==================================CMR12================================== 12. Cardiopulmonary by-pass for open heart surgery, and use of oxygenators: - disk oxygenators - bubble oxygenators - membrane oxygenators And their influence on the methods of anesthesia in these patients. Evolution of the technology of extra corporeal circulation and its influence on anesthetic methods. 1 UI - 87088151 AU - Berman J ; Mockros LF TI - Mass transfer to fluids flowing through rotating nonaligned straight tubes. AB - Relatively inefficient heat/mass transfer is characteristic of tubular devices if the Reynolds number is low. One method of improving the heat/mass transfer efficiency of such devices is by inducing transverse laminar secondary circulations that are superimposed on the primary flow field; the resulting transverse velocity components lead to fluid mixing and hence augmented mass transfer in the tube lumen. The present work is a theoretical and experimental investigation of the enhanced transport in rotating, nonaligned, straight tubes, a method of transport enhancement that utilizes Coriolis acceleration to create transverse fluid mixing. This technique couples the transport advantages of coiled tubes with the design advantages of straight tubes. The overall mass balance equation is numerically solved for transfer into fluids flowing steadily through rotating nonaligned straight tubes. This solution, for small Coriolis disturbances, incorporates a third order perturbation solution for the primary and secondary flow fields. For sufficiently small Coriolis disturbances the bulk concentration increase is found to be uniquely determined by the value of a single similarity parameter. As the Coriolis disturbance is increased, however, two additional parameters are required to accurately characterize the mass transfer. In general, increasing the Coriolis accelerations results in an increase in mass transfer. There are solution regimens, however, in which increasing this acceleration can lead to a decrease in mass transfer efficiency. This interesting phenomena, which has important design implications, appears to result from velocity-weighting effects on the exiting sample. Experiments, involving the measurement of oxygen transferred into water and blood, produced data that agree with the theoretical predictions. MH - Biomechanics ; Biomedical Engineering ; Biophysics ; Blood Flow Velocity ; *Extracorporeal Circulation ; *Heat ; Human ; Models, Cardiovascular ; Oxygen/BLOOD ; Oxygenators ; Support, U.S. Gov't, P.H.S. SO - J Biomech Eng 1986 Nov;108(4):342-9 2 UI - 87086143 AU - Sell LL ; Cullen ML ; Whittlesey GC ; Yedlin ST ; Philippart AI ; Bedard MP ; Klein MD TI - Hemorrhagic complications during extracorporeal membrane oxygenation: prevention and treatment. AB - Hemorrhage related to systemic heparinization is the major complication of extracorporeal membrane oxygenation (ECMO). Intracranial hemorrhage (ICH) is the most devastating complication. ICH developed in 13 of our 25 ECMO patients (52%). Six died, six survived with normal neurologic function, and one is severely impaired. In nine of 13 patients (69%) ECMO was discontinued when serial cranial ultrasounds showed progressive ICH. Seizures developed in six infants while receiving ECMO, and ICH developed in all. There is a correlation between hypertension and ICH. A hypertension index (hours systolic BP greater than 90/hours receiving ECMO) was 0.1 +/- 0.12 for infants without ICH and 0.37 +/- 0.28 for infants with ICH (P less than .05). ICH developed in 79% of the patients with an index greater than 0.1. Twenty neck explorations were required in the first 20 patients for incisional bleeding (mean blood loss, 21.9 +/- 18.0 mL/kg/d). We now use fibrin glue following cannulation and have done only one neck exploration in the last five patients (mean blood loss, 2.8 +/- 2.2 mL/kg/d, P less than .05). Endobronchial bleeding has responded to phenylephrine lavage and increased positive end-expiratory pressure. We