Thesis (M.S.)--University of Michigan, 1982.

Orientador: Norma Sueli Pinheiro Módolo / Banca: Eliana Marisa Ganem / Banca: Antonio Argolo Sampaio Filho / Resumo: Anestesia para cirurgia cardíaca pediátrica é frequentemente realizada em pacientes graves sob condições fisiológicas anormais. No intra-operatório, existem variações significativas da volemia, temperatura corporal, composição plasmática e fluxo sanguíneo tecidual, alem de ativação da inflamação, com consequências fisiopatológicas importantes. Medidas seriadas de lactato arterial e glicemia podem indicar estados de hipoperfusão e exacerbação da resposta neuro-endocrino-metabólica ao trauma servindo como marcadores prognóstico de morbimortalidade nessa população. Correlacionar os níveis de glicemia e de lactato arterial no período perioperatório de crianças submetidas a cirurgia cardíaca com a ocorrência de complicações e morte no pós-operatório e comparar os níveis intraoperatórios de glicemia e lactato arterial de acordo com as condições perioperatórias. Dados de prontuário foram coletados em uma ficha padronizada com informações referentes ao procedimento anestésico-cirúrgico e condições perioperatórias dos pacientes. Comparações das médias dos valores perioperatórios de glicemia e lactato nos grupos de pacientes que apresentaram, ou não, complicações pós-operatórias e as frequências referentes às condições perioperatórias foram estabelecidas conforme cálculo da razão de chances e em análises univariáveis não paramétricas. Níveis arteriais mais elevados de lactato foram observados nos pacientes que cursaram com complicações e/ou óbito no perioperatório de cirurgia cardíaca pediátrica. Valores mais elevados de glicemia intraoperatória também foram observados nos indivíduos que apresentaram complicações pós-operatórias, mas não entre os que foram a óbito. O emprego de circulação extracorpórea (CEC) esteve associado a maiores valores de glicemia e lactato arterial durante a cirurgia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Anesthesia for pediatric cardiac surgery is often performed in critically ill patients with abnormal physiologic conditions. During the intraoperative period, inflammation response is evoked and significant variations in blood volume, core temperature, plasma composition and tissue blood flow are expected with important pathological consequences. Regular measures of arterial lactate and serum glucose levels may indicate systemic hypoperfusion and exacerbation of the hormonal and metabolic response to trauma and therefore be useful as prognostic biomarkers of morbidity and mortality in this population. Correlate the perioperative blood glucose and arterial lactate levels of children that underwent open-heart surgery and the occurrence of complications and death in the postoperative period and compare those levels during surgery under different perioperative conditions. Data regarding the anesthetic and surgical procedures and the perioperative conditions of the patients were collected from medical records in a standardized form. Comparisons of blood glucose and arterial lactate levels of patients with or without postoperative complications were made by the estimation of the odds ratio for morbidity and mortality. Frequencies related to the perioperative conditions were established according to nonparametric univariate analysis. Higher perioperative arterial lactate levels were observed in children that developed complications and/or died after heart surgery. Higher intraoperative levels of blood glucose were also observed in patients with postoperative complications, but not in those who died. The use of cardiopulmonary bypass (CPB) was associated with higher levels of glucose and lactate in surgery. The prediction capability of those biomarkers for different kinds of complications varied with the utilization of CPB in the procedure. Hypoglycemia was associated with higher rates... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-01Bitstream added on 2014-06-13T20:59:38Z : No. of bitstreams: 1 alves_rl_me_botfm.pdf: 622546 bytes, checksum: 5a3ceaac5bfc1f74584e92d8378b2d33 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Anestesia para cirurgia cardíaca pediátrica é frequentemente realizada em pacientes graves sob condições fisiológicas anormais. No intra-operatório, existem variações significativas da volemia, temperatura corporal, composição plasmática e fluxo sanguíneo tecidual, alem de ativação da inflamação, com consequências fisiopatológicas importantes. Medidas seriadas de lactato arterial e glicemia podem indicar estados de hipoperfusão e exacerbação da resposta neuro-endocrino-metabólica ao trauma servindo como marcadores prognóstico de morbimortalidade nessa população. Correlacionar os níveis de glicemia e de lactato arterial no período perioperatório de crianças submetidas a cirurgia cardíaca com a ocorrência de complicações e morte no pós-operatório e comparar os níveis intraoperatórios de glicemia e lactato arterial de acordo com as condições perioperatórias. Dados de prontuário foram coletados em uma ficha padronizada com informações referentes ao procedimento anestésico-cirúrgico e condições perioperatórias dos pacientes. Comparações das médias dos valores perioperatórios de glicemia e lactato nos grupos de pacientes que apresentaram, ou não, complicações pós-operatórias e as frequências referentes às condições perioperatórias foram estabelecidas conforme cálculo da razão de chances e em análises univariáveis não paramétricas. Níveis arteriais mais elevados de lactato foram observados nos pacientes que cursaram com complicações e/ou óbito no perioperatório de cirurgia cardíaca pediátrica. Valores mais elevados de glicemia intraoperatória também foram observados nos indivíduos que apresentaram complicações pós-operatórias, mas não entre os que foram a óbito. O emprego de circulação extracorpórea (CEC) esteve associado a maiores valores de glicemia e lactato arterial durante a cirurgia... / Anesthesia for pediatric cardiac surgery is often performed in critically ill patients with abnormal physiologic conditions. During the intraoperative period, inflammation response is evoked and significant variations in blood volume, core temperature, plasma composition and tissue blood flow are expected with important pathological consequences. Regular measures of arterial lactate and serum glucose levels may indicate systemic hypoperfusion and exacerbation of the hormonal and metabolic response to trauma and therefore be useful as prognostic biomarkers of morbidity and mortality in this population. Correlate the perioperative blood glucose and arterial lactate levels of children that underwent open-heart surgery and the occurrence of complications and death in the postoperative period and compare those levels during surgery under different perioperative conditions. Data regarding the anesthetic and surgical procedures and the perioperative conditions of the patients were collected from medical records in a standardized form. Comparisons of blood glucose and arterial lactate levels of patients with or without postoperative complications were made by the estimation of the odds ratio for morbidity and mortality. Frequencies related to the perioperative conditions were established according to nonparametric univariate analysis. Higher perioperative arterial lactate levels were observed in children that developed complications and/or died after heart surgery. Higher intraoperative levels of blood glucose were also observed in patients with postoperative complications, but not in those who died. The use of cardiopulmonary bypass (CPB) was associated with higher levels of glucose and lactate in surgery. The prediction capability of those biomarkers for different kinds of complications varied with the utilization of CPB in the procedure. Hypoglycemia was associated with higher rates... (Complete abstract click electronic access below)

