[HSF] Any One Had This Complication?

[smschwartz at mac.com]

Valsartan (ARB). 
We try to use vasopress in doses below 0.1 mcg/kg/min. We also measure cerebral O2 sats with the Somanetics monitor. How do you handle a vasodilated patient, refractory to neosynephrine and vasopressin?  

SMSMD

-----Original Message-----

From:  Prasanna Simha M <prasannasimha at gmail.com>
Subj:  Re: [HSF] Any One Had This Complication?
Date:  Sun Apr 27, 2008 7:03 pm
Size:  3K
To:  OpenHeart-L at lists.hsforum.com

Steve, Vasopressin can cause this.In fact it was the suspected culprit in
one of the cases.
What is Diovan ?
Prasanna

On Mon, Apr 28, 2008 at 4:41 AM, Steven Schwartz <smschwartz at mac.com> wrote:

> Hal,
> Very interesting timing. I did an aortic root replacement (27mm SJM with
> valsalva graft), coronary reimplantation and RIMA-RCA for 80% proximal RCA
> stenosis in a 65 yo man WITHOUT history of significant vascular disease (and
> good distal pulses on exam). He had two bloody stools the evening after
> surgery, but only a mild metabolic acidosis. The following morning,
> hemodynamics were stable, but CK was about 5000, with very little MB
> fraction. GI medicine has seen him, his abdomen in non-tender, and he seems
> to be resolving what we think was a transient bowel ischemia. Pump flows
> were >5 l/m, he had no acidosis during the pump run, but was significantly
> vasodilated during and after bypass (requiring vasopressin infusion to keep
> his BP > 50 mmHg). He was on 320mg of Diovan in addition to beta blockers
> preop.
> Any thoughts?
> Steven Schwartz
>
>
> On Apr 27, 2008, at 5:49 AM, Hgrmd at aol.com wrote:
>
>  Dear Members,
> >  Last Friday was a tough day at the office.  First I did a  mitral,
> > tricuspid, Cox-maze, CABG x1 on a 72 yo lady.  I then did an AVR,  MVR
> > (heavily
> > calcified posterior annulus), tricuspid, CABG x 4, Cox-maze on a 78  yo
> > man.  His
> > past history was notable for the fact that he had an  aorto-enteric
> > fistula
> > (previous AAA repair) requiring excision of the graft and  a right
> > axillary-bifemoral bypass.  Intraop, I noticed that the LIMA had
> >  unusually brisk flow.
> > About 4 hours postop, he had a bright red  stool.  NG aspirate
> > nonbloody.  By
> > yesterday afternoon, he had begun  to develop abdominal tenderness.  He
> > had a lap
> > in the early evening.   There was a dead colon requiring resection.  The
> > small
> > bowel reportedly  looked ischemic, but viable.  He's much better this
> > morning, though he's  now developed ATN.  His heart is working great.
> >  It'll be a
> > struggle,  but I'm cautiously optimistic he'll make it.  Anybody seen
> > this
> > scenario?
> >
> > Hal
> >
> >
> >
> > **************Need a new ride? Check out the largest site for U.S. used
> > car
> > listings at AOL Autos.
> > (http://autos.aol.com/used?NCID=aolcmp00300000002851)
> > _______________________________________________
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>
> Steven M. Schwartz, MD
> smschwartz at mac.com
>
>
>
>
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Prasanna Simha M
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