., Soutter, I. D., Mathieu, A., Gafni, A., Dauphin, A., Torsher, L., Tierney, M., Hopkins, H. S., Baylon, G. J., Peter, Elizabeth A., Bellhouse, C. P., Dore, Caroline, Rachwal, T. W., Lanigan, D. T., Yip, Raymond, Derdemezi, J. B., Britt, B. A., Withington, D. E., Reynolds, F., Patrick, A., Man, W., Searle, N. R., Ste-Marie, H., Kostash, Mark A., Johnston, Richard, Bailey, R. J., Sharpe, M. D., Woda, R. P., Haug, M., Slugg, P., Lockrem, J., Barnett, G., Finegan, B. A., Robertson, M., Taylor, D., Frost, G., Koshal, A., Rodney, Grant E., Reichert, Clayton C., O’Regan, Desmond N., Blackstock, Derek, Steward, David J., Wenstone, Richard, Harrington, Ellen, Wong, A., Braude, B., Fear, D., Bissonnette, B., Reid, Craig W., Hull, Kathryn A., Yogendran, S., McGuire, G., Chan, V., Hartley, E., Van Kessel, K., Weisel, R., Takla, N., Tremblay, N. A., Ralley, F. E., Ramsay, J. G., Robbins, G. R., Salevsky, F. C., Gandhi, S., Nimphius, N., Dionne, Bernard, Jodoin, Christian, Lorange, Michel, Lapointe, Alain, Hawboldt, Geoffrey, Volgyesi, G. A., Tousignant, Guy, Barnett, R., and Gallant, B.

Published
1992
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5. Abstracts of papers presented at the annual meeting,

Author

Prigent, F., Hubscher, C., Oksenlhendler, G., Soyer, R., Winkier, C., Moffitt, E., Sethna, D., Gray, R., Bussell, J., Raymond, M., Matloff, J., Sprigge, J. M., Wynands, J. E., Whalley, D. G., Bevan, D., Nathan, H., Townsend, G. E., Patel, Y., Wong, P., Townsend, G., Patel, Y., King, F. G., Manson, H. J., Snellen, J. W., Chang, K. S., Gotta, Alexander W., Sullivan, Colleen A., Fournier, Louis, Major, Diane, Normandin, N., Perreault, L., Plamondon, L., Rousseau, P., Blain, R., Girard, M., Forget, G., Clark, G S., Castro, C., Teasdale, S. J., Grady, M., Glynn, M. F. X., Tweed, W. A., Donen, N., Pope, W. D. B., Persaud, T. V. N., Devaux, C., Roussignol, M. C., Vinckler, C., Finucane, B. T., Floyd, J. B., Petro, D. J., Braswell, R., Morison, D. H., Dunn, G. L., Fargas-Babjak, A. M., Moudgil, G. C., Smedstad, K. G., Woo, J., Davies, A. O., Morison, H., Gyasi, Williams H. K., Bevan, D. R., Williams, R. T., Sloan, I. A. J., McLeod, M. E., Anderton, B. G., Steward, D. J., Chinyanga, H. M., Vandenberhe, H., Soldin, S. J., MacLeod, S., Abrams, L., Griepp, R., Ergin, A., Matsuoka, M,, Bussieres, J., Heroux, M., Joncas, H., Randour, P., Donati, F., Friesen, Robert M., Bonet, Jorge F., Hardy, J. F., Boulanger, M., Maille, J. G., Taillefer, J., Sahab, P., Delorme, M., Cunningham, A. J., Patrick Kelly, C., Farmer, James, Watson, A. G., Moote, C. A., Knill, R. L., Clement, J. L., Mutch, W. A., Culligan, J. D., Thomson, l. R., Rogers, Kent H., Milne, Brian, and Salerno, Tomas A.

Published
1982
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7. Abstracts

Author

Kieraszewicz, H. T., Lam, A. M., Steward, D. J., Volgyesi, G. A., Smedstead, K. G., Powles, A. C. P., Wolf, G. L., Capuano, C., Chartrand, D., Couture, J., Cole, C. P., Donatī, F., Maillé, J. G., Roof, A., Blain, R., Finley, G. A., Cherry, M., Cotton, D., Nicholas, J. F., Petkau, D., Kettner, J. D., Ramsay, J. G., Townsend, G. E., Martin, R., Tétrault, J. P., Tétreault, L., Lamarche, Y., Veilleux, L. J., Gotta, A. W., Carsons, S., Abrams, L., Sullivan, C., Futter, M. E., Whalley, D. R., Wynands, J. E., Bevan, D. R., Ghignone, M., Prewitt, R. M., Razen, M., Girling, L., Slykerman, L., Kay, J. C., Noble, W. H., Forrest, J. B., Chambers, C., Kozody, R., Cheney, F., Chambers, C., Carli, F., Higgs, B. D., Knill, R. L., Thompson, W. R., Clement, J. L., Varkey, G. P., Spoerel, W. E., Moffat, J. A., McDougall, M., Spence, D., Saunders, F., Shelley, E. S., Cervenko, F. W., Brunet, D., Milne, B., Harris, P. W., Morison, D. H., Dunn, G. L., Fargas-Babjak, A. M., Moudgil, G. C., Smedsted, K., Woo, J., Williams, J. G., Strunin, L., Ward, S., Wright, D., Corall, I., Neill, E. A. M., Marty, J., De Champlain, J., Kenefick, J. P., Roth, S., Jhamandas, K., Hemmings, C. T., Weeks, S. K., Smith, J. B., Ong, B. Y., Tweed, W. A., Yarnell, R., Sitar, D. S., McLeod, M. E., Roy, L., and Bennett, K. J.

Published
1983
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8. Reply

Author

Townsend, G. E., Wynands, J E., Whalley, D. G., and Bevan, D. R.

Published
1984
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12. Enoxaparin for unstable angina and ancrod for cardiac surgery following heparin allergy.

Author

Smith RE, Townsend GE, Berry BR, and Bowen T

Subjects
Aged, Animals, Anticoagulants adverse effects, Cattle, Coronary Artery Bypass, Diphenhydramine therapeutic use, Drug Hypersensitivity etiology, Humans, Male, Swine, Ancrod therapeutic use, Angina, Unstable drug therapy, Anticoagulants therapeutic use, Enoxaparin therapeutic use, Heparin adverse effects
Abstract

Objective: To describe a patient who presented with heparin allergy and required alternate anticoagulation for unstable angina and coronary artery bypass surgery. To review therapeutic alternatives to porcine heparin for patients with hypersensitivity or intolerance to standard heparin anticoagulation., Case Summary: A 74-year-old man with a 15-year-old coronary artery bypass graft presented to the emergency room with unstable angina and was scheduled for urgent coronary artery revascularization. A bolus dose of porcine heparin was administered followed by a continuous infusion. Shortly afterward the patient developed a type I allergic reaction to the porcine heparin that was confirmed by rechallenge. Three alternatives to porcine heparin were tried, including bovine lung heparin, low-molecular-weight heparin (enoxaparin), and ancrod. The patient was found to be cross-sensitive to bovine lung heparin, but tolerated enoxaparin for unstable angina without cross-sensitivity. Anticoagulation for cardiopulmonary bypass was achieved with an infusion of ancrod that was later reversed with cryoprecipitate. The patient was discharged postoperatively on day 5 without the complication of excessive bleeding., Discussion: Type I allergic reaction to unfractionated heparin is a rare occurrence and could be the result of a variety of factors. Possible causes for the reaction include a porcine protein, a preservative contained in the heparin solution, or a hapten formed between heparin and a plasma protein. We considered four alternatives to heparin anticoagulation: rush desensitization, bovine lung heparin, low-molecular-weight heparin, and ancrod. The patient was cross-sensitive to bovine lung heparin, but was able to tolerate low-molecular-weight heparin (enoxaparin). This was unexpected because enoxaparin is derived from unfractionated porcine heparin. Testing for cross-sensitivity had no value in this case, as two negative subcutaneous test doses were followed by dramatic reactions when the drugs were given intravenously. Although enoxaparin has been used for anticoagulation during bypass surgery, there is more experience with ancrod as an alternative to heparin. Repeat bypass surgery, which normally results in above-average blood loss, was successfully performed with a very low fibrinogen concentration (< 0.15 g/L) during ancrod anticoagulation., Conclusions: We conclude that ancrod was a safe and effective alternative to heparin for coronary artery bypass surgery in this patient in whom a heparin product had caused a hypersensitivity reaction. We discovered on two occasions that a negative subcutaneous test dose for heparin allergy did not predict a severe type I allergic reaction when the heparin was later administered intravenously. Furthermore, we found that a low-molecular-weight heparin administered subcutaneously for a short period of time did not cause cross-sensitivity in a patient with a type I allergy to unfractionated heparin.