It is generally recognized that a serious illness with concurrent hospitalization in an ICU will have an impact on family members. Few researchers, however, have described the ways in which spouses are affected when their mates are hospitalized in an ICU. Therefore, this study aimed to describe and explain the spouses' experiences of having a mate in an ICU following coronary artery bypass graft surgery. Kleinman's conceptual framework guided the development of the research question and provided the focus for data collection and analysis. Kleinman proposes that an understanding of the client's perspective is necessary for the provision of effective health care. A qualitative research method based on the theoretical perspective of phenomenology was used to answer the research question. The spouses' viewpoints were elicited through unstructured interviews. The sample consisted of seven spouses, four women and three men. The spouses were interviewed on two occasions, once while their mate was still in the ICU and once shortly following their mate's discharge from the ICU. A total of 13 in-depth interviews were conducted over a 3 month period. Data were analyzed simultaneously with and following data collection. Responses that were similar were grouped together into categories. After the data were examined and sorted into categories, the researcher defined the theme that dominated each category. The themes that emerged from the data were clarified, validated, and/or rejected by the participants during subsequent interviews. As relationships between the categories were identified, the important aspects of the spouses' experiences became apparent. The findings revealed that the spouses located the ICU experience within the context of their experience with their mate's coronary artery bypass graft surgery. The spouses understood and made sense of the ICU experience by attaching meaning to specific events that related to the entire surgical experience. They perceived the surgical experience as consisting of three distinct but interrelated phases: pre-surgery; waiting during surgery; and post-surgery. During each phase, the spouses described and explained how they reacted to and coped with each new situation. These two themes, "reaction to the situation" and "coping with the situation," appeared as threads throughout the entire surgical experience. By organizing the data in relation to phases and themes, the researcher was able to meaningfully understand and communicate the spouses' entire surgical experience. In view of the study findings, implications for nursing practice, education and research are delineated. / Applied Science, Faculty of / Nursing, School of / Graduate

