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Discontinuation of Cardiopulmonary Bypass

  • Chapter
Cardiopulmonary Bypass

Abstract

Discontinuation of cardiopulmonary bypass (CPB) is an obvious, necessary part of every operative procedure that includes extracorporeal circulation. This process removes the functions of blood flow and respiration from the heart-lung machine and returns them to the patient’s heart and lungs. To avoid mishap, it should be approached in a systematic, thorough manner. In this chapter, we will discuss the preparations for discontinuing bypass support and the mechanics of weaning a patient from CPB. We will then review cardiovascular pharmacologic support in the peri-CPB period, and management of the patient who cannot be readily weaned from CPB support.

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References

  1. Tofler OB. Electrocardiographic changes during profound hypothermia. Br Heart J 1962;24:265–268.

    PubMed  CAS  Google Scholar 

  2. Schwab RH, Lewis DW, Killough JH, Templeton JY. Electrocardiographic changes occurring in rapidly induced deep hypothermia. Am JMed Sci 1964; 248: 290–303.

    CAS  Google Scholar 

  3. Trevino A, Razi B, Beller BM. The characteristic electrocardiogram of accidental hypothermia. Arch Intern Med 1971; 127: 470–473.

    PubMed  CAS  Google Scholar 

  4. Braunwald E. The hemodynamic significance of atrial systole. Am JMed 1964; 37: 665–669.

    CAS  Google Scholar 

  5. Konstadt SN, Reich DL, Thys DM, et al. Importance of atrial systole to ventricular filling predicted by transesophageal echocardiography. Anesthesiology 1990; 72: 971–976.

    PubMed  CAS  Google Scholar 

  6. England MR, Gordon G, Salem M, Chernow B. Magnesium administration and dysrhythmias after cardiac surgery. JAMA 1992; 268: 2395–2402.

    PubMed  CAS  Google Scholar 

  7. Evans GL, Smulyan H, Eich RH. Role of peripheral resistance in the control of cardiac output. Am J Cardiol 1967; 20: 216–221.

    PubMed  CAS  Google Scholar 

  8. Royster RL, Butterworth JF, Prough DS, et al. Preoperative and intraoperative predictors of inotropic support and long-term outcome in patients having coronary artery bypass grafting. Anesth Analg 1991; 72: 729–736.

    PubMed  CAS  Google Scholar 

  9. Entress JJ, Dhamee S, Olund T, et al. Pulmonary artery occlusion pressure is not accurate immediately after cardiopulmonary bypass. J Cardiothorac A nesth 1990; 4: 558–563.

    CAS  Google Scholar 

  10. Konstadt SN, Thys D, Mindich BP, et al. Validation of quantitative intraoperative transesophageal echocardiography. Anesthesiology 1986; 65: 418–421.

    PubMed  CAS  Google Scholar 

  11. Abel MD, Nishimura RA, Callahan MJ, et al. Evaluation of intraoperative transesophageal echocardiography. Anesthesiology 1987; 66: 64–68.

    PubMed  CAS  Google Scholar 

  12. Cingolani HE, Mattiazzi AR, Blesa ES, Gonzalez NC. Contractility in isolated mammalian heart muscle after acid-base changes. Circ Res 1970; 26: 269–278.

    PubMed  CAS  Google Scholar 

  13. Gerst PH, Fleming WH, Malm JR. Increased susceptibility of the heart to ventricular fibrillation during metabolic acidosis. Circ Res 1966; 19: 63–70.

    CAS  Google Scholar 

  14. Kassirer JP. Serious acid-base disorders. N Engl J Med 1974; 291: 773–776.

    PubMed  CAS  Google Scholar 

  15. Bleich HL, Schwartz WB. TRIS buffer (THAM). N Engl JMed 1966; 274: 782–786.

    CAS  Google Scholar 

  16. Nussmeier NA, Moskowitz GJ, Weiskopf RB, et al. In vitro anesthetic wash-in and wash-out via bubble oxygenators. Anesth Analg 1988; 67: 982–987.

