Controversies in Cardiovascular Anesthesia
Phillip Fyman, Alexander W. Gotta
Springer US, May 31, 1988 - Medical - 192 pages
On 16 October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic effect of diethyl ether in a public demonstration in the "ether dome" of the Bulfinch Building of the Massachusetts General Hospital in Boston. The patient, Gilbert Abbott, suffered no pain, and the surgeon, Dr. John C. Warren, was able to complete a suture ligature of a vas cular tumor of the jaw without the hurry that until then was so necessary. The operation proved a failure, since the tumor recurred; but the demonstration of ether's anesthetic effect was a great success. Operative pain was conquered, and surgery could advance from a crude and unscientific practice where speed was paramount, and the major body cavities could not be entered, into the unique blend of science and art that it is now. "Gentlemen, this is no hum bug," supposedly muttered Warren, perhaps the last noncontroversial assess ment of anesthesiology to be made by a surgeon. The screams of resisting patients in pain were stilled, and quiet entered the operating room for the first time. But the new science of pain relief was quickly wrapped in controversy. An argument immediately arose as to who could legitimately claim primacy for the discovery. Morton's attempt to hide the true nature of his anesthetic agent, coupled with an effort to patent the discovery, clouded his reputation and stimulated other claimants to push themselves forward.
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Blood gases should not be temperature corrected during hypothermia
High pump flows and pressure are desirable during cardiopulmonary
Low pressure during cardiopulmonary bypass is preferable
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50 mmHg acid-base acidosis agents Anesth Analg Anesthesiology autoregulation blood pH blood pressure body temperature brain buffer CABG CABG surgery cardiac output cardiac surgery cardiopulmonary bypass cardiovascular carotid artery carotid endarterectomy catheter catheterization cerebral blood flow cerebral ischemia changes clamping clinical complications constant coronary artery bypass coronary artery disease coronary artery surgery correlation decrease dysfunction ectotherms effects enflurane factors fentanyl halothane heart hemodynamic hibernation hypertension hypotension hypothermia hypothermic increase induced intracellular intraoperative ischemic isoflurane left ventricular levels maintained mean arterial pressure metabolic mmHg monitoring myocardial infarction myocardial ischemia myocardial oxygen narcotic neurologic deficits normal oxygen oxygen consumption Paco2 patients undergoing PCWP perfusion pressure perioperative pH and Pco2 Physiol plasma postoperative preoperative protein pulmonary artery reduced regional anesthesia renal response result shunt significant stenosis stroke stump pressure sufentanil surgical therapy Thorac Cardiovasc Surg tissue uncorrected values vascular resistance venous ventricular function volatile anesthetics