have controlled pleural space bleeding with topical thrombin. None of the hemorrhagic complications encountered correlate with the activated clotting time or the amount of heparin used. There is an increased risk of hemorrhage associated with platelet counts less than 100,000/microL for 75% of a day (P less than .05) so that aggressive platelet transfusion remains important in preventing hemorrhagic complications during ECMO. MH - Cerebral Hemorrhage/ETIOLOGY/PREVENTION & CONTROL ; Drug Combinations/THERAPEUTIC USE ; Extracorporeal Circulation/ *ADVERSE EFFECTS ; Factor XIII/THERAPEUTIC USE ; Female ; Fibrinogen/THERAPEUTIC USE ; Fibronectins/THERAPEUTIC USE ; Hemorrhage/*ETIOLOGY/PREVENTION & CONTROL/THERAPY ; Heparin/ ADVERSE EFFECTS ; Human ; Hypertension/ETIOLOGY ; Infant ; Infant, Newborn ; Male ; *Oxygenators, Membrane ; Platelet Count ; Thrombin/THERAPEUTIC USE ; Tissue Adhesives/THERAPEUTIC USE SO - J Pediatr Surg 1986 Dec;21(12):1087-91 3 UI - 87040512 AU - Schlesinger AE ; Cornish JD ; Null DM TI - Dense pulmonary opacification in neonates treated with extracorporeal membrane oxygenation. AB - Chest radiographic findings in three neonates with respiratory failure secondary to meconium aspiration treated with extracorporeal membrane oxygenation (ECMO) are described. The degree of pulmonary opacification on the chest radiographs failed to correlate with the patients' clinical status as measured by the arterial oxygen levels but correlated well with the peak airway pressure (PAP) and continuous positive airway pressure (CPAP) settings on the mechanical ventilator. Because a variable portion of the arterial blood oxygenation is performed by the extracorporeal membrane oxygenator and unusually large fluctuations in airway pressure settings can occur in these patients while on ECMO, it is important to realize that the chest radiograph may not be an accurate predictor of the patients' clinical status. MH - Aspiration ; Case Report ; *Extracorporeal Circulation ; Female ; Human ; Infant, Newborn ; Lung/*RADIOGRAPHY ; Male ; Meconium ; *Oxygenators, Membrane ; Respiratory Insufficiency/ETIOLOGY/ RADIOGRAPHY/*THERAPY SO - Pediatr Radiol 1986;16(6):448-51 4 UI - 87016082 AU - Cilley RE ; Zwischenberger JB ; Andrews AF ; Bowerman RA ; Roloff DW ; Bartlett RH TI - Intracranial hemorrhage during extracorporeal membrane oxygenation in neonates. AB - Intracranial hemorrhage is a complication of extracorporeal membrane oxygenation for the treatment of neonatal respiratory failure. A retrospective review of 35 neonates treated with extracorporeal membrane oxygenation was performed; ten had intracranial hemorrhage. Infants with intracranial hemorrhage had lower birth weights and were gestationally younger than infants with intracranial hemorrhage. Eight of eight neonates of less than 35 weeks' gestational age sustained intracranial hemorrhage. Six died immediately after extracorporeal membrane oxygenation was stopped. Two lived less than 1 year. Two of 27 neonates older than 34 weeks' gestational age sustained intracranial hemorrhage. One child is normal, the other died at 18 months of age. Based on the results of this study, the risk of intracranial hemorrhage appears low in neonates of greater than 34 weeks' gestational age who undergo extracorporeal membrane oxygenation treatment for severe respiratory failure. The use of extracorporeal membrane oxygenation, as it is presently performed, is contraindicated in neonates of less than 35 weeks' gestational age because of the risk of intracranial hemorrhage. MH - Cerebral Hemorrhage/*ETIOLOGY ; Extracorporeal Circulation ; Female ; Gestational Age ; Human ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Oxygenators, Membrane/*ADVERSE EFFECTS ; Respiratory Distress Syndrome/*THERAPY ; Retrospective Studies ; Ultrasonic Diagnosis SO - Pediatrics 1986 Oct;78(4):699-704 5 UI - 87016081 AU - Andrews AF ; Nixon CA ; Cilley RE ; Roloff DW ; Bartlett RH TI - One- to three-year outcome for 14 neonatal survivors of