    PubMed  CAS  Google Scholar 

  17. Murphy DA, Craver JM, Jones EL, et al. Recognition and management of ascending aortic dissection complicating cardiac surgical operations. J Thorac Cardiovasc Surg 1983; 85: 247–256.

    PubMed  CAS  Google Scholar 

  18. Moorthy SS, Pond W, Rowland RG. Severe circulatory shock following protamine (an anaphylactic reaction). Anesth Analg 1980; 59: 77–78.

    PubMed  CAS  Google Scholar 

  19. Lowenstein E, Johnston WE, Lappas DG, et al. Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin. Anesthesiology 1983; 59: 470–473.

    PubMed  CAS  Google Scholar 

  20. Horrow JC. Protamine: a review of its toxicity. Anesth Analg 1985; 64: 348–361.

    PubMed  CAS  Google Scholar 

  21. Cohn LH. Dobutamine in the postcardiac surgery patient. In: Chatterjee K, ed. Dobutamine — A Ten-Year Review. New York: NCM Publishers Inc; 1989: 123–138.

    Google Scholar 

  22. Breisblatt WM, Stein KL, Wolfe CJ, et al. Acute myocardial dysfunction and recovery: a common occurrence after cardiopulmonary bypass surgery. J Am Coll Cardiol 1990; 15: 1261–1269.

    PubMed  CAS  Google Scholar 

  23. Mangano DT. Biventricular function after myocardial revascularization in humans: deterioration and recovery patterns during the first 24 hours. Anesthesiology 1985; 62: 571–577.

    PubMed  CAS  Google Scholar 

  24. Gray R, Maddahi J, Berman D, et al. Scintigraphic and hemodynamic demonstration of transient left ventricular dysfunction immediately after uncomplicated coronary artery bypass grafting. J Thorac Cardiovasc Surg 1979; 77: 504510.

    Google Scholar 

  25. Khuri SF, Warner KG, Josa M, et al. The superiority of continuous cold blood cardioplegia in the metabolic protection of the hypertrophied human heart. J Thorac Cardiovasc Surg 1988; 95: 442–454.

    PubMed  CAS  Google Scholar 

  26. Sell TL, Purut CM, Silva R, et al. Recovery of myocardial function during coronary artery bypass grafting. Intraoperative assessment by pressure-volume loops. J Thorac Cardiovasc Surg 1991; 101: 681–687.

    PubMed  CAS  Google Scholar 

  27. Fowler MB, Laser JA, Hopkins GL, et al. Assessment of the beta adrenergic receptor pathway in the intact failing human heart: progressive receptor down-regulation and subsensitivity to agonist response. Circulation 1986; 74: 1290–1302.

    PubMed  CAS  Google Scholar 

  28. Bristow MR, Ginsburg R, Minobe W, et al. Decreased catecholamine sensitivity and β-adrenergic receptor density in failing human hearts. N Engl J Med 1982;307:205–211

    PubMed  CAS  Google Scholar 

  29. Reyes JG, Karp RB, Buttner EE, et al. Neuronal and adrenomedullary catecholamine release in response to cardiopulmonary bypass in man. Circulation 1982; 66: 49–55.

    Google Scholar 

  30. Spahn DR, Frasco P, Smith LR, et al. Cardiopulmonary bypass induces physiologic β-adrenergic receptor desensitization. Abstracts of the 14th Annual Meeting of the Society of Cardiovascular Anesthesiology. 1992; 178.

    Google Scholar 

  31. Mantz J, Marty J, Pansard Y, et al. β-Adrenergic receptor changes during coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990; 99: 75–81.

    PubMed  CAS  Google Scholar 

  32. Sharvan K. Transesophageal echocardiography; how valuable is it for heart monitoring during cardiac surgery? Curr Opin Anesth 1992; 5: 94–103.

