TY - JOUR
T1 - Inaccuracy of radial artery pressure measurement after cardiac operations
AU - Mohr, R.
AU - Lavee, J.
AU - Goor, D. A.
N1 - Funding Information:
T he characteristic nunifes.t:Jtions of sun bum reactions such as erythema, edema, dermal infiltrate, hyper-pigmentation, and peeling off or scaling of the skin arc more common in persons with fair skin than in those w ith darker skin f11 . It is generall y believed that this is due to the lesser protection afforded by the melanin in the skin of the former, and that this is probably due to the lower concentrations of melanin in their skin I2J. Clinical evidence indicates that in addition to sunburn re:tctions, many cutaneous cancers arc more prevalent :tnd severe among people with red hair and "Celtic type" skin f3]. The generation ofO:? during the irradiation of melanin has been reported earlier lA,::; 1- The comparison of 0 2 generation by cumelanin and pheomelanin during irradiation revealed that the phcomclanm produces larger amounts of 0 2 than does eumelanin 161. This is interesting since rccenr studies show that pheomcbnin, a pigment in red hair, when irradiated produces free radicals which arc capable of inflicting cell injury [7-9·1. On the other hand. cumclanin, a constituent pigm ent of black hair produces considerably less cellular damage [7). These observations suggest that pheomebnin in the skin may Manuscript received July 25, I '.185; accepