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Objectives To investigate an association between the preoperative plasma B-type natriuretic peptide (BNP) concentration and cerebral regional saturation (rSO2) measured using the INVOS oximeter (Medtronic, Minneapolis, MN). Design A retrospective data analysis. Setting Single university hospital. Participants Patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Interventions None. Measurements and Main Results Associations of variables obtained from preoperative blood laboratory tests and transthoracic echocardiography with baseline rSO2 before induction of general anesthesia were investigated using bivariate and multivariate regression analyses in 330 OPCAB patients. With bivariate analyses, age; body size–related variables such as weight and body surface area; hematologic function–related variables such as blood hemoglobin (Hb) concentration and arterial oxygen saturation; renal function–related variables including estimated glomerular filtration rate, creatinine, and blood urea nitrogen; hepatic function–related variables including cholinesterase, albumin, total bilirubin, and alanine aminotransferase; serum electrolytes including sodium, chloride, and phosphorus; BNP or log-transformed BNP; and 13 transthoracic echocardiography variables such as left ventricular ejection fraction highly significantly correlated with baseline rSO2 (p Conclusions Preoperative BNP and Hb concentrations were 2 major factors associated with INVOS rSO2 in patients undergoing OPCAB.

To investigate anesthesia management in patients undergoing right lung surgery after a previous left upper lobectomy (LUL) that may require special precautions since angulation of the left bronchus can hamper correct placement of a left-sided double-lumen tube (DLT), and one-lung ventilation (OLV) depending solely on the left lower lobe may lead to inadequate oxygenation.A retrospective data analysis.Single university hospital.Patients underwent right lung surgery after previous LUL.None.Anesthesia management was investigated in 18 patients who underwent right lung surgery following LUL. All intubation procedures were performed under bronchoscopic guidance to prevent airway trauma. OLV could be achieved with a left-sided DLT in 12 patients, while tubes other than this were required in 6 patients, including a right-sided DLT (n = 3) and a bronchial blocker (n = 3). The presence or absence of remarkable bronchial angulation, characterized by a combination of a wide (140°) angle between the trachea and left main bronchus and a narrow (100°) angle between the left main and lower bronchi critically affected tube selections. The minimum SpO2 during OLV was 90.9±4.1%. In 2 patients, intermittent bilateral ventilation was required to treat desaturation. In all the patients, the scheduled surgery could be completed.Extent of left bronchial angulations had a critical impact on whether or not a left-sided DLT could be used in patients undergoing right lung surgery after LUL.

EPARIN-INDUCED THROMBOCYTOPENIA (HIT), presenting as severe thrombocytopenia and possible vascular thrombosis resulting from platelet activation secondary to immune response to heparin-platelet factor 4 (PF4) complexes, is a critical concern in patients with this disorder and at risk of exposure to heparin. 1 Patients with HIT requiring cardiopulmonary bypass (CPB) present complex issues regarding the choice of an alternative agent to heparin for anticoagulation during CPB. Alternative anticoagulants include lepirudin, bivalirudin, danaparoid, and argatroban. 2 Argatroban seems to be a reasonable option, especially for patients with renal failure because it is metabolized and eliminated primarily via a hepatic route. 3-5 Furthermore, its anticoagulant effect is spontaneously reversed within 2 to 4 hours because of its short elimination half-life (39-53 minutes), and its anticoagulant effect can be conveniently monitored with the activated coagulation time (ACT). 3-5 Although several case reports described the successful management of anticoagulation with argatroban in on-pump cardiac surgery, 6-9 the lack of an effective antidote may pose a significant problem. At present, reports describing the use of argatroban for adult on-pump cardiac surgery are quite limited in number. Therefore, there is no consensus regarding precautions necessary with the use of argatroban for CPB. A patient presented with renal failure and a history of HIT; the patient underwent on-pump cardiac surgery using argatroban. Initially, the authors could not achieve a target ACT for CPB using an argatroban dosing protocol described previously, 8 and after achieving adequate anticoagulation with a higher dose, prolonged, severe coagulopathy after CPB was encountered.

Objective: No systematic study has been conducted to investigate effects of deep hypothermic circulatory arrest (DHCA) on electroencephalographic bispectral index (BIS) and suppression ratio (SR). Thus, the effects of DHCA were evaluated on BIS and SR. Design: A prospective clinical study. Setting: University hospital (single institute). Participants: Twenty consecutive patients undergoing thoracic aortic surgery using DHCA under narcotics-sevoflurane anesthesia. Interventions: BIS and SR were monitored during cardiopulmonary bypass, simultaneously with nasopharyngeal temperature (NPT). Measurements and Main Results: BIS decreased to 0 with induction of deep hypothermia and rose again with rewarming, although rates of BIS changes in response to cooling and rewarming varied widely among patients. Typically, BIS decreased slowly until NPT reached 26°C during cooling and then it began to decrease rapidly and reached 0 at 17°C, in inverse proportion to SR, which increased rapidly with deep hypothermia and reached 100% at 17°C. When SR was 50% or more, BIS was determined by SR according to the expression: BIS = 50 − SR/2. With rewarming, BIS rose again and returned to precooling baseline levels. Time to the beginning of the BIS recovery significantly correlated with duration of DHCA. Conclusions: With induction of deep hypothermia, BIS decreased in a biphasic manner to 0 at rates varying among patients. With rewarming, BIS rose again at rates extremely widely varying among patients. The rate of BIS recovery was related to duration of DHCA. BIS may be capable of conveniently tracing suppression and recovery of a part of cerebral electrical activity before, during, and after DHCA.