Fernando N A, Keenan R L, Boyan C P
J Thorac Cardiovasc Surg. 1978 Apr;75(4):531-5.
The anesthetic management of 17 patients undergoing cardiac transplantation is described. Recipients had severe biventricular failure and pulmonary hypertension. Careful administration of diazepam and morphine was the preferred induction method, and pancuronium was the favored relaxant for both intubation and maintenance. Sterile technique was used in placing endotracheal tubes. Relatively small doses of morphine and diazepam, combined with 50 percent nitrous oxide, were satisfactory for the maintenance of anesthesia. Postperfusion problems were few but included poor tolerance of hypovolemia and an exaggerated hypotensive response to protamine. Isoproterenol was required to support ventricular performance, but no other cardiac stimulants were needed. Postoperative courses were uneventful. There were no operative deaths and no recall of awareness during the operation with the described method of "light" anesthesia.
本文描述了17例接受心脏移植患者的麻醉管理情况。受体均有严重的双心室衰竭和肺动脉高压。谨慎给予地西泮和吗啡是首选的诱导方法，泮库溴铵是插管和维持阶段较常用的肌松药。放置气管导管时采用无菌技术。相对小剂量的吗啡和地西泮，联合50%氧化亚氮，对于维持麻醉效果良好。灌注后问题较少，但包括对血容量减少耐受性差以及对鱼精蛋白过度的低血压反应。需要异丙肾上腺素来支持心室功能，但无需其他心脏兴奋剂。术后病程平稳。采用所述“浅”麻醉方法，手术期间无手术死亡，也无术中知晓情况。
