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PubMed1988

[The effect of thoracic peridural analgesia on the cortisol and glucose response in surgery of the abdominal aorta].

UNLABELLED: It has been shown that the stress response to lower abdominal surgery can be inhibited by epidural analgesia (EA). But EA seems to have little influence on the stress reaction to major abdominal surgery. The purpose of our study was to find out whether EA is able to diminish the cortisol and glucose response to major transabdominal surgery. METHODS: 31 patients undergoing elective surgery of the abdominal aorta were subdivided at random into 3 different anaesthesia groups: 1. halothane anesthesia, 2. neuroleptanalgesia (NLA) and 3. thoracic EA with bupivacaine (0.5%) in combination with a light general anesthesia. Some patients of each group received an intravenous infusion of 5% glucose. Blood samples were drawn before anesthesia, after intubation, 5 times during surgery and at the end of the operation and were analysed for cortisol and glucose. During the early postoperative period, 1, 2 and 24 h after surgery, only cortisol was measured. RESULTS: Only the glucose levels of patients who received no carbohydrate-containing infusion fluids were used for evaluation of the stress response. In the halothane group, there was a significant increase of the mean cortisol and glucose levels after the start of surgery. No intraoperative elevations of blood glucose and cortisol were seen in the EA group. Patients of the NLA group showed no hyperglycaemia and only mild elevations of the cortisol levels during the intraoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

[Prevention of hypertensive crises in the perioperative period. Efficacy and safety of the use of urapidil].

Hypertension and tachycardia are frequently encountered in the perioperative setting. Aim of this study was to evaluate the efficacy and safety of Urapidil when used for prevention of perioperative blood pressure elevations. 348 patients, at risk for hypertensive crises, were randomly administered either Urapidil or "no treatment". Blood pressure and heart rate were measured the day before as well as immediately before intervention and were continuously monitored during the intraoperative period. This study has shown a pronounced and well tolerated antihypertensive effect of Urapidil during anaesthesia in these patients. The effect on diastolic values was specific for Urapidil, since systolic pressure was lowered also in the control group as a consequence of anaesthesia. Urapidil treatment resulted to be effective in preventing hypertensive reactions following algogenic stimulation. This becomes particularly evident towards the end of the operative period, when the hypotensive effect attributable to the anesthetic itself progressively decreases.

Adolescent↗
PubMedDate not supplied

[The effect of the graft contraction rate on the intraoperative hemodynamics in orthotopic heart transplantation].

Intraoperative hemodynamics has been studied during orthotopic heart transplantation (OHT) in 36 recipients, aged 14 to 56 years, with spontaneous contractions of the graft. It has been established that patients with HR greater than 110 beats per min were in most cases characterized by normal central venous pressure (CVP) and venous blood oxygenation parameters. In lower HR, CVP is considerably higher and the indexes characteristic of the adequacy of cardiac output to body oxygen requirements are deteriorated. Right after OHT there is a reverse dependence between HR and CVP, with the lowest CVP values corresponding to HR intervals 101-120 and 121-140 per min. It has been concluded that tachycardia in the intraoperative period ensures a more effective function of the transplanted heart.

Adolescent↗
PubMed1986

Recurrent versus residual carotid stenosis. Incidence detected by Doppler ultrasound.

A sterile Doppler probe was used for intraoperative monitoring of the integrity of carotid endarterectomy of 125 vessels of 107 patients. Our objective was to reduce the contribution of residual carotid lesions to recurrent stenosis, which was evaluated by Doppler spectrum analysis in the early (less than 3 months, 66 arteries) and late (3-77 months, mean 32 months, 47 arteries) postoperative period. Intraoperative Doppler monitoring detected residual occlusion in six (4.8%) external carotid arteries and stenosis in ten (8.0%) internal carotid arteries permitting selected arteriography and correction of all significant lesions. Follow-up revealed one (1.5%) asymptomatic common carotid occlusion at 6 weeks and three (6.4%) asymptomatic internal carotid stenoses at 6, 10 and 25 months after operation. When compared to previous published experience, these results suggest that intraoperative correction of residual carotid obstruction detected by Doppler ultrasound may reduce the incidence of postoperative "recurrent" carotid stenosis.

Adult↗
PubMed2002

Distal nerve blocks at the wrist for outpatient carpal tunnel surgery offer intraoperative cardiovascular stability and reduce discharge time.

UNLABELLED: Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique. IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge.

Adult↗
PubMed1996

Perioperative mucosal pH and splanchnic endotoxin concentration in orthotopic liver transplantation.

Although impairment of splanchnic perfusion may induce mucosal hypoxia and endotoxaemia during orthotopic liver transplantation (OLT), little is known about the changes in mucosal oxygenation during and after the procedure. To study the effects of liver surgery itself on mucosal pH (pHi) and the response of pHi to acute changes in portal flow, we measured gastric pHi during six liver resections using tonometry: in two patients, after clamping of the hepatoduodenal ligament, pHi decreased within 30 min and recovered promptly after reperfusion. We then investigated gastric and sigmoid pHi (pHig, pHis) during the perioperative phase in 18 OLT. Median pHi values were low before surgery (pHig 7.28 (first/third quartiles 7.22/7.34); pHis 7.27 (7.12/7.36)). Although global oxygen delivery and haemodynamic variables remained constant and veno-venous bypass (VVB) was used to maintain portal flow, pHi declined during the anhepatic phase (pHig 7.19 (7.13/7.23), P < 0.01; pHis 7.13 (7.06/7.24), P < 0.05). After reperfusion of the graft, pHi recovered and did not differ from baseline values by the end of OLT. After operation pHig increased further, reaching the highest values 30 h after ICU admission (7.34 (7.26/7.38)). In the intraoperative period, no significant endotoxaemia was observed either in portal or systemic blood. The maximum reduction in pHi was related neither to the duration of VVB and OLT nor to the number of red cell units transfused. pHi after reperfusion did not correlate with graft viability or dysfunction of the lung or kidney. We conclude that pHi indicates mucosal ischaemia during OLT which is not necessarily associated with endotoxaemia, and intraoperative pHi monitoring does not appear to be a valuable predictor of postoperative graft failure and organ dysfunction.

Adult↗
PubMed2005

On the intraoperative molecular status of renal allografts after vascular reperfusion and clinical outcomes.

Many hypothesize that subtle inflammation and immune activity detected in the intraoperative period are linked to adverse postkidney transplant clinical outcomes. To this end, renal allografts were analyzed for expression of pro-inflammatory, inflammation-induced adhesion molecules, immune activation as well as anti-apoptotic genes expressed 15 min after vascular reperfusion (zero-hour) to determine whether this analysis can aid in predicting the occurrence of delayed graft function (DGF), acute rejection (AR), and the quality of graft function at 6 mo. Intraoperative biopsies were obtained from 75 consecutively performed renal allografts in which consent was obtained 15 min after vascular reperfusion. These biopsies were analyzed by quantitative real-time PCR for transcription of 15 select genes and by standard histopathology. Posttransplant clinical outcomes were also analyzed in respect to intraoperative transcriptional profiles and clinical parameters available at the time of transplantation. This study demonstrates that a limited and hypothesis-driven PCR-based transcriptional profile of the zero-hour kidney biopsy predicts posttransplant clinical outcomes including DGF, early AR, and the quality of renal function 6 mo posttransplantation. For some clinical endpoints, the combined use of molecular analysis and established clinical indicators available at the time of transplantation further enhances the quality of prognosis. The transcriptional profiling data provide absolutely essential data to the predictive models, particularly with respect to AR and renal function 6 mo posttransplantation.

Biomarkers↗
PubMed1998

[A case of acute empyema who underwent omentopexy and was found to have gastric cancer during operation].

A 76-year-old man had undergone omentopexy for empyema. He was found to have gastric cancer and revealed Borrmann III by gastroendoscopy intraoperative period. Segmental gastrectomy was performed without dissection of lymph nodes, because his general condition was poor. After operation, the patient showed septic shock, ARDS and hepato-renal failure but his condition was getting improved by conservative therapy. After 5 years later, he was examined gastro-endoscopy, abdominal and chest CT and revealed no recurrence sign.

Acute Disease↗
PubMed2001

Complete atrioventricular block during renal transplantation in a patient with Alport's syndrome: case report.

CONTEXT: Patients with Alport's syndrome (causing 5% of end-stage renal disease) have a higher risk of heart conduction abnormalities. OBJECTIVE: To report a case of Alport's syndrome developing complete atrioventricular block during renal transplantation. CASE REPORT: A 21-year-old man with chronic renal failure due to Alport's syndrome was submitted to a renal transplantation under epidural anesthesia and, during the intraoperative period, a complete atrioventricular block was diagnosed and promptly treated with a transcutaneous pacemaker. This extensive sympathetic block can contribute towards disturbances in the heart conduction system, particularly in patients with chronic renal disease in hemodialysis. Even in patients with a normal preoperative electrocardiogram or no conduction system disturbances, some degree of atrioventricular block, including complete atrioventricular block, can occur. In this situation, a transcutaneous pacemaker provides rapid and effective treatment in the operating room, thereby permitting the planning of a definitive treatment.

