Arterial pressure and deltoid muscle gas tensions during cardiopulmonary bypass in man
Tóm tắt
The results of this study demonstrate that standard techniques of conducting cardiopulmonary bypass produce low muscle oxygen and high muscle carbon dioxide tensions and, thus, little perfusion of skeletal muscle. Our findings also show that Pmo2 and PmC02 do not return to pre-bypass levels until the mean arterial blood pressure exceeds 12 kPa (90 ton) during bypass and that utilization of vasopressor drugs during bypass maintains the pressure; but at the expense of muscle blood flow. The data indicate that both high mean blood pressure and high flow are necessary during bypass to ensure skeletal muscle perfusion and suggest, when combined with preliminary animal findings, that this type of bypass perfusion may prove to be superior to standard techniques in hastening recovery after cardio-pulmonary bypass.
Tài liệu tham khảo
Furuse, A., Brawley, R.K., Struve, E., &Gott, V.L. Skeletal muscle gas tension: indicator of cardiac output and peripheral tissue perfusion. Surgery74: 214 (1973).
Filler, R.M. &Das, J.B. Muscle pH, Po2, Pco2 monitoring: a review of laboratory and clinical evaluations. Adv. Exp. Med. Biol.50: 175 (1974).
Wakabayashi, A., Yoshimasa, N., Woolley, T., Mullin, P.J., Watanabe, H., Takashi, I., &Connolly, J.E. Continuous percutaneous monitoring of muscle pH and oxygen pressure. Arch. Surg.110: 802 (1975).
Stanley, T.H., Gray, N.H., Stanford, W., &Armstrong, R. The effects of high-dose morphine on fluid and blood requirements of open-heart operations. Anesthesiology38: 536 (1973).
Stanley, T.H., Gray, N.H., Isern-Amaral, J. A., &Patton, C. Comparison of blood requirements during morphine and halothane anesthesia for open-heart surgery. Anesthesiology41: 34 (1974).
McGoon, D.C., Moffitt, E.A., Theye, R.A., &Kirkin, J.W. Physiologic studies during high flow, normothermic, whole body perfusion. J. Thoracic Cardiovasc. Surg.39: 275 (1969).
Zuhdi, N., Carey, J., Cutter, J., Rader, L., &Greer, A. Intentional hemodilution. Arch. Surg. 57: 554 (1963).
Anderson, M.N. &Ravdin, I.S. What is “optimum flow rate?“ Surgery43: 1021 (1956).
Tufo, H.M., Ostfeld, A.M., &Shekelle, R. Central nervous system dysfunction following open-heart surgery. J.A.M.A.212: 1333 (1970).
Stanley, T.H. &Isern-Amaral, J.H. Periodic analysis of mixed venous oxygen tension to monitor the adequacy of perfusion during and after cardiopulmonary bypass. Canad. Anaesth. Soc. J.21: 454 (1974).
Berger, R.L. &Norman, J.C. Cardiac surgery. Ed.J. Norman. New York, Appleton-Century-Crofts,Chap.6 (l972).