    Google Scholar 

  33. Bailey JM, Levy JH, Kopel MA, et al. Relationship between clinical evaluation of peripheral perfusion and global hemodynamics in adults after cardiac surgery. Crit Care Med 1990; 18: 1353–1356.

    PubMed  CAS  Google Scholar 

  34. Barry WH. Mechanisms of myocardial cell injury during ischemia and reperfusion. J Card Surg 1987; 2: 375–383.

    PubMed  CAS  Google Scholar 

  35. Borgers M. The role of calcium in the toxicity of the myocardium. Histochem J 1986; 13: 839–848.

    Google Scholar 

  36. Nayler WG. Calcium and cell death. Eur Heart J 1983; 4 (suppl C): 33–41.

    PubMed  CAS  Google Scholar 

  37. Scheidegger D, Dropp LJ, Schellenberg JC. Role of the systemic vasculature in the hemodynamic response to changes in plasma ionized calcium. Arch Surg 1980; 115: 206–211.

    PubMed  CAS  Google Scholar 

  38. Engleman RM, Harji-Rousou S, Bres RH, et al. Rebound vasospasm after coronary revascularization in association with calcium antagonist withdrawal. Ann Thorac Surg 1984; 37: 469–472.

    Google Scholar 

  39. Sethna DH, Gray RJ, Moffit EA, et al. Dobutamine and cardiac oxygen balance in patients following myocardial revascularization. Anesth Analg 1982; 61: 917–920.

    PubMed  CAS  Google Scholar 

  40. Van Trigt P, Spray TL, Pasque MK, et al. The comparative effects of dopamine and dobutamine on ventricular mechanics after coronary artery bypass grafting: a pressure-dimension analysis. Circulation 1984;(suppl I ): 112–117.

    Google Scholar 

  41. Goldberg LI, Hsuh Y, Resnekov L. Newer catecholamines for treatment of heart failure and shock: an update on dopamine and a first look at dobutamine. Prog Cardiovasc Dis 1977; 19: 327–340.

    PubMed  CAS  Google Scholar 

  42. Lawless CE, Loeb HS. Pharmacokinetics and pharmacodynamics of dobutamine. In: Chatterjee K, ed. Dobutamine: A Ten Year Review. New York: NCM Publishers; 1989: 33–47.

    Google Scholar 

  43. Leier CV, Heran PT, Huss P, et al. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation 1978; 58: 466–475.

    PubMed  CAS  Google Scholar 

  44. Tuttle RR, Mills J. Development of a new catecholamine to selectively increase cardiac contractility. Circ Res 1975; 36: 185–196.

    PubMed  CAS  Google Scholar 

  45. Ruffolo RR Jr, Spradlin TA, Pollock GD, et al. Alpha and beta adrenergic effects of the stereoisomers of dobutamine. J Pharmacol Exp Ther 1981; 219: 447–452.

    PubMed  CAS  Google Scholar 

  46. Leier CV, Unverferth DV. Dobutamine. Ann Intern Med 1983; 99: 490–496.

    PubMed  CAS  Google Scholar 

  47. Stephenson LW, Blackstone EH, Korchoukos NT. Dopamine vs epinephrine in patients following cardiac surgery: randomized study. Surg Forum 1976; 27: 272–275.

    PubMed  CAS  Google Scholar 

  48. Sung BH, Aubison C, Thadani U, et al. Effects of L-epinephrine on hemodynamics and cardiac function in coronary disease: dose response studies. Clin Pharmacol Ther 1988; 43: 308–316.

    PubMed  CAS  Google Scholar 

  49. Tinker J. Pro: strong inotropes (ie, epinephrine) should be drugs of first choice during emergence from cardiopulmonary bypass. J Cardiothorac Anesth 1987; 1: 256–258.

    PubMed  CAS  Google Scholar 

  50. Stenn PA, Tinker JH, Pluth JR, et al. Efficacy of dopamine, dobutamine and epinephrine during emergence from cardiopulmonary bypass in man. Circulation 1978; 57: 378–384.

