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Biomedical subjects

G Silvay

Publications and source records attributed to G Silvay.

45 records · Page 3Linked to original sources
PubMedDate not supplied

Left heart assist device: early clinical experiences with management of postperfusion low cardiac output.

Low cardiac output is a continuing cause of mortality after intracardiac operation in patients coming to surgery with advanced myocardial dysfunction. A simple method using a left heart assist device (LHAD) after open heart surgery to manage low cardiac output resistant to all adjuvant therapy is described. Except for the special cannulas, all equipment necessary for the LHAD is available in any unit performing open-heart surgery. Fifteen patients who could not be separated from conventional cardiopulmonary bypass underwent postoperative support with the LHAD (up to 501 hours). Ten patients were weaned from the device and 6 were dismissed from the hospital. Four patients remain alive, the longest period after operation being 24 months. A major asset of the LHAD is that thoracic reentry is not required at termination of LHAD support, since their design permits the cannulas to remain permanently in situ. This is thought to be an important concept, since critically ill patients requiring support are precisely those in whom added risk would be imposed by a second operation.

Adult↗
PubMedDate not supplied

Lower esophageal contractility: a technique for measuring depth of anesthesia.

Until recently, there has been no simple, accurate, reliable technique for monitoring depth of anesthesia during surgery. A system that measures lower esophageal contractility (LEC) has been designed for this purpose. The system consists of a monitor and a disposable esophageal probe equipped with provoking and measuring balloons. Since the motor control of the esophagus is directly controlled by the brain stem, LEC was postulated to be a reflection of the anesthetic state of the patient. Multiple-center clinical studies have shown that LEC correlates significantly (p less than 0.005) with concentrations of volatile anesthetic agents and patient responses to surgical stimulation. Closed-loop anesthetic techniques have been developed at several institutions based on LEC and hemodynamic parameters. Lower esophageal contractility has been shown to be an accurate monitor of anesthetic depth for a variety of surgical procedures and anesthetic techniques.

Anesthesia↗
PubMedDate not supplied

Ketamine.

Explore the source record for details and available documents.

Anesthesia, Intravenous↗
PubMedDate not supplied

Hemostasis in aortic and cardiothoracic surgery.

Hemostasis abnormalities in cardiovascular and aortic surgery remain a major source of morbidity and mortality in patients undergoing such complex procedures. The need for frequent transfusions of red cell and other blood products increases risks and costs to patients and institutions providing patient care. Specifically in cardiovascular and aortic surgery, the nature of the surgery is, at best, semi-elective, and careful preparation to preserve the hemostatic mechanisms of the body is essential. Contact of blood with the extracorporeal circuit induces a hemorrhagic diathesis through a variety of different mechanisms. Dilution of the patient's blood volume by the extracorporeal circuit prime causes depletion of platelets and coagulation factor levels. Aorto intimal disease initiates fibrinolysis by the release of tissue plasminogen activator. Due to the numerous etiologies of bleeding, a combination of blood conservation strategies is suggested. The ideal combination of interventions has yet to be determined and is currently dependent on patient variables, physician and institutional practices, and economic pressures.

Aminocaproic Acid↗
PubMedDate not supplied

Circulatory support with a left-heart assist device after intracardiac operation: design concepts and management techniques.

A simple left-heart assist device was developed to reduce left ventricular preload while simultaneously increasing total systemic blood flow. It consists of special cannulas connected to a simple extracorporeal tubing loop and roller pump, designed to permit bypass of as much as 5 liters of blood per minute from left atrium to ascending aorta. Employed in 15 patients with advanced heart disease who were in low cardiac output following repair, the system was proven effective. An asset of the device is the ability to subsequently separate the patient from the device without need to reenter the thorax or abdomen.

Assisted Circulation↗