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Objectives: Pulmonary endarterectomy is a heavy surgical procedure that is performed under cardiopulmonary bypass (CPB) and aimed to cure postembolic pulmonary hypertension. Reperfusion oedema is both the hallmark of successful surgical procedure and the most frequent postoperative complication. Post-CPB lung dysfunction was not mentioned in any report. We undertook a study to determine whether post-CPB lung dysfunction was present in these patients., Methods: In a retrospective cohort study with matching on some baseline covariates, we selected 41 patients who had undergone pulmonary endarterectomy and in whom pre-, intra- and postoperative records were complete. The control group was composed of 39 patients operated on from elective cardiac surgery during the same period and matched with a study group for age, gender, body mass index, blood creatinine, diabetes and baseline partial pressure of oxygen/fraction of inspired oxygen ratio. Criteria for post-CPB lung dysfunction were partial pressure of oxygen/fraction of inspired oxygen ratio decrease and bilateral basal oedema. Explanatory variables for post-CPB lung dysfunction were coronary arterial bypass, pleura opening, static pulmonary compliance measured at the time of thorax closed then retracted, fluid infusion, transfusion and vasopressors., Results: All patients operated on from pulmonary endarterectomy presented radiological oedema reperfusion in surgical unblocking areas. Among them, only 2 had bilateral basal oedema when compared to the 24 patients from the control group (P < 0.001). Partial pressure of oxygen/fraction of inspired oxygen ratio increased in the study group and decreased in the control group (30 ± 109 vs -67 ± 134 mmHg, P < 0.001). Control group patients with high-baseline pulmonary compliance were at risk for post-CPB lung dysfunction., Conclusions: Patients operated on from pulmonary endarterectomy were saved from post-CPB lung dysfunction. The latter could be induced by a mechanical phenomenon., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Introduction: Lung dysfunction following cardiac surgery is currently viewed as the consequence of atelectasis and lung injury. While the mechanism of atelectasis has been largely detailed, the pathogenesis of lung injury after cardiopulmonary bypass is still unclear. Based upon clinical and experimental studies, we hypothesized that lungs could be injured through a mechanical phenomenon., Methods: We recorded pulmonary compliance at six key moments of a heart operation in 62 adult patients undergoing elective cardiac surgery. We focused on the period lasting from anesthetic induction to aorta unclamping. We calculated the variation of static and dynamic pulmonary compliance caused by thorax opening; ΔCstat1 and ΔCdyn1 and that caused by cardiopulmonary bypass, ΔCstat2 and ΔCdyn2. Blood gases were performed under standardized ventilation after anesthetic induction and after surgical closure. The PaO 2 /FiO 2 ratio was calculated. ∆PaO 2 /FiO 2 was the criterion for lung dysfunction. We compared ΔCstat1 and ΔCdyn1 with both ∆PaO 2 /FiO 2 and, respectively, ΔCstat2 and ΔCdyn2., Results: Static and dynamic compliance increased with the opening of the thorax and decreased with the start of cardiopulmonary bypass. The PaO 2 /FiO 2 ratio diminished after surgery. ΔCstat1 and ΔCdyn1 were negatively correlated with both ∆PaO 2 /FiO 2 (r=-0.42; p<0.001 and r=-0.44; p<0.001) and, respectively, with ΔCstat2 and ΔCdyn2 (r=-0.59; p<0.001 and r=-0.53; p<0.001)., Conclusions: Increased pulmonary compliance induced by the opening of the thorax is correlated with worsened intrapulmonary shunt after cardiopulmonary bypass. A mechanical phenomenon could be partly responsible for post-operative hypoxemia.

This prospective study aimed to assess the quality of interpretation by Teaching Hospital anaesthesiologists of preoperative electrocardiograms (ECG). It was carried out over a period of 7 months, and included 500 patients scheduled for elective surgery. The ECG was first interpreted by the anaesthesiologist during the preoperative visit, and later during the postoperative period, by a cardiologist. The two interpretations were compared using the following criteria: minor anomalies, which would not influence the anaesthetic technique already selected; major anomalies, which, on the other hand, are known to increase anaesthetic morbidity and mortality rates, thereby influencing the choice of anaesthetic technique; and interpretative errors concerning only the major anomalies, i.e. anomalies not seen by the anaesthesiologist (false negatives), anomalies found which did not exist (false positives), and erroneous or incomplete interpretation. Interpretation of the ECG by the anaesthesiologist was written on the anaesthetic record for only 156 patients (31.2%). Among the 500 ECG's, 141 were found to be abnormal by the cardiologist (28.2%). Seventy-three of them had 1 or more major abnormalities. Of the 156 ECG's interpreted by an anaesthesiologist, 64 (41%) were abnormal. The overall error rate was 21.1%, the major error rate being 7.1%. The overall false negative rate was 12.8%, with 7 major ischaemic abnormalities (4.5%) having not been found, including 4 (2.6%) diagnostic errors. About 3.8% of ECG's were wrongly interpreted as abnormal by the anaesthesiologist; all errors were of minor importance, but nevertheless responsible for delayed surgery, loss of time, and extra expenditure in laboratory tests.(ABSTRACT TRUNCATED AT 250 WORDS)