Several prevention and treatment strategies have been applied in order to prevent hypoxemia after open heart surgery with comparable good results. The aim of this study is to compare the effectiveness of two different alveolar recruitment maneuvers [RM] for the management of oxygenation impairment in cardiac surgical patients. A total number of sixty patients were included in this study. All patients underwent cardiac surgical procedures with extracorporeal circulation and developed oxygenation impairment after withdrawal of extracirculation support and sternal closure. Patients were randomly assigned into two Groups A and B according to the applied RM. In Group A three hyperinflations of the lungs were applied at an airway pressure of 40cmH2O for 10 sec, whereas in Group B Pressure Control Ventilation was applied for 2min with the inspiratory pressure set at 40cmH2O. After application of any of the two RM, PEEP was increased from 5 to 10 cmH2O in all patients. Anesthesia induction and maintenance and mechanical ventilation settings were similar in both study Groups. Continue reading

The deficiency of the natural heart pacemaker, the conduction disturbances and the appearance of arrhythmias are common complications after cardiac surgery. Placement of epicardiac electrodes (ventricular, atrial, or both) during cardiac surgery remains common practice, even though few patients will actually need some kind of temporary epicardiac pacing for various periods of time. Temporary epicardiac pacing may be ventricular, atrial or atrioventricular, depending on the specific features of each patient and it aims at preserving the cardiac rhythm, securing the desired heart rate and achieving an acceptable cardiac output. Temporary epicardiac pacing is not without danger, since, under specific circumstances, it may have a negative impact on the hemodynamics of the patient, to the point of circulatory collapse. It may also cause ventricular tachycardia (R on T phenomenon) and cardiac arrhythmias (if pacing is not synchronized to the heart’s natural pacemaker). Ventricular Pacing and Sensing (VVI) is accomplished by the placement of electrodes only on the ventricles, which a priori means a certain degree of hemodynamic compromise, due to the loss of atrial contribution in preserving cardiac output. In certain occasions, this impact may be even more significant. This case report concerns  a patient who underwent Coronary Artery Bypass Grafting (CABG) and after placement of the electrodes of temporary epicardiac ventricular pacing he presented significant decrease in systemic arterial pressure and the appearance of cannon A waves on central venous pressure (CVP) tracing every time the pacemaker was triggered. These phenomena, which receded after the disconnection of the pacemaker, consists a case of Pacemaker Syndrome.This problem was solved by adjusting the pacemaker’s frequency at a rate lower than that of the patient’s natural pacemaker.

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