extracorporeal membrane oxygenation. AB - Extracorporeal membrane oxygenation, using venoarterial or venovenous perfusion, is a safe and effective procedure in the term of near-term infant with life-threatening respiratory failure. Without extracorporeal membrane oxygenation, due to the severity of their disease, these children are at high risk for neurologic damage, chronic lung disease, and death. Because survival is not expected without extracorporeal membrane oxygenation therapy, there is no corresponding control group to which these survivors may be compared. In this report, we reviewed the outcome at 1 to 3 years in the first 14 survivors of extracorporeal membrane oxygenation treated at our institution. Seven of 14 neonatal extracorporeal membrane oxygenation survivors (50%) were normal or near normal at between 1 and 3 years of age. Ten (71%) had normal mental ability. We conclude that in neonates with high mortality risk from respiratory failure, near-normal growth and development can be expected in the majority who survive with extracorporeal membrane oxygenation treatment. MH - Cerebral Hemorrhage/ETIOLOGY ; Child Development Disorders/ ETIOLOGY ; Comparative Study ; Electroencephalography ; Extracorporeal Circulation ; Female ; Follow-Up Studies ; Growth ; Human ; Infant, Newborn ; Intelligence Tests ; Male ; *Oxygenators, Membrane/ADVERSE EFFECTS ; Respiratory Distress Syndrome/*THERAPY ; Risk ; Tolazoline/THERAPEUTIC USE SO - Pediatrics 1986 Oct;78(4):692-8 6 UI - 87013359 AU - Boldt J ; von Bormann B ; Kling D ; Ratthey K ; Mulch J ; Hempelmann G TI - New membrane oxygenator (LPM 50): influence on extravascular lung water and pulmonary function in comparison to bubble oxygenator. AB - A prospective, randomized, clinical study involving 30 patients undergoing aorta-coronary bypass grafting was designed to compare the influence of a new membrane oxygenator and a commonly used bubble oxygenator on extravascular lung water and pulmonary function after extracorporeal circulation. Although membrane oxygenators might have some advantages from the biochemical and biophysical points of view, in this clinical study no differences in lung water accumulation and pulmonary gas exchange could be detected between bubble and membrane oxygenators after extracorporeal circulation. MH - Body Water/*PHYSIOLOGY ; Clinical Trials ; Extracorporeal Circulation ; Human ; Lung/*PHYSIOLOGY ; Oxygen/BLOOD ; *Oxygenators, Membrane ; Random Allocation ; Respiration SO - J Thorac Cardiovasc Surg 1986 Oct;92(4):798-800 7 UI - 86268122 AU - Trento A ; Griffith BP ; Hardesty RL TI - Extracorporeal membrane oxygenation experience at the University of Pittsburgh. AB - Between January, 1981, and May, 1985, 33 infants suffering from acute cardiorespiratory failure were treated with extracorporeal membrane oxygenation (ECMO) when all other forms of conventional management had failed. Only the patients with respiratory failure that was thought to be reversible were treated. Prolonged conventional respiratory management (more than five days) was considered a contraindication to ECMO support because of irreversible damage to the lungs caused by the barotrauma associated with conventional ventilation. Eighteen of the 33 patients (54%) survived and were discharged from the hospital. Patients with congenital diaphragmatic hernia had a high incidence of fatal bleeding complications (8 of 14). Good results were obtained in the newborns with persistent fetal circulation and meconium aspiration syndrome. We conclude that ECMO markedly improves the survival of newborns with severe respiratory failure who would have a mortality close to 100% with conventional respiratory management. MH - Acute Disease ; *Extracorporeal Circulation ; Hemorrhage/ETIOLOGY ; Hernia, Diaphragmatic/CONGENITAL/SURGERY ; Human ; Infant, Newborn ; Oxygen Consumption ; *Oxygenators, Membrane ; Postoperative Complications/THERAPY ; Respiratory Distress Syndrome/THERAPY SO - Ann Thorac Surg 1986 Jul;42(1):56-9 8 UI - 86246115 