Adult↗
PubMed1999

Endovascular aortic repair is associated with greater hemodynamic stability compared with open aortic reconstruction.

OBJECTIVE: Examination of overall hemodynamic stability in patients undergoing endovascular aortic repair (EAR) compared with open aortic repair (OAR). DESIGN: Retrospective study. SETTING: University hospital setting. PARTICIPANTS: Seventy-two patients undergoing OAR and 17 patients undergoing EAR were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Physiologic parameters were extracted every 15 seconds from computerized anesthesia records. Median values were calculated for every 2-minute epoch, and the absolute value of the fractional change in median (|FCM|) from epoch to epoch was calculated for a maximum of 5 hours during the intraoperative period. The incidence of extremes in hemodynamic parameters was compared. Data are presented as median and interquartile ranges. The frequency of |FCM| greater than 0.06 for mean arterial pressure (MAP) was significantly greater in the OAR compared with the EAR group (0.37 [0.30, 0.46] vs 0.14 [0.11, 0.21], p < 0.0001), implying greater stability in MAP during EAR. Similarly, the mean pulmonary artery pressures (MPAPs) were significantly more stable during EAR compared with OAR (frequency of |FCM| > 0.07: EAR, 0.20 [0.16, 0.27] vs OAR, 0.32 [0.26, 0.391; p < 0.01). No intergroup differences were detected in heart rate (HR), systolic (SPAP) or diastolic pulmonary artery pressures (DPAP), or central venous pressures (CVPs). With the exception of a greater incidence of low CVP during EAR, there were no significant differences in the frequency of extremes of hemodynamic values between groups. CONCLUSION: These results show improved hemodynamic stability during EAR compared with OAR.

Aged↗
PubMed1987

Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections. A randomized clinical trial.

The authors report the results of a randomized, prospective study to assess the effectiveness of perioperative antibiotic prophylaxis in preventing postoperative infections following clean neurosurgical operations. The study group comprised 846 patients treated between October, 1979, and June, 1984. Antibiotics, including cefazolin and gentamicin, were administered only in the immediate preoperative and intraoperative periods. Sixteen patients, none of whom developed infections, were excluded from final statistical analysis because they had inadvertently been entered into the study while failing to meet entry criteria. Fifteen wound infections (3.64%) developed in the group of 412 patients who did not receive antibiotics, whereas only four infections (0.96%) were identified among the 418 patients who received antibiotics. The difference is statistically significant (p = 0.008) and represents a 74% reduction in infection rate with antibiotics. An analysis of subgroups of surgical procedures revealed a dramatic decrease in craniotomy infections from 6.77% to 0% (p = 0.003). Of the four infections that occurred among the antibiotic-treated patients, three were in cases where foreign bodies had been implanted. No complications of antibiotic usage were identified. The rates of infection in areas of the body other than the surgical wound were no different in the antibiotic-treated and nontreated groups. All wound infections in both antibiotic-treated and nontreated patients involved similar types of Gram-positive organisms, suggesting that antibiotic prophylaxis did not produce infections with resistant or unusual organisms. This study, combined with other recently published analyses, suggests that routine perioperative antibiotic prophylaxis can significantly reduce the incidence of postoperative neurosurgical infections.

Adult↗
PubMed2001

Tranexamic acid administration after cardiac surgery: a prospective, randomized, double-blind, placebo-controlled study.

BACKGROUND: Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. METHODS: Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg x kg(-1) x h(-1) for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg x kg(-1) x h(-1) for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. RESULTS: No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg x kg(-1) x h(-1) tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. CONCLUSIONS: Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.

Adult↗
PubMed1992

Improvements in hepatocellular carcinoma resection by intraoperative ultrasonography and intermittent hepatic inflow blood occlusion.