    Google Scholar 

  51. Butterworth JF IV, Prielipp RC, Royster RL, et al. Dobutamine increases heart rate more than epinephrine in patients recovering from aortocoronary bypass surgery. J Cardiothorac Vasc Anesth 1992; 6: 535–545.

    PubMed  Google Scholar 

  52. Zaritsky AL, Chernow B. Catecholamines, sympathomimetics. In: Chernow B, ed. The Pharmacologic Approach to the Critically Ill Patient. Baltimore. Williams & Wilkins; 1983: 481–509.

    Google Scholar 

  53. Dole WP. Autoregulation of the coronary circulation. Prog Cardiovasc Dis 1987; 29: 293–323.

    PubMed  CAS  Google Scholar 

  54. Lemmer JH, Bothma MJ, McKenney P, et al. Norepinephrine plus phentolamine improves regional blood flow during experimental low cardiac output syndrome. Ann Thorac Surg 1984; 38: 108–116.

    PubMed  CAS  Google Scholar 

  55. Schaer GL, Fink MP, Parrillo JF. Norepinephrine alone versus norepinephrine plus low-dose dopamine: enhanced renal blood flow with combination pressor therapy. Crit Care Med 1985; 13: 492–496.

    PubMed  CAS  Google Scholar 

  56. Lucas CE. A new look at dopamine and norepinephrine for hyperdynamic septic shock. Chest 1994; 105: 7–8.

    PubMed  CAS  Google Scholar 

  57. Lathi KS, Shulman MS, Diehl JT, et al. The use of amrinone and norepinephrine for inotropic support during emergence from cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1991; 5: 250–254.

    PubMed  CAS  Google Scholar 

  58. Robinson RJS, Tchervenkov C. Treatment of low cardiac output after aortocoronary artery bypass surgery using a combination of norepinephrine and amrinone. J Cardiothorac Anesth 1987; 1: 229–233.

    PubMed  CAS  Google Scholar 

  59. Dupuis J, Bondy R, Cattran C, et al. Amrinone and dobutamine as primary treatment of low cardiac output syndrome following coronary artery surgery: a comparison of their effects on hemodynamics and outcome. J Cardiothorac Vasc Anesth 1992; 6: 542–553.

    PubMed  CAS  Google Scholar 

  60. Royster RL, Whiteley JW, Butterworth JF IV. Amrinone therapy during emergence from cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 101: 942–943.

    PubMed  CAS  Google Scholar 

  61. Colucci WS, Wright RF, Braunwald E. New positive isotropic agents in the treatment of congestive heart failure: mechanisms of action and recent clinical developments. (Second of two parts) N Engi J Med 1986; 314: 349–358.

    CAS  Google Scholar 

  62. Gage J, Rutman H, Lucido D, et al. Additive effects of dobutamine and amrinone on myocardial contractility and ventricular performance in patients with severe heart failure. Circulation 1986; 74: 367–373.

    PubMed  CAS  Google Scholar 

  63. Bondy R, Ramsay JG. Reversal of refractory right ventricular failure with amrinone. J Cardiothorac Vasc Anesth 1991; 5: 255–257.

    PubMed  CAS  Google Scholar 

  64. Hines R. Use of amrinone in perioperative states. Pract Cardiol 1987; 9 (suppl): 33–37.

    Google Scholar 

  65. Udelson JE, Cannon RU III, Bacharack SL, et al. Betaadrenergic stimulation with isoproterenol enhances left ventricular diastolic performance in hypertrophic cardiomyopathy despite potentiation of myocardial ischemia. Circulation 1989; 79: 371–382.

    PubMed  CAS  Google Scholar 

  66. Chiarello M, Gold HK, Leibach RC, et al. Comparison between the effects of nitroprusside and nitroglycerin on ischemic injury during acute myocardial infarction. Circulation 1976; 54: 766–733.

