Faculty Bibliography

Introduction : Rapid infusion devices are becoming increasingly popular for the administration of warm fluids and blood in hypovolemic patients. A recently developed system, Thermacor 1200 (Smisson-Cartledge Biomedical LLC, Macon, GA), consists of a central device to which a disposable cartridge of fluid lines attaches. Performance characteristics of this device have yet to be evaluated. We compared the Thermacor 1200 with a currently utilized infusion device, FMS 2000 (Belmont Instrument Corp., Billerica, MA), to evaluate maximum flow rates, accuracy of actual versus set flow rates, fluid warming capabilities, and air bubble elimination. Methods : A ThermaCor 1200 and an FMS 2000, owned by our institution, were evaluated in vitro after being tested for proper functioning. FMS 2000 was tested with the packaged 4.5ft patient line, and Thermacor 1200 with packaged 3ft (TC3) and 6ft (TC6) patient lines. Maximum flow rates of lactated Ringer's (LR) and expired packed red blood cells (PRBCs) were measured with 22, 20, 18, 16, 14 and 8.5F gauge catheters, using a graduated cylinder and stopwatch. Flow rate accuracy was determined by comparing the actual versus displayed flow rates, for LR and PRBCs. Temperature was measured, at various flow rates, with an electronic probe (Wavetek 23XT, San Diego, CA) positioned 3cm from the distal port of the outflow tubing, for LR and PRBCs. Air elimination capability was determined, for LR only, by infusing fluid into an inverted 20mL syringe submerged in a bucket of water, and measuring the resulting air trapped in the syringe. All measurements were repeated six times. Data were analyzed using one-factor ANOVA, and the Tukey multiple comparisons method. Statistical significance was defined as p<0.05. Results : Maximum flow rates were higher with TC3 and TC6 than with FMS 2000 in most instances, especially when using larger catheter bores (Table 1). Flow rates were more accurate with TC3 and TC6 than with FMS 2000 for LR (1.4, 1.6, and 3.5% variance from target rate, respectively; p<.001) and for PRBCs (2.1, 2.6, and 5.9% variance from target rate, respectively; p<.001). Temperatures of delivered fluid were higher with TC3 and TC6 as compared to the FMS 2000 for LR (38.0, 37.8, and 36.8degreeC. respectively; p<.001) and PRBCs (38.2, 38.1, and 37.2degreeC, respectively; p<.001). Air was not detected in fluid infused from either device. Discussion : In this experiment, the performance of the Thermacor 1200, at both lengths of patient line, was superior to that of the FMS 2000 in that it infused LR and PRBCs at higher and more accurate flow rates, at higher temperatures. (Table presented)

The beta-adrenergic receptor blocking drugs are commonly used in the treatment of patients with idiopathic hypertropic subaortic stenosis (IHSS). These drugs, however, are contraindicated in patients with chronic obstructive pulmonary disease (COPD). We report the anesthetic management of a patient with IHSS complicated by severe COPD. We concluded that the beta(1) selective, ultra-short acting beta-blocker, esmolol, can be used intraoperatively when both conditions are present. The pathophysiology and the commonly used anesthetic drugs and practices for treatment of patients with IHSS are reviewed

It is fortunate that serious embolic phenomena are uncommon because, with the exception of neurosurgery in the sitting position and cardiac surgery, thoracic echocardiography and the precordial Doppler device, the most sensitive indicators of embolism, are seldom used. Vigilance is required of the anesthesiologist to recognize the rapid fall in end-tidal PCO2, the usual first indicator of a clinically significant PE. Any sudden deterioration in the patient's vital signs should include embolism in the differential diagnosis, particularly during procedures that carry a high risk of the complication