From September, 1989, to December, 1990 (late period), intraoperative ultrasonography (IOU) and intermittent hepatic inflow blood occlusion were introduced in hepatectomy. Compared with the early period from January, 1983, to August, 1989, the resectability of hepatocellular carcinoma (HCC) increased from 12.1 to 62.1% (P less than 0.0001). More resections on cirrhotic patients (P less than 0.05) and more combined resections with other organs (P less than 0.005) were carried out. Although the operation time was longer (P less than 0.01), less blood loss during surgery and fewer perioperative blood transfusions (P less than 0.001) were found during the late period. Since the rate at which classical resections were performed has reduced (P less than 0.001), postoperative morbidity has also decreased (P less than 0.05). Although the surgical mortality did not differ between the two periods, most deaths in the early period were caused by postoperative hepatic failure which was not found in the late period. Since IOU can clarify the intrahepatic vasculature and identify impalpable and invisible tumors, more precise resections can now be carried out. Intermittent hepatic inflow occlusion reduces blood loss during surgery without increasing risk. We suggest both techniques should be mandatory in hepatectomy for HCC in order for the safety range of resections to be broadened.

Adolescent↗
PubMed1999

Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs.

The present study used a meta-analysis to examine 4 questions about intraoperative hypothermia. The questions addressed were as follows: (1) Is the difference in adverse patient outcomes between normothermic and mildly hypothermic patient groups significant across studies and within studies? (2) What is the magnitude of the difference in adverse patient outcomes across studies? (3) What are the costs resulting from the difference in adverse patient outcomes? (4) Does a significant difference exist in effectiveness of modality for maintaining intraoperative normothermia? The results of this meta-analytic study provide evidence that the difference in adverse patient outcomes between the normothermic and mildly hypothermic patients is significant across studies for all adverse outcomes examined. The magnitude of this difference and the costs resulting from these adverse outcomes are presented. In addition, a significant difference in effectiveness between warming modalities for maintaining intraoperative normothermia was found. A significant increase in the risk of costly complications occurred when patient temperatures dropped a mean of 1.5 degrees C. For example, patients who become mildly hypothermic are much more likely to receive blood transfusions and to develop infections; both of these outcomes result in increased costs. Minimizing adverse outcomes is critical to cost-effective patient care in today's competitive healthcare environment. The cost of preventing intraoperative hypothermia is much less than the cost of treating the adverse outcomes that affect patients experiencing intraoperative hypothermia. Meta-analytic results allowed us to conclude that hypothermia averaging only 1.5 degrees C less than normal resulted in cumulative adverse outcomes adding between $2,500 and $7,000 per surgical patient to hospitalization costs across a variety of surgical procedures. In conclusion, patients whose temperatures have been maintained at normal levels during the intraoperative period experience fewer adverse outcomes, and their overall hospital costs are lower. Intraoperative normothermia is maintained more effectively with the use of forced air warming.

Cost Savings↗
PubMed1997

Continuous intraoperative noninvasive cardiac output monitoring using a new thoracic bioimpedance device.

OBJECTIVES: To compare a new noninvasive bioimpedance device with the standard thermodilution method during the intraoperative period in high-risk patients undergoing oncological surgery. DESIGN: Prospectively collected data with retrospective analysis. SETTING: The study was undertaken at a university hospital, single institution. PARTICIPANTS: Twenty-three selected adults undergoing extensive, ablative oncological surgery. INTERVENTIONS: Simultaneous measurements of cardiac output by a new bioimpedance method and the standard thermodilution method during the intraoperative and immediate postoperative periods. MEASUREMENTS AND MAIN RESULTS: The correlation coefficient between the two methods was r = 0.89, p < 0.001. Bias and precision analysis between the two techniques showed a mean bias of 0.1 L/min and SD of the bias [precision] of 1.0 L/min [95% level of agreement +2.1 L/min to -1.9 L/min]. After software enhancement, data from the last 11 monitored patients showed improved correlation between the two methods; r = 0.93, mean bias -0.1 L/min, and precision 0.8 L/min. Electrical and motion-induced interference only transiently impaired the performance of the new impedance method. CONCLUSION: This new impedance device is a safe, reliable, clinically acceptable alternative to the invasive thermodilution method in the operating room environment.

Adult↗
PubMed2004

Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors.

