Alan J. Spotnitz

Hemorrhage related reexploration following open heart surgery: the impact of pre-operative and post-operative coagulation testing.

PURPOSEnOur objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery.nnnMETHODSnRetrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures.nnnRESULTSnEighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients (P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients (P<0.05).nnnCONCLUSIONSnPre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.

Effects of Intravenous Famotidine on Gastric Acid Secretion in Patients Undergoing Cardiac Surgery

Objective: To determine the effects of cardiopulmonary bypass and famotidine on gastric acid secretion in adults undergoing cardiac surgery. Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: University teaching hospital. Participants: Eighteen patients undergoing elective cardiac surgery with cardiopulmonary bypass. Main Outcome Measures: Famotidine 20 mg or NaCl 0.9% placebo was administered intravenously following induction of anesthesia and placement of a nasogastric pH probe. A second dose was given 12 hours after surgery in the intensive care unit. Gastric pH was measured continuously and gastric volume was measured every 4 hours for up to 24 hours after cardiopulmonary bypass. Results: Following famotidine administration, pH increased by 43% within 45 minutes and remained above 5.5 throughout the study period (p < 0.05 vs placebo and baseline). The gastric pH did not increase, but remained above 4.0 in most patients in the placebo group for up to 12 hours after cardiopulmonary bypass. Gastric volumes were on average 24% lower in the famotidine group (p > 0.05). Conclusions: Gastric acid secretion is decreased during and for 12 hours after cardiopulmonary bypass. Perioperative administration of famotidine suppresses gastric secretion in cardiac surgery patients.

Bilateral adrenal hemorrhage after an open heart operation

Bilateral adrenal hemorrhage and acute adrenal insufficiency were diagnosed after coronary bypass grafting in a 65-year-old man. The symptoms were nonspecific and easily mistaken for other postoperative complications. Diagnosis was based on finding of adrenal hemorrhage on computed tomogram and confirmed biochemically with an adrenal stimulation test. Corticosteroid therapy was curative.

Electrically Driven Implantable Prostheses

The electrochemical and electrical nature of muscular and biological reactions has been known for centuries. The work of Galvani in the eighteenth century in his famous frog leg experiment as a Professor of Anatomy at Padua University, led to Volta’s experiments and epochal discovery of the production of electricity by electrochemical reactions. Galvani also observed what is now known as “injury potential,” the voltage difference between an injured area and the surrounding tissue. The existence of dc or time-varying electrical activity with the majority of physical and chemical processes in living organisms has also been well established. More recently, the electrophysiological aspects of living tissue were investigated by Drs. Yasuda and Fukada.(1)

Hemodynamic Effects of Intravenous Famotidine in Patients Undergoing Cardiac Surgery

Study Objective. To determine the hemodynamic effects of famotidine in patients undergoing cardiac surgery.

Famotidine Pharmacokinetics in Patients Undergoing Cardiac Surgery

SummaryIn order to study the pharmacokinetics of famotidine in cardiac surgery patients, we administered famotidine 20mg by intravenous injection at the beginning of surgery and 12 hours after surgery in 8 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Total body clearance, volume of distribution, and elimination half-life were calculated using noncompartmental analysis and compared with published normal parameters (control) using a 2-tailed, 1-sample t-test. Intra- and postoperative clearances were 2.93 ± 1.06 and 3.18 ± 1.06 ml/min/kg, respectively, which were more than 50% less than the control value (6.07 ml/min/kg; p<0.0005). The volume of distribution (1.0 L/kg) was unaltered during the study and did not differ from the control value (1.19 L/kg; p>0.08). Intra- and postoperative half-lives were 4.52 ± 2.21 hours and 4.27 ± 1.58 hours, respectively, which were more than 50% longer than control (2.92 hours; p<0.03). Famotidine pharmacokinetics are significantly altered during cardiac surgery with cardiopulmonary bypass, and these changes persist for up to 24 hours after surgery.

Clinical Experience With the Jahnke‐Barron Heart Support

The Jahnke‐Barron heart support has proven to be a useful adjunct to coronary artery surgery by allowing an easy access to the coronary arteries while maintaining a quiet operating field. Further, the use of this device eliminates the need for a surgical assistant or a heart holder.