    Google Scholar 

  67. Kaplan JA, Jones EL. Vasodilator therapy during coronary artery surgery: comparison of nitroglycerin and nitroprusside. J Thorac Cardiovasc Surg 1979; 77: 301–309.

    PubMed  CAS  Google Scholar 

  68. Cooper GJ, Wilkinson GA, Angelini GD. Overcoming perioperative spasm of the internal mammary artery: which is the best vasodilator? J Thorac Cardiovasc Surg 1992; 104: 465–468.

    PubMed  CAS  Google Scholar 

  69. Ganz W, Marcus HS. Failure of intracoronary nitroglycerin to alleviate pacing-induced angina. Circulation 1972; 46: 880–889.

    PubMed  CAS  Google Scholar 

  70. D’Ambra M, La Raia P, Philbin D, et al. Prostaglandin El — a new therapy for refractory right heart failure and pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg 1985; 89: 567–572.

    PubMed  Google Scholar 

  71. Vincent JL, Carlier E, Pinsky MR, et al. Prostaglandin El infusion for right ventricular failure after cardiac transplantation. J Thorac Cardiovasc Surg 1992; 103: 33–39.

    PubMed  CAS  Google Scholar 

  72. Palmer RMJ, Ashton DS, Mocada S. Vascular endothelial cells synthesize nitric oxide from L-arginine. Nature 1988; 333: 664–666.

    PubMed  CAS  Google Scholar 

  73. Frostell CG, Blomqvist H, Hedenstierna G, et al. Inhaled nitric oxide selectively reverses human hypoxic pulmonary vasoconstruction without causing systemic vasodilation. Anesthesiology 1993; 78: 427–435.

    PubMed  CAS  Google Scholar 

  74. Pearl RG. Inhaled nitric oxide. The past, the present, and the future. Anesthesiology 1993; 78: 413–416.

    PubMed  CAS  Google Scholar 

  75. Girard C, Lehot JJ, Pannetier JC, et al. Inhaled nitric oxide after mitral valve replacement in patients with chronic pulmonary artery hypertension. Anesthesiology 1992; 77: 880–883.

    PubMed  CAS  Google Scholar 

  76. Sellden H, Winberg P, Gustafsson LE, et al. Inhalation of nitric oxide reduced pulmonary hypertension after cardiac surgery in a 3.2-kg infant. Anesthesiology 1993; 78: 577–580.

    PubMed  CAS  Google Scholar 

  77. Roberts JD, Polaner DM, Lang P, et al. Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet 1992; 340: 818–819.

    PubMed  CAS  Google Scholar 

  78. Rossaint R, Falke KJ, Lopez F, et al. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 1993;328:399–405.

    PubMed  CAS  Google Scholar 

  79. Stern DH, Gershon JI, Allen FB, et al. Can we trust the direct radial artery pressure immediately following cardiopulmonary bypass? Anesthesiology 1985; 62: 557–561.

    PubMed  CAS  Google Scholar 

  80. Pauca AL, Hudspeth AS, Wallenhaupt SL, et al. Radial artery-to-aorta pressure difference after discontinuation of cardiopulmonary bypass. Anesthesiology 1989; 70: 935–941.

    PubMed  CAS  Google Scholar 

  81. Pauca AL, Wallenhaput SL, Kon ND. Reliability of the radial arterial pressure during anesthesia. Is wrist compression a possible diagnostic test? Chest 1994; 105: 69–75.

    PubMed  CAS  Google Scholar 

  82. Gradinac S, Coleman GM, Taegtmeyer H, et al. Improved cardiac function with glucose-insulin-potassium after aortocoronary bypass grafting. Ann Thorac Surg 1989; 48: 484–489.

    PubMed  CAS  Google Scholar 

  83. Coleman GM, Cradinac S, Taegtmeyer H, et al. Efficacy of metabolic support with glucose-insulin-potassium for left ventricular pump failure after aortocoronary bypass surgery. Circulation 1989; 80 (suppl I): 91–96.