Published
1996
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15. Fentanyl infusion anesthesia for aortocoronary bypass surgery: plasma levels and hemodynamic response.

Author

Sprigge JS, Wynands JE, Whalley DG, Bevan DR, Townsend GE, Nathan H, Patel YC, and Srikant CB

Subjects
Female, Fentanyl blood, Fentanyl pharmacology, Humans, Infusions, Parenteral, Kinetics, Male, Middle Aged, Anesthesia, Intravenous, Coronary Artery Bypass, Fentanyl administration & dosage, Hemodynamics drug effects
Abstract

Plasma fentanyl concentrations were measured by radioimmunoassay in patients during aortocoronary bypass surgery and correlated with hemodynamic responses to surgical stimulation. Thirty patients scheduled for aortocoronary bypass surgery were divided into three groups of 10. Patients in group 1 received fentanyl, 30 micrograms/kg, as a loading dose followed by an infusion of 0.3 microgram/kg/min; those in group 2 received 40 micrograms/kg as a loading dose followed by an infusion of 0.4 microgram/kg/min; and those in group 3 received 50 micrograms/kg as the loading dose followed by an infusion of 0.5 microgram/kg/min. The total dose of fentanyl administered to each group up to the time of rewarming on cardiopulmonary bypass was 60 micrograms/kg, 90 micrograms/kg, respectively. Each of the dose regimens produced stable plasma concentrations starting approximately 20 minutes after induction and continuing until the infusion was discontinued. Patients in group 1 had a mean plasma concentration of 10 to 12 ng/ml in the stable period compared with 12 to 14 ng/ml in group 2 and 15 to 18 ng/ml in group 3. Fewer patients in group 3 responded to intubation and surgical stimulation than in the other groups, although the differences between groups were not statistically significant. Response to stimulation was treated by the administration of droperidol or volatile anesthetic agents. At a plasma concentration of 15 ng/ml, 50% of patients had an increase in systolic blood pressure which required treatment. This minimal intra-arterial concentration, analogous to MAC, can be achieved by the administration of fentanyl as a loading dose of 50 micrograms/kg followed by an infusion of 0.5 microgram/kg/min.

Published
1982

16. Blood pressure response and plasma fentanyl concentrations during high- and very high-dose fentanyl anesthesia for coronary artery surgery.