AU - Sethia B ; Wheatley DJ TI - The current status of mechanical circulatory support. AB - In summary, techniques for support of a failing circulation have advanced steadily over the past thirty years. Just as the use of the intra-aortic balloon pump has permitted successful treatment of certain groups of high-risk patients, so increasing application of more invasive techniques of mechanical circulatory support has extended the range of surgical endeavour. Nevertheless, it is evident that further advances in the design and construction of mechanical circulatory support devices are most likely to occur in conjunction with developments in bioengineering technology. These advances will in turn demand analysis by means of careful animal and clinical investigations. Although the general clinical use of an off-the-shelf mechanical ventricular support will give rise to major financial and ethical problems it is likely that application of these devices may herald a new era in the field of artificial organ replacement. MH - Assisted Circulation/INSTRUMENTATION/*TRENDS ; Cardiopulmonary Bypass ; Heart-Assist Devices ; Heart, Artificial ; Human ; Intra-Aortic Balloon Pumping ; Oxygenators, Membrane ; Review SO - Clin Phys Physiol Meas 1986 May;7(2):101-16 9 UI - 86232293 AU - Brans YW ; Cornish JD ; Kuehl TJ ; Dutton EB ; Andrew DS ; Menchaca EM TI - Effect of extracorporeal membrane oxygenation on body water content and distribution of baboon neonates. AB - Water contents of the various body compartments were estimated before and after a 7- to 10-h period of extracorporeal membrane oxygenation in five healthy baboon neonates. Total body water, extracellular water, and plasma volume were estimated simultaneously by antipyrine, bromide, and T-1824 dilution. Volumes of intracellular water, interstitial water, and blood and red cells were calculated from the experimental estimates. Mean preextracorporeal membrane oxygenation estimates of body water volume were in agreement with those previously reported in baboon neonates. During extracorporeal membrane oxygenation, no statistically significant changes occurred in the water content of the various body compartments. This absence of changes was contrasted to the changes demonstrated in human infants and adults undergoing intracardiac surgery with extracorporeal oxygenation and hypothermia and various hypotheses were put forward to explain the different changes observed. MH - Animal ; Animals, Newborn/*PHYSIOLOGY ; Body Water/*METABOLISM ; Extracorporeal Circulation/*INSTRUMENTATION ; Female ; Male ; Oxygenators, Membrane/*ADVERSE EFFECTS ; Papio ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. SO - Pediatr Res 1986 May;20(5):381-4 10 UI - 86199433 AU - Beck R ; Anderson KD ; Pearson GD ; Cronin J ; Miller MK ; Short BL TI - Criteria for extracorporeal membrane oxygenation in a population of infants with persistent pulmonary hypertension of the newborn. AB - Extracorporeal membrane oxygenation (ECMO) has been available since 1975 as a therapy of last resort to provide adequate oxygenation for term infants with acute lung disorders that do not respond to maximal medical therapy. Virtually all term infants with serious lung disease have persistent pulmonary hypertension of the newborn (PPHN) characterized by significant right-to-left shunting of blood and severe diffusion defects manifested as increased alveolar-arterial oxygen gradients (AaDO2). Criteria for initiation of ECMO therapy have been developed in several institutions but at the present time there are no universal criteria applicable to all infants with PPHN. We have attempted to establish entry criteria that may be used for different populations of infants with PPHN. Based on a retrospective review of 30 infants with PPHN in our institution, we have defined standards of maximal medical therapy. An alveolar-arterial oxygen difference (AaDO2) of greater than or equal to 610 for 8 hours has been shown to be associated with 79% mortality in this population. This