On December 7, 1972, a hearing was held in Washington, D.C. on the use and abuse of antimicrobials. Senator Gaylor Nelson of the Sub-committee on the Monopoly of the Select Committee on Small Business stated, "Antibiotics are among the most frequently prescribed drugs in this country exceeded only by the psychoactive drugs." Dr. Charles C. Edwards, former Commissioner of the Food and Drug Administration, recognized that a problem existed and recommended the establishment of a National Task Force on the clinical use of antimicrobials (Kunin, et al., 1973). The following examples of illustrate problems the medical profession faces with antimicrobials. Of the 33 million patients discharged from general hospitals in 1972, 27% received one or more antibiotics during their hospital stay. The totals almost 9 million patients receiving antibiotics during the course of the year (McGowan, 1976). Dr. John Porterfield of JCAH recognized the Pharmacy-Therapeutics and Infection Control Committees as the formal organizational elements with the ultimate responsibility for formulating drug usage studies and overall administration of a quality assurance program. It was the opinion of Zeman et al., (1974), that in a large hospital (more than 500 beds) a separate Antibiotic Utilization Committee may more efficiently handle the volume of data and work. To implement this monitoring system, Brodie and Smith, (1976), recommended five drug utilization review principles: (1) authority, (2) operational and demographic characteristics of the delivery setting and service population, (3) knowledge of the existing pattern of utilization, (4) comparison of the later with local standards, and (5) evaluation of the impact of review on utilization patterns. Pierpaoli, et al., (1976), suggested that, conceptually a monitoring program could include utilization of retrospective and prospective chart review processes, complimented by a formal education program, and in-house controls on the use of certain antibiotics. A monitoring system could consist of evaluating antibiotics in three possible ways: (1) evaluate the usage of an antibiotic, or a family of antibiotics, in all medical-surgical cases, (2) evaluate one type of medical or surgical problem and review prophylactic and therapeutic use of all antibiotics, or (3) evaluate the usage of one antibiotic in one type of medical or surgical problem. The method of studying one antibiotic in one type of clinical condition might have some advantages since the number of variables is much smaller than either of the other two systems. I decided to use this approach and concentrate an open-heart surgery in which the cephalosporins have been used prophylactically.

The initial use of optical fibres to transmit laser energy intravascularly was accompanied by a high rate of perforations and the production of inadequate vascular channels when used for recanalisation. The laser thermal probe - in which all laser energy is converted into heat by a metal cap at the tip of the fibre, prior to tissue application - was one of the earliest modifications designed to overcome these problems. The studies in this thesis were concerned with the application of the laser thermal probe to percutaneous peripheral and coronary artery angioplasty and His bundle ablation. In vitro studies were commenced in March 1987 when the first (argon) laser generator was installed in the cardiac catheterisation laboratory at Guy's Hospital and these were followed by clinical studies in three groups of patients: nine with peripheral artery occlusions, three with coronary artery stenoses and four with supraventricular arrhythmias using either argon or Nd-YAG energies. Suggestions that enhanced safety might be possible with on-line monitoring and/or control of the probe temperature were studied by recording the temperature responses in simulated circulations at flow rates observed clinically. The highly variable temperatures recorded in blood indicate that these measures are unlikely to contribute to improvements in either efficacy or clinical safety. An earlier report of successful peripheral artery recanalisation using the laser thermal probe was confirmed in the patients studied here, though a learning curve was evident. Coronary laser angioplasty had also been performed in a few patients with a similar device but without as much success. A more flexible "over the wire" laser probe was assessed here, first in cadaver coronary arteries and then in three patients undergoing coronary angioplasty. The lack of success seen with this laser thermal probe relates to the considerable differences found between peripheral and coronary arteries: percutaneous accessibility, vessel size and the susceptibility to thermal injury being the most important. These aspects and subsequent developments in coronary laser angioplasty are discussed further. The final chapter considers a hitherto new area for laser thermal probe application the interruption of arrhythmia circuits. Cadaver and electrophysiological studies indicated that ablation of the bundle of His might be possible with this device - without the need for a general anaesthetic. The course of the first patient ever to undergo this procedure is described, as well as the implications for percutaneous His bundle ablation using other energy sources.