Author

Wynands JE, Townsend GE, Wong P, Whalley DG, Srikant CB, and Patel YC

Subjects
Cardiopulmonary Bypass, Dose-Response Relationship, Drug, Double-Blind Method, Female, Fentanyl blood, Humans, Male, Middle Aged, Postoperative Period, Random Allocation, Stress, Physiological physiopathology, Anesthesia, Intravenous methods, Blood Pressure drug effects, Coronary Vessels surgery, Fentanyl administration & dosage
Abstract

We examined whether different plasma fentanyl concentrations could maintain hemodynamic stability during coronary artery surgery. Two randomly selected groups of 10 patients were studied. Patients in group 1 received a single 75-micrograms/kg intravenous dose of fentanyl; patients in group 2 received the same dose but it was followed by an infusion of fentanyl at a rate of 0.75 micrograms/kg/min. The total dose of fentanyl in group 2 was 162 +/- 6.5 micrograms/kg (mean +/- SEM). At some point during surgery, all 10 patients in group 1 and 7 of 10 patients in group 2 had a hypertensive response. Plasma fentanyl concentrations in the two groups were not significantly different in the period 10-45 min after induction of anesthesia. At 60 min, corresponding to the time of aortic root dissection, mean plasma fentanyl concentration was statistically significantly lower in group 1 than in group 2 (13.5 +/- 1.4 ng/ml and 24 +/- 2.3 ng/ml, respectively, P less than 0.01). However, no significant difference was observed in the frequency of hypertensive response between the two groups in the period before cardiopulmonary bypass. During cardiopulmonary bypass, plasma fentanyl concentrations in group 1 were 2-3 times lower than those in group 2, and hypertension was observed in all 10 patients in group 1 but in only 2 patients in group 2 (P less than 0.05). Patients in group 1 were ventilated for 16.6 +/- 1.5 h, and those in group 2 for 19.1 +/- 1.8 h, postoperatively (P greater than 0.05). Six patients in group 1 required vasodilating drugs, whereas eight patients in group 2 required alpha-adrenergic agonists. Although the plasma fentanyl concentrations achieved were not successful in totally suppressing a hypertensive response, this study suggests that a plasma fentanyl concentration might be attainable to effect this.

Published
1983

17. A trial of desmopressin (1-desamino-8-D-arginine vasopressin) to reduce blood loss in uncomplicated cardiac surgery.

Author

Hackmann T, Gascoyne RD, Naiman SC, Growe GH, Burchill LD, Jamieson WR, Sheps SB, Schechter MT, and Townsend GE

Subjects
Adult, Aged, Blood Transfusion, Blood Volume, Cardiopulmonary Bypass, Clinical Trials as Topic, Deamino Arginine Vasopressin administration & dosage, Double-Blind Method, Hemostatics administration & dosage, Humans, Middle Aged, Random Allocation, Time Factors, von Willebrand Factor analysis, Cardiac Surgical Procedures, Deamino Arginine Vasopressin therapeutic use, Hemorrhage prevention & control, Hemostatics therapeutic use, Postoperative Complications prevention & control
Abstract

Previous studies have suggested that desmopressin may reduce the bleeding diathesis that often complicates open-heart surgery. To pursue this question further, we performed a double-blind, randomized, placebo-controlled trial to determine whether the previously reported beneficial effect of desmopressin on hemostasis during complex cardiac surgery was applicable to all elective cardiac surgical procedures involving cardiopulmonary bypass. In 150 consecutive patients, most of whom underwent primary coronary-artery bypass grafting, we compared the effects of intravenous desmopressin (0.3 microgram per kilogram of body weight) with those of saline placebo on postoperative blood loss and the need to replace blood products. The median amount of blood lost within the first 24 hours after operation was similar in the desmopressin and placebo groups (865 vs. 738 ml; P = 0.26). The postoperative use of blood replacement products did not differ significantly between the groups (1025 ml [95 percent confidence interval, 300 to 4140 ml] in the desmopressin group and 860 ml [247 to 5346 ml] in the placebo group). Desmopressin is believed to exert its hemostatic effect by releasing von Willebrand factor. The level of ristocetin cofactor, a functional index of the level of von Willebrand factor, was increased approximately twofold from base line in both treatment groups 90 minutes and 24 hours after the administration of medication. Similarly, the levels of von Willebrand factor multimers increased uniformly in both groups. These findings may be consistent with a normal stress response of von Willebrand factor to major surgery and could explain our failure to detect a therapeutic effect of desmopressin. We conclude that the majority of patients who undergo elective cardiac surgery receive no hemostatic benefit from the use of desmopressin.