BACKGROUND: Patients with a mediastinal mass are at risk for cardiorespiratory complications in the perioperative period. The authors' objectives were to evaluate the incidence of life-threatening intraoperative cardiorespiratory and postoperative respiratory complications in adult patients and to study the usefulness of clinical signs and symptoms, radiologic evaluation, and pulmonary function tests in the determination of the perioperative risk. METHODS: The authors reviewed the investigation and treatment of adult patients presenting with anterior or middle mediastinal masses for surgery under anesthesia between January 1994 and July 2000. RESULTS: Ninety-eight patients underwent 105 anesthetic cases. The incidences of intraoperative cardiorespiratory and postoperative respiratory complications were 4 in 105 and 11 in 105, respectively. No collapse of the airways occurred during anesthesia. However, a high incidence of early postoperative life-threatening respiratory complications was observed (7 in 105). In a multivariate logistic regression analysis model, perioperative complications were predicted by the occurrence of cardiorespiratory signs and symptoms at the initial presentation (odds ratio [OR], 6.2) and the presence of combined obstructive and restrictive patterns (mixed pulmonary syndrome) on pulmonary function tests (OR, 3.9). Intraoperative complications were associated with pericardial effusion on computed tomography scan (OR, 19.8). Postoperative respiratory complications were related to tracheal compression of more than 50% on preoperative computed tomography scan evaluation (OR, 7.4) and mixed pulmonary syndrome on pulmonary function tests (OR, 15.1). CONCLUSION: Obstruction of the airway in an adult with a mediastinal mass is a rare event in the intraoperative period. Nevertheless, caution should be observed for the occurrence of early postoperative life-threatening respiratory complications. Patient at high risk of perioperative complications can be identified by the occurrence of cardiopulmonary signs and symptoms at presentation, combined obstructive and restrictive pattern on pulmonary function tests, and computed tomography scan findings (tracheal compression > 50%, pericardial effusion, or both).

Adult↗
PubMed1990

[Intraoperative diagnosis of the heart and great vessels--echocardiography].

Two-dimensional echocardiography including color Doppler techniques can be used for analysis of the morphology and function and of the blood flow of the heart and the great vessels. Epicardial echocardiography has the advantage of high resolution and multiple scan planes. The restriction to the intraoperative period is a clear disadvantage. In addition, the scan planes are difficult to standardize. Transesophageal echocardiography can be used for monitoring during the whole operative period but is restricted to horizontal and/or longitudinal scan planes. It is a non-contact procedure and thus, sterile conditions are not affected. For evaluation of surgical success, intraoperative echocardiography can be used for analysis in patients with congenital heart disease, mitral valve regurgitation, hypertrophic obstructive cardiomyopathy, and aortic dissection. Acute intraoperative revisions with a second extracorporal circulation period will avoid reoperation. In patients with coronary artery disease the flow within the bypass and also the status of the anastomosis can be scanned and may contribute to reduce the perioperative infarct rate. Intraoperative echocardiography needs additional costs and man power. Only after randomized comparative prospective studies have demonstrated that patients controlled by intraoperative echocardiography have a better outcome and prognosis than patients without intraoperative control this method will become routine in open-heart surgery.

Echocardiography↗
PubMed2004

Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient.

OBJECTIVES: To determine the femoral-to-radial arterial pressure gradient, as well as the factors associated with them, in patients receiving cardiopulmonary bypass (CPB) with profound hypothermia and circulatory arrest. DESIGN: Retrospective automated hemodynamic record review. SETTING: University hospital. PARTICIPANTS: Patients undergoing pulmonary thromboendarterectomy with deep hypothermic circulatory arrest. MEASUREMENTS AND MAIN RESULTS: The automated hemodynamic records of 54 consecutive patients undergoing pulmonary thromboendarterectomy with deep hypothermic circulatory arrest were reviewed, comparing the femoral and radial arterial pressures throughout the intraoperative period. In 20 of the patients, the hemodynamic data from the first 16 postoperative hours were also studied. Forty-one of 54 (76%) of the patients exhibited a mean arterial gradient of at least 10 mmHg either during or after CPB, femoral being higher. Clinically significant gradients were noted throughout the CPB period and the post-CPB period in these patients. In the 54 patients studied, the systolic blood pressure (SBP) gradient was 32 +/- 19 mmHg after CPB (95% confidence limits 28.2 mmHg, 39.0 mmHg), and the mean arterial pressure (MAP) gradient was 6.3 +/- 4.9 mmHg (95% confidence limits 5.5 mmHg, 8.6 mmHg). The duration of clinically significant SBP (>10 mmHg) and MAP (>5 mmHg) gradients in the postoperative period were 5.2 +/- 5.7 hours and 5.8 +/- 7.2 hours, respectively. Advanced age correlated with high post-CPB pressure gradients in this population and was associated with prolonged postoperative resolution of the gradients. CONCLUSIONS: The femoral-to-radial arterial pressure gradients, particularly systolic, after CPB, were greater and of longer duration in these patients undergoing deep hypothermic circulatory arrest than gradients previously reported for routine CPB. Central arterial pressure monitoring is recommended for patients undergoing deep hypothermic circulatory arrest, being valuable both for intraoperative and postoperative care.

Age Factors↗