    Google Scholar 

  84. Jain U, Sullivan HJ, Pifarre R, et al. Graft atheroembolism as the probable cause of failure to wean from cardiopulmonary bypass. J Cardiothorac Anesth 1990; 4: 476–480.

    PubMed  CAS  Google Scholar 

  85. Justice C, Leach J, Edwards WS. The harmful effects and treatment of coronary air embolism during open heart surgery. Ann Thorac Surg 1972; 14: 47–53.

    PubMed  CAS  Google Scholar 

  86. Profeta J, Silvay G. Perioperative right ventricular failure due to air in the coronary vein graft. In: Reyes JG, Hall KD, eds. Common Problems in Cardiac Anesthesia. Chicago: Year Book Medical Publishers Inc; 1987: 304–309.

    Google Scholar 

  87. van Herwerden LA, Fraser AG, Bos E. Left ventricular outflow tract obstruction after mitral valve repair assessed with intraoperative echocardiography. J Thorac Cardiovasc Surg 1991; 102: 461–463.

    PubMed  Google Scholar 

  88. Doty DB. The surgeon’s response to a low-output state after cardiopulmonary bypass: etiologies and remedies. J Card Surg 1990; 5 (suppl): 256–258.

    PubMed  CAS  Google Scholar 

  89. Reichert SLA, Visser CA, Moulijn AC, et al. Intraoperative transesophageal color-coded doppler echocardiography for evaluation of residual regurgitation after mitral valve repair. J Thorac Cardiovasc Surg 1990; 100: 756–761.

    PubMed  CAS  Google Scholar 

  90. Hill RF. Increased central venous pressure during cardiopulmonary bypass. In: Reyes JG, Hall KD, eds. Common Problems in Cardiac Anesthesia. Chicago: Year Book Medical Publishers Inc; 1987: 27–30.

    Google Scholar 

  91. Kirklin JK, Kirklin JW, Pacifico AD. Cardiopulmonary bypass. In: Arciniegas E, ed. Pediatric Cardiac Surgery. Chicago: Year Book Medical Publishers; 1985: 67–77.

    Google Scholar 

  92. Hansen RM, Viquerat CE, Matthay MA, et al. Poor correlation between pulmonary arterial wedge pressure and left ventricular end-diastolic volume after coronary artery bypass surgery. Anesthesiology 1986; 64: 764–770.

    PubMed  CAS  Google Scholar 

  93. Reichert CLA, Visser CA, Koulen JJ, et al. Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters. J Thorac Cardiovasc Surg 1992; 104: 321–326.

    PubMed  CAS  Google Scholar 

  94. Andersen LW, Baek L, Degn H, et al. Presence of circulating endotoxins during cardiac operations. J Thorac Cardiovasc Surg 1987; 93: 115–119.

    PubMed  CAS  Google Scholar 

  95. Freyschuss U, Hjemdahl P, Juhlin-Dannfelt A, et al. Cardiovascular and metabolic responses to low-dose adrenaline infusion: an invasive study in humans. Clin Sci 1986; 70: 199–206.

    PubMed  CAS  Google Scholar 

  96. Stratton JR, Pfeifer MA, Ritchie JL, et al. Hemodynamic effects of epinephrine: concentration-effect study in humans J Appl Physiol 1985; 58: 1199–1206.

    PubMed  CAS  Google Scholar 

  97. Jaimovich D, Kecshes SA. Management of reactive airway disease. In: Viayasagar D, Carlson R, Geheb MA, eds. Critical Care Clinics. Philadelphia: WB Saunders Co; 1992; 8: 147–162.

    Google Scholar 

  98. Loeb HS, Ostrenga JP, Gaul W, et al. Beneficial effects of dopamine combined with intravenous nitroglycerin on hemodynamics in patients with severe left ventricular failure. Circulation 1983; 68: 813–820.