Published
1989
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18. Narcotic requirements for intravenous anesthesia.

Author

Wynands JE, Wong P, Townsend GE, Sprigge JS, and Whalley DG

Subjects
Aorta surgery, Dermatologic Surgical Procedures, Female, Fentanyl administration & dosage, Humans, Hypertension blood, Hypertension etiology, Male, Middle Aged, Sternum surgery, Sympathetic Nervous System physiology, Anesthesia, Intravenous, Blood Pressure, Coronary Artery Bypass, Fentanyl blood
Abstract

MAC BAR, the minimum end-tidal alveolar anesthetic concentration that inhibits adrenergic response to a noxious stimulus in 50% of subjects, is a quantifiable physiological parameter that can be used to determine potency and therapeutic indices of volatile anesthetics. We wished to determine whether there is a minimal intraarterial plasma concentration (MIC BAR) of an opiate such as fentanyl that will prevent a hypertensive response to noxious stimuli in 50% of patients undergoing aortocoronary bypass surgery (ACBP). Forty-three patients with good left ventricular function were studied. All patients were premedicated with diazepam, morphine, and scopolamine. Five groups of patients were anesthetized with different fentanyl anesthesia protocols, each designed to produce different plasma fentanyl concentrations (PFC). A 20% increase in systolic blood pressure compared to control was considered an adrenergic response that related to the plasma fentanyl concentration inferred from each patient's PFC time-concentration curve. Only four patients became hypertensive with a PFC greater than 20 ng/ml. One patient became hypertensive at intubation with a PFC of 12.3 ng/ml. There was no statistically significant difference in the mean PFC in patients who became hypertensive at each event. During aortic dissection, when significantly more patients became hypertensive, there was no difference in the incidence of hypertension in patients with a PFC above or below 20 ng/ml. Two patients became hypertensive at skin incision with a PFC over 30 ng/ml. A MIC BAR could not be identified because of the great variability in the PFC of patients who became hypertensive.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1984

19. Effect of heated humidified gases on temperature drop after cardiopulmonary bypass.

Author

Ralley FE, Ramsay JG, Wynands JE, Townsend GE, Whalley DG, and DelliColli P

Subjects
Adult, Aged, Gases, Hot Temperature, Humans, Humidity, Middle Aged, Nasopharynx, Time Factors, Anesthesia methods, Body Temperature Regulation, Coronary Artery Bypass, Hypothermia, Induced adverse effects
Abstract

In an attempt to prevent the decrease in nasopharyngeal temperature (NPT) ("afterdrop") after cardiac surgery, 30 patients undergoing hypothermic cardiopulmonary bypass (CPB) were randomly assigned to receive humidified heated inspired gases at 45 degrees C at the proximal end of the endotracheal tube (group I) or dry gases at room temperature (group II), from the time of termination of CPB. All patients received high flow rates on CPB during the rewarming period with the use of vasodilator drugs when necessary. Both groups were comparable with respect to total bypass time, rewarming time, and temperature at termination of CPB. In addition, the NPT was compared with the tympanic membrane temperature (TMT) in group I to assess the validity of the NPT under these conditions. The results indicate that heating and humidifying inspired gases do not prevent afterdrop and do not falsely increase the nasopharyngeal temperature. The reasons for the ineffectiveness of heated humidified gases may include a large heat deficit at termination of CPB despite a normal NPT, and the very small heat content of heated gases. Monitoring the temperature of a site that reflects the heat deficit, and a more complete rewarming during CPB are suggested as a better approach to the prevention of afterdrop.

Published
1984

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