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The purpose of this randomized, double-blind study was to evaluate the efficacy of midazolam and propofol for postoperative sedation and early extubation following cardiac surgery. ASA physical status II-III patients scheduled to undergo elective first-time cardiac surgery with an ejection fraction > 45% were eligible. All patients received a standardized sufentanil/isoflurane anaesthesia. During cardiopulmonary bypass 100 micrograms.kg-1.min-1 propofol was substituted for isoflurane. Upon arrival in the Intensive Care Unit (ICU), patients were randomized to either 10 micrograms.kg-1.min-1 propofol (n = 21) or 0.25 microgram.kg-1.min-1 midazolam (n = 20). Infusion rates were adjusted to maintain sedation within a predetermined range (Ramsay 2-4). The infusion was terminated after four hours. Patients were weaned from mechanical ventilation and their tracheas extubated when Haemodynamic stability, haemostasis, normothermia and mental orientation were confirmed. Haemodynamic measurements, arterial blood gas tensions and pulmonary function tests were recorded at specified times. There were no differences between the two groups for the time spent at each level of sedation, number of infusion rate adjustments, amount of analgesic and vasoactive drugs, times to awakening and extubation. The costs of propofol were higher than those of midazolam. There were no differences in haemodynamic values, arterial blood gas tensions and pulmonary function. We conclude that midazolam and propofol are safe and effective sedative agents permitting early extubation in this selected cardiac patient population but propofol costs were higher.

To describe the factors predisposing to transesophageal echocardiography (TEE) probe damage and to propose a strategy aimed at preventing damage to the TEE probe. Description of equipment and procedures: Damage to the TEE probe can occur anywhere and anytime during use in the operating room (OR) or when the probe is not in use in the OR, such as in the cleaning room, during storage or during transport of the probe. The components of the strategy used in our institution to avoid probe damage are: 1) storage of the probe in a dedicated holder in the OR when it is not in use, 2) use of a lexan box in the OR to protect the probe connector, 3) use of a custom-made holder when the probe is inserted in the patient, 4) use of a dedicated holder for soiled TEE probe storage in the cleaning room and for subsequent probe storage. We describe a comprehensive strategy designed to decrease TEE probe damage and the associated expenses. Further studies will be required to determine the effectiveness of the proposed measures.

Magnesium potentiates the effect of nondepolarizing neuromuscular blocking agents. It is used in cardiac anesthesia to prevent hypertension and arrhythmias. This study was performed to measure the interaction between magnesium and cisatracurium in cardiac surgery. Twenty patients scheduled for elective cardiac surgery were randomly assigned to receive magnesium sulfate (70 mg x kg(-1) at induction followed by 30 mg x kg(-1) x hr(-1)) or placebo. The ulnar nerve was stimulated and the electromyographic response of the adductor pollicis was measured. Cisatracurium 0.1 mg x kg(-1) was given at induction, followed by 0.05 mg x kg(-1) when the first twitch in the train-of-four reached 25%. Ionized magnesium was 1.32 +/- 0.24 mmol x L(-1) in the treatment group vs 0.47 +/- 0.4 mmol x L(-1) in the control group. Duration of action of the intubating dose was longer in the magnesium group (74 +/- 20 min) than in the placebo group (42 +/- 6 min, P = 0.0001). Duration of the first maintenance dose was 69 +/- 16 min in the magnesium group vs 35 +/- 7 min in the placebo group (P = 0.0001). Total dose of cisatracurium administered throughout surgery was 0.19 +/- 0.07 mg x kg(-1) in the magnesium group compared with 0.29 +/- 0.01 mg x kg(-1) in the placebo group (P = 0.017). Hemodynamic variables and temperature were similar in both groups. In patients undergoing cardiac surgery, administration of magnesium sulfate, resulting in ionized levels of 1.3 mmol x L(-1), results in a 30-35 min prolongation of the neuromuscular blockade induced with intubating and maintenance doses of cisatracurium and does not alter hemodynamic stability.

To compare the hemodynamic effects of sevoflurane when used for induction and maintenance of anesthesia with a total intravenous technique in patients with known coronary artery disease (CAD). Thirty patients undergoing elective coronary artery bypass graft (CABG) were randomly allocated to receive either sevoflurane (S group, n = 15) at a minimal concentration of 4% in oxygen for induction and at 0.5-2 MAC end-tidal concentration for maintenance, or a total intravenous technique (T group, n = 15) consisting of midazolam for induction and propofol for maintenance. In both groups, anesthesia was supplemented with sufentanil and muscle relaxation with cis-atracurium. Hemodynamic measurements included systemic and pulmonary pressures, heart rate, mixed venous oxygen saturation and cardiac output at the following times: pre-induction, 7 and 25 min post-induction, chest closure, one hour after surgery and pre and post tracheal extubation. More patients in the S group (8/15) presented bradycardia in the induction period (T:2/15) (P = 0.05). During maintenance of anesthesia, treatment of hypertension was more frequent in the T group (12/15) than in the S group (6/15) (P = 0.025). All other parameters were comparable. Induction of anesthesia in patients with CAD, VCRII with sevoflurane supplemented by sufentanil provided hemodynamic responses comparable with those of TIVA although bradycardia was observed more often with sevoflurane. Intraoperative control of systemic blood pressure was achieved with fewer interventions with a sevoflurane/sufentanil maintenance than with a propofol/sufentanil technique in CABG surgery.

PurposeTo compare the hemodynamic effects of sevoflurane when used for induction and maintenance of anesthesia with a total intravenous technique in patients with known coronary artery disease (CAD).MethodsThirty patients undergoing elective coronary artery bypass graft (CABG) were randomly allocated to receive either sevoflurane (S group, n = 15) at a minimal concentration of 4% in oxygen for induction and at 0.5-2 MAC end-tidal concentration for maintenance, or a total intravenous technique (T group, n = 15) consisting of midazolam for induction and propofol for maintenance. In both groups, anesthesia was supplemented with sufentanil and muscle relaxation with cis-atracurium. Hemodynamic measurements included systemic and pulmonary pressures, heart rate, mixed venous oxygen saturation and cardiac output at the following times: pre-induction, 7 and 25 min post-induction, chest closure, one hour after surgery and pre and post tracheal extubation.ResultsMore patients in the S group (8/15) presented bradycardia in the induction period (T:2/15) (P = 0.05). During maintenance of anesthesia, treatment of hypertension was more frequent in the T group (12/15) than in the S group (6/15) (P = 0.025). All other parameters were comparable.ConclusionInduction of anesthesia in patients with CAD, VCRII with sevoflurane supplemented by sufentanil provided hemodynamic responses comparable with those of TIVA although bradycardia was observed more often with sevoflurane. Intraoperative control of systemic blood pressure was achieved with fewer interventions with a sevoflurane/sufentanil maintenance than with a propofol/sufentanil technique in CABG surgery.