    PubMed  CAS  Google Scholar 

  99. Monrad ES, Bairn DS, Smith HS, et al. Milrinone, dobutamine and nitroprusside: comparative effects on hemodynamics and myocardial energetics in patients with severe congestive heart failure. Circulation 1986; 73 (III): 168–174.

    Google Scholar 

  100. Udelson JE, Bacharach SL, Canon RO III, et al. Minimum left ventricular pressure during β-adrenergic stimulation in human subjects. Circulation 1990; 82: 1174–1182.

    PubMed  CAS  Google Scholar 

  101. Honerjager P, Schafer-Korting M, Reiter M. Involvement of cyclic AMP in the direct inotropic action of amrinone: biochemical and functional evidence. Naunyn-Schmiedeberg’s Arch Pharmacol 1981; 318: 112–120.

    CAS  Google Scholar 

  102. Firth BG, Ratner AV, Grassman ED, et al. Assessment of the inotropic and vasodilator effects of amrinone versus isoproterenol. Am J Cardiol 1984; 54: 1331–1336.

    PubMed  CAS  Google Scholar 

  103. Levy JH, Ramsay J, Bailey JM. Pharmacokinetics and pharmacodynamics of phosphodiesterase III inhibitors. J Cardiothorac Anesth 1990; 4 (suppl 5): 7–11.

    Google Scholar 

  104. Levy JH, Bailey JM. Amrinone: its effect on vascular resistance and capacitance in human subjects. Chest 1994; 105: 62–64.

    PubMed  CAS  Google Scholar 

  105. Wilmshurst PT, Thompson DS, Juul SM, et al. Effects of intracoronary and intravenous amrinone infusions in patients with cardiac failure and patients with near normal cardiac function. Br Heart J 1985; 53: 493–506.

    PubMed  CAS  Google Scholar 

  106. Kass DA, Grayson R, Marino R. Pressure-volume analysis as a method for quantifying simultaneous drug (amrinone) effects on arterial load and contractile state in vivo. J Am Coll Cardiol 1990; 16: 726–732.

    PubMed  CAS  Google Scholar 

  107. Konstram MA, Cohen SR, Weiland DS, et al. Relative contribution of inotropic and vasodilator effects to amrinoneinduced hemodynamic improvement in congestive heart failure. Am J Cardiol 1986; 57: 242–248.

    Google Scholar 

  108. Anderson JL, Bairn DS, Fein SA, et al. Efficacy and safety of sustained (47 hours) intravenous infusions of mmrinone in patients with severe congestive heart failure: a multicenter study. J Am Coll Cardiol 1987; 9: 711–722.

    PubMed  CAS  Google Scholar 

  109. Rutman HI, LeJemtel TH, Sonneblick EH. Newer cardiotonic agents: implications for patients with heart failure and ischemic heart disease. J Cardiothorac Anesth 1987; 1: 59–70.

    PubMed  CAS  Google Scholar 

  110. DiSesa V. The rational selection of inotropic drugs in cardiac surgery. J Card Surg 1987; 2: 385–406.

    PubMed  CAS  Google Scholar 

  111. Vitex TS. Pro: Calcium salts are contraindicated in the weaning of patients from cardiopulmonary bypass. J Cardiothorac Anesth 1988; 2: 567–569.

    Google Scholar 

  112. Koski G. Con: Calcium salts are contraindicated in weaning patients from cardiopulmonary bypass coronary artery surgery. J Cardiothorac Anesth 1988; 2: 570–575.

    PubMed  CAS  Google Scholar 

  113. Johnston WE, Robertie PG, Butterworth JF IV, et al. Is calcium or ephedrine superior to placebo for emergence from cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1992; 6: 528–534.

    PubMed  CAS  Google Scholar 

  114. Royster RL, Butterworth JF IV, Prielipp RE, et al. A randomized, blinded, placebo-controlled evaluation of calcium chloride and epinephrine for inotropic support after emergence from cardiopulmonary bypass. Anesth Analg 1992; 74: 3–13.

