Sujet(s)
Blessures du thorax/complications , Blessures du thorax/imagerie diagnostique , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/étiologie , Plaies non pénétrantes/complications , Plaies non pénétrantes/imagerie diagnostique , Adulte , Humains , Mâle , Résultat thérapeutique , Insuffisance tricuspide/chirurgie , ÉchographieRÉSUMÉ
This randomised, single-blind, double-control study compared and established prospectively the best transoesophageal echocardiography methods for determining cardiac output in patients after cardiac surgery. Thirty patients undergoing coronary artery bypass grafting were included. Measurements were taken postoperatively, after stabilisation in the intensive care unit. Cardiac output was determined by transoesophageal echocardiography in randomised order through the aortic, mitral, and pulmonary valves, right and left ventricular outflow tracts, transgastric surface areas of the left ventricle and left ventricle two-dimensional volumes (Simpson's rules). 'Eyeball guessing' was done off-line. The best results were transaortic measurements using the triangular shape assumption of valve opening, but some values deviated considerably, and none of these approaches reached the limit of agreement set at 30% when compared to thermodilution. Eyeball guessing was comparable to the best transoesophageal echocardiography measurements. We conclude that transoesophageal echocardiography is an unreliable tool for determination of cardiac output in intensive care after cardiac surgery.
Sujet(s)
Débit cardiaque , Pontage aortocoronarien , Échocardiographie transoesophagienne/méthodes , Soins postopératoires/méthodes , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Soins de réanimation/méthodes , Femelle , Humains , Mâle , Adulte d'âge moyen , Études prospectives , Reproductibilité des résultats , Méthode en simple aveugle , ThermodilutionRÉSUMÉ
Bleeding after complex ascending aortic, aortic root or transverse arch surgery which is inaccessible or difficult to control may present a major problem. Here, we describe a modified Cabrol-shunt technique using complete mediastinal coverage with decompression into the innominate vein where the classical technique is not suitable. The long-term fate of the classical aortoatrial and modified mediastinal to innominate shunts has been analyzed to assess their potential complications.
Sujet(s)
Anévrysme de l'aorte thoracique/chirurgie , Implantation de prothèses vasculaires/instrumentation , Hémostase chirurgicale/instrumentation , Hémorragie postopératoire/chirurgie , Anévrysme de l'aorte thoracique/mortalité , Bioprothèse , Veines brachiocéphaliques/chirurgie , Décompression chirurgicale/instrumentation , Études de suivi , Humains , Péricarde/chirurgie , Complications postopératoires/mortalité , Complications postopératoires/chirurgie , Hémorragie postopératoire/mortalité , Réintervention , Taux de survie , Techniques de sutureRÉSUMÉ
OBJECTIVES: to compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). METHODS: retrospective analysis of 91 consecutive patients (age 43 to 89 years) who underwent EVAR under local (LA, 63 patients), epidural (EDA, 8 patients) and general (GA, 20 patients) anaesthesia. RESULTS: EVAR was successfully achieved in all patients without mortality or neurological, cardiac and respiratory complications. Vasopressive support as well as median fluid balance were significantly lessened in the LA group compared to GA group (p<0.0002). Stay in the Intensive Care Unit was necessary in 17 (27%), four (50%) and 14 (70%) patients, respectively, and median hospital stay was 3, 4.5, and 5.5 days, with a statistically significant difference between LA and GA group (p<0.0005). CONCLUSION: LA is a safe anaesthetic method for the endovascular repair of infrarenal abdominal aneurysm, offering several advantages: simplicity, stable haemodynamics, and reduced consumption of ICU and hospital beds.