AaDO2/time interval is established as a major criterion for institution of extracorporeal membrane oxygenation. MH - Carbon Dioxide/BLOOD ; Comparative Study ; Extracorporeal Circulation ; Female ; Hernia, Diaphragmatic/CONGENITAL/MORTALITY ; Human ; Hydrogen-Ion Concentration ; Infant, Newborn ; Male ; Oxygen/BLOOD ; *Oxygenators, Membrane ; Persistent Fetal Circulation Syndrome/MORTALITY/PHYSIOPATHOLOGY/*THERAPY ; Positive Pressure Respiration ; Pulmonary Alveoli/PHYSIOPATHOLOGY ; Pulmonary Diffusing Capacity ; Respiration, Artificial ; Retrospective Studies SO - J Pediatr Surg 1986 Apr;21(4):297-302 11 UI - 86156636 AU - Hickling KG TI - Extracorporeal CO2 Removal in severe adult respiratory distress syndrome. AB - Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function. There are several possible mechanisms by which the technique may facilitate lung repair, including improvement of lung tissue oxygenation, the avoidance of high airway pressures and regional alkalosis in the lung, a reduction in oxygen toxicity, and the frequency observed reduction in pulmonary artery pressure. The apparent effectiveness of the technique and other associated evidence have implications which should lead us to reconsider some aspects of our conventional management of patients with severe ARDS. MH - Alkalosis, Respiratory/PREVENTION & CONTROL ; Blood Pressure ; Carbon Dioxide/*BLOOD ; *Extracorporeal Circulation ; Heparin/ THERAPEUTIC USE ; Human ; Ischemia/PREVENTION & CONTROL ; Lung/ BLOOD SUPPLY ; Methods ; *Oxygenators, Membrane ; *Positive Pressure Respiration ; Pressure ; Pulmonary Artery/ PHYSIOPATHOLOGY ; Pulmonary Fibrosis/ETIOLOGY ; Respiratory Distress Syndrome, Adult/BLOOD/*THERAPY ; Review ; Ventilation-Perfusion Ratio SO - Anaesth Intensive Care 1986 Feb;14(1):46-53 12 UI - 86116878 AU - Cavarocchi NC ; Pluth JR ; Schaff HV ; Orszulak TA ; Homburger HA ; Solis E ; Kaye MP ; Clancy MS ; Kolff J ; Deeb GM TI - Complement activation during cardiopulmonary bypass. Comparison of bubble and membrane oxygenators. AB - A prospective randomized trial involving 91 patients undergoing cardiopulmonary bypass compared the effects of bubble oxygenators (with and without methylprednisolone sodium succinate) and membrane oxygenators on complement activation and transpulmonary sequestration of leukocytes. Patients were divided as follows: Group I, 30 patients, bubble oxygenator; Group II, 31 patients, bubble oxygenator and methylprednisolone sodium succinate (30 mg/kg); Group III, 30 patients, membrane oxygenator. In Group I, C3a increased from 323 +/- 171 ng/ml during cardiopulmonary bypass to 1,564 +/- 785 ng/ml at 25 minutes after bypass (p less than 0.0001). A significant decrease in C3a was found in Groups II and III compared to Group I (p less than 0.0001). C5a did not change significantly during cardiopulmonary bypass in any group. Reestablishment of pulmonary circulation at the end of bypass produced significant transpulmonary leukocyte sequestration in Group I; the median cell difference was 1,700/microliter. Transpulmonary sequestration was significantly (p less than 0.0001) less in Group II (median cell difference = 200/microliter) and in Group III (median cell difference = 400/microliter) than in Group I. We conclude that cardiopulmonary bypass with a bubble oxygenator alone initiates significantly (p less than 0.0001) more C3a activation and leukocyte sequestration than when methylprednisolone sodium succinate (30 mg/kg) is given 20 minutes before the start of cardiopulmonary bypass with a bubble oxygenator or when a silicone membrane oxygenator is used. MH - Adrenal Cortex Hormones/PHARMACODYNAMICS ; Adult ; Aged ; *Cardiopulmonary Bypass/ADVERSE EFFECTS ; Clinical Trials ; Comparative Study ; *Complement Activation/DRUG EFFECTS ; Complement 3/METABOLISM ; Female ; Heart Diseases/IMMUNOLOGY/ SURGERY ; Human ; Leukocytosis/ETIOLOGY/IMMUNOLOGY ; Male ; Middle Age ; *Oxygenators/ADVERSE EFFECTS ; *Oxygenators, Membrane/ADVERSE EFFECTS ; Prospective