The design of a microcomputer-based monitoring and display system for a cardiopulmonary bypass loop is discussed. Analog signals representing blood temperature and oxygen saturation of sample points entering and leaving the blood oxygenator, patient temperature, oxygenator heat exchanger water temperature and hemoglobin content are monitored and displayed. The hemoglobin content and oxygen saturation signals, input from a reflective-type hemoglobin meter and oximeter are corrected for blood temperature and operator input pH. The oxygen saturation is also corrected for hemoglobin content. Oxygen transfer to the patient is calculated and displayed to evaluate the effectiveness of the system in cardiopulmonary support. Alarms are issued for free gas in blood, no blood flow, and high oxygenator water temperature. The hardware and software design is described along with schematics and flowcharts. A complete software listing is included. The monitoring and display system is operational, but has not been tested with flowing blood. / M.S.

Introduction: Coronary artery bypass grafting surgery is an effective treatment for coronary heart disease for many patients; however, evidence suggests that there are some patients who do not report a good post-operative recovery. Although several studies have begun investigating possible reasons for these observations, little is known about the impact of CABG on quality of life and there still remains a lack of information that can help clinicians identify those people more likely to experience poorer recovery so that interventions can be targeted appropriately. Aims: The overall aim was to investigate barriers to and facilitators of recovery after CABG. Method: Phase 1 was a retrospective qualitative study involving semi-structured interviews with eleven patients who had undergone CABG and with ten health professionals experienced in caring for these patients. Data were analysed using thematic analysis. Phase 2 was a prospective study comprising two components, questionnaire and interview. The questionnaire included measures of quality of life, perceived recovery, demographic and psychosocial variables and was administered prior to surgery and at six and twelve months post-surgery. A sample of ten people who completed questionnaires were interviewed at the same time points and data analysed using framework analysis. Results: Interview data described the patient experience of undergoing CABG and identified components of a good recovery from the patient perspective. Patient and health professional participants identified numerous barriers and facilitators to recovery at three key time points - prior to surgery, during the hospital inpatient stay and post-CABG - and noted the complex inter-relationships between them, thus emphasising the need for a holistic approach to investigating recovery. Questionnaire data described the pattern of psychosocial functioning, quality of life and perceived recovery across the surgical pathway and identified depression and self-efficacy as the main predictors of post-CABG quality of life and perceived recovery. Using interview and questionnaire data a model of recovery is proposed. Conclusions: Findings from this research have identified a complex inter-related network of barriers and facilitators to recovery, suggested the possible mechanisms by which they impact on post-CABG outcome and identified recommendations for clinical practice.

Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.

A patient monitor device for use during open heart surgery has been designed and constructed. The device uses a VIC 20 microcomputer along with some additional circuitry to monitor 3 separate functions. The first patient variable monitored is the blood flow rate through the extracorporeal blood circuit during surgery. The device also continuously monitors and displays 6 separate temperatures. Finally, 3 individual timers are monitored and displayed with the device. Both the hardware and the software used in the design are fully described. / Master of Science