    PubMed  CAS  Google Scholar 

  115. Urban MK, Hines R. The effect of calcium on pulmonary vascular resistance and right ventricular function. J Thorac Cardiovasc Surg 1992; 104: 327–332.

    PubMed  CAS  Google Scholar 

  116. Broner CW, Stidham GL, Westen-Kirchner DF, et al. A prospective, randomized, double-blind comparison of calcium chloride and calcium gluconate therapies for hypocalcemia in critically ill children. J Pediatr 1990; 117: 986–989.

    PubMed  CAS  Google Scholar 

  117. Dage RL, Kariya T, Hsieh CP, et al. Pharmacology of enoximone. Am J Cardiol 1987; 60: 10c - 14c.

    PubMed  CAS  Google Scholar 

  118. Boldt J, Kling D, Moosdorf R, Hempelmann G. Enoximone treatment of impaired myocardial function during cardiac surgery: combined effects with epinephrine. J Cardiothorac Anesth 1990; 4: 462–468.

    PubMed  CAS  Google Scholar 

  119. Brown RA, Dixon J, Farmer JB, et al. Dopexamine: a no-val agonist at peripheral dopamine receptors and β 2-adrenoreceptors. Br J Pharmacol 1985; 85: 599–608.

    PubMed  CAS  Google Scholar 

  120. Smith GN, Hall JC, Farmer JB, et al. The cardiovascular actions of dopexamine hydrochloride, an agonist at dopamine receptors and β 2-adrenoreceptors in the dog. J Pharm Pharmacol 1987; 39: 636–641.

    PubMed  CAS  Google Scholar 

  121. Ghosh S, Gray B, Odura A, et al. Dopexamine hydrochloride: pharmacology and use in low cardiac output states. J Cardiothorac Vasc Anesth 1991; 4: 382–389.

    Google Scholar 

  122. Parrillo JE. Vasodilator therapy. In: Chernow B, ed. The Pharmacological Approach to the Critically Ill Patient. Baltimore: Williams & Wilkins; 1983: 283–302.

    Google Scholar 

  123. Cohen MV, Downey JM, Sonnenblick EH, et al. The effects of nitroglycerin on coronary collateral and myocardial contractility. J Clin Invest 1973; 52: 2836–2847.

    PubMed  CAS  Google Scholar 

  124. Moncada S, Radomski MW, Palmer RM. Endothelium-derived relaxing factor: identification as nitric oxide and role in the control of vascular tone and platelet function. Biochem Pharmacol 1988; 37: 2495–2501.

    PubMed  CAS  Google Scholar 

  125. Haefeli WE, Bumbleton M, Zenet L, et al. Comparison of vasodilatory responses to nitroglycerin and its dinitrate metabolites in human veins. Clin Pharmacol Ther 1992; 52: 590–596.

    PubMed  CAS  Google Scholar 

  126. Cossum PA, Galbraith AJ, Roberts MS, et al. Loss of nitroglycerin from intravenous infusion sets. Lancet 1978; 2: 349–350.

    PubMed  CAS  Google Scholar 

  127. Dupuis J, Lalonde G, Lemieux R, et al. Tolerance to intravenous nitroglycerin in patients with congestive heart failure: role of increased intravascular volume, neurohumoral activation and lack of prevention with n-acetylcystine. J Am Coll Cardiol 1990; 16: 923–931.

    PubMed  CAS  Google Scholar 

  128. Said SI. Pulmonary metabolism of prostaglandin and vasoactive peptides. Annu Rev Physiol 1982; 44: 257–268.

    PubMed  CAS  Google Scholar 

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Michelsen, L.G., Shanewise, J.S. (1995). Discontinuation of Cardiopulmonary Bypass. In: Mora, C.T., Guyton, R.A., Finlayson, D.C., Rigatti, R.L. (eds) Cardiopulmonary Bypass. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2484-6_17

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  • DOI: https://doi.org/10.1007/978-1-4612-2484-6_17

  • Publisher Name: Springer, New York, NY

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