Studies ; Random Allocation ; Time Factors SO - J Thorac Cardiovasc Surg 1986 Feb;91(2):252-8 1 UI - 86266398 AU - Aps C ; Hutter JA ; Williams BT TI - Anaesthetic management and postoperative care of cardiac surgical patients in a general recovery ward. AB - The postoperative care of 143 cardiac surgical patients has been successfully conducted in a general surgical recovery ward. Admission was limited to overnight stay only and all but two patients were returned to the general ward the following day. There were no deaths. The intra-operative anaesthetic management was considered to have played an important part in the success of this technique. MH - Adult ; Aged ; *Anesthesia, General ; Blood Gas Analysis ; Cardiopulmonary Bypass ; *Heart Surgery ; Human ; Middle Age ; *Postoperative Care ; Recovery Room SO - Anaesthesia 1986 May;41(5):533-7 2 UI - 86185726 AU - Matar AF TI - Concomitant coronary and cerebral revascularization under cardiopulmonary bypass. AB - The question as to whether a staged or a combined surgical approach is safer in the management of patients with coexistent coronary and extracranial cerebrovascular disease has been widely investigated and debated. Advances in myocardial protection techniques have reduced cardiac morbidity and mortality and have rendered a combined approach as safe as a staged approach, if not safer. There have been no similar advances in cerebral protection, particularly for high-risk patients with bilateral disease. In this series, 32 consecutive patients with coexistent advanced coronary and extracranial vascular disease underwent cerebral and coronary revascularization that used the combined approach. Cerebral revascularization was performed under hypothermic cardiopulmonary bypass on 30 of these patients. There was no operative mortality, no hematoma formation, and no reoperation. Blood loss, length of hospital stay, and total cost were similar to those for isolated coronary bypass procedures. MH - Aged ; Anesthesia/METHODS ; *Aortocoronary Bypass ; Brain/ PATHOLOGY ; *Cardiopulmonary Bypass/METHODS ; Carotid Artery Diseases/COMPLICATIONS/PATHOLOGY/SURGERY ; *Cerebral Revascularization ; Cerebrovascular Disorders/COMPLICATIONS/ PATHOLOGY/*SURGERY ; Coronary Disease/COMPLICATIONS/PATHOLOGY/ *SURGERY ; Coronary Vessels/PATHOLOGY ; Endarterectomy ; Female ; Human ; Male ; Middle Age ; Postoperative Complications ; Risk SO - Ann Thorac Surg 1986 Apr;41(4):431-5 3 UI - 86159487 AU - Jonmarker C ; Nordstr:om L ; Werner O TI - Changes in functional residual capacity during cardiac surgery. AB - A gas washout technique was used to measure the functional residual capacity (FRC) in eight patients during anaesthesia for cardiac surgery. The patients were anaesthetized with droperidol, fentanyl and nitrous oxide, alcuronium was given and the lungs were ventilated with a volume controlled ventilator. FRC was measured at three stages before skin incision, after sternotomy but before cardiopulmonary bypass, and after closure of the sternum. The pleural cavities were intact in all patients during the operation. FRC before skin incision was 1.7 +/- 0.5 litre (mean +/- 1 SD). A 55% mean increase in volume was noted after sternotomy and placement of the sternal retractor (P less than 0.001). Mean FRC after sternal closure was 16% lower than the preincision value (P less than 0.05). Arterial Po2 was measured in 22 other patients who underwent coronary artery bypass surgery and in whom F/o2 was 0.5. Pao2 increased significantly when the sternum was opened, but decreased after cardiopulmonary bypass. There was a further significant decrease on closure of the sternum. MH - Aged ; Anesthesia, General ; Aortic Valve/*SURGERY ; *Aortocoronary Bypass ; Cardiopulmonary Bypass ; *Functional Residual Capacity ; Human ; *Lung Volume Measurements ; Male ; Middle Age ; Oxygen/BLOOD ; Partial Pressure ; Sternum/SURGERY ; Support, Non-U.S. Gov't SO - Br J Anaesth 1986 Apr;58(4):428-32 4 UI - 86156857 AU - Samuelson PN ; Reves JG ; Kirklin JK ; Bradley E Jr ; Wilson KD ; Adams M TI - Comparison of sufentanil and enflurane-nitrous oxide anesthesia for myocardial revascularization. AB - This study compared the stress response in patients with coronary artery disease undergoing myocardial revascularization anesthetized with either sufentanil and oxygen or enflurane-nitrous oxide and oxygen. Throughout induction and maintenance of anesthesia, and while the patients were in the intensive care unit, hemodynamics plus plasma catecholamine, sufentanil, and enflurane concentrations were recorded and compared. Three groups were studied: sufentanil, 15 micrograms/kg at induction; sufentanil, 15 micrograms/kg at induction plus 10 micrograms/kg on initiation of cardiopulmonary bypass (CPB); and enflurane anesthesia. Hemodynamics were remarkably stable in all groups but required considerable fine tuning when enflurane was administered. The "stress: of CPB was blunted by the additional dose of sufentanil, as well as by enflurane. This was reflected in those patients receiving the extra sufentanil or enflurane by less severe increases in their epinephrine or norepinephrine concentrations and by less frequent use of sodium nitroprusside to control mean arterial pressure compared to the group of patients given the lower-dose sufentanil. This study suggests that higher blood levels of sufentanil can attenuate, but not eliminate, the stress response to CPB, as can enflurane, and that both the narcotic and inhalation anesthetic techniques for patients with coronary artery disease were quite satisfactory. MH - *Anesthesia ; Cardiopulmonary Bypass ; Comparative Study ; Creatine Kinase/BLOOD ; *Enflurane/PHARMACODYNAMICS ; Epinephrine/ BLOOD ; Female ; Fentanyl/*ANALOGS & DERIVATIVES/BLOOD/ PHARMACODYNAMICS ; Hemodynamics/DRUG EFFECTS ; Human ; Intensive Care Units ; Male ; Middle Age ; *Myocardial Revascularization ; Nitroprusside/PHARMACODYNAMICS ; *Nitrous Oxide/PHARMACODYNAMICS ; Norepinephrine/BLOOD SO - Anesth Analg 1986 Mar;65(3):217-26 5 UI - 86128258 AU - Nussmeier NA ; Arlund C ; Slogoff S TI - Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. AB - The authors prospectively investigated the ability of thiopental to decrease neuropsychiatric complications as a consequence of open-ventricle operations requiring cardiopulmonary bypass. Eighty-nine randomly assigned patients received sufficient thiopental to maintain electroencephalographic silence throughout the period from before atrial cannulation to termination of bypass. These patients received an average of 39.5 mg/kg of thiopental, while 93 control patients received only fentanyl. On the first postoperative day, five thiopental (5.6%) and eight control (8.6%) patients exhibited clinical neuropsychiatric abnormalities. By the tenth postoperative day, all neuropsychiatric dysfunction had resolved in the thiopental group but persisted in seven (7.5%) control patients (P less than 0.025). The incidence of complications was significantly related to calcification of replaced valves, aortic valve replacement, advanced age, and prolonged bypass, but not to low blood pressure during perfusion. The authors believe their data are consistent with embolism as the most important cause of sensory-motor neurologic dysfunction following cardiopulmonary bypass. The data also provide evidence that thiopental in sufficient dosage can reduce the clinical consequences of these events. This is the first demonstration of cerebral protection by a barbiturate in humans. MH - Age Factors ; Aged ; Barbiturates/*THERAPEUTIC USE ; Blood Pressure ; Calcinosis/COMPLICATIONS ; Cardiopulmonary Bypass/ *ADVERSE EFFECTS ; Delusions/ETIOLOGY ; Electroencephalography ; Female ; Hallucinations/ETIOLOGY ; Heart Valve Prosthesis ; Human ; Male ; Memory Disorders/ETIOLOGY ; Middle Age ; Myocardial Contraction/DRUG EFFECTS ; Neuropsychological Tests ; Postoperative Complications/PREVENTION & CONTROL/*PSYCHOLOGY ; Sleep Stages ; Thiopental ; Time Factors SO - Anesthesiology 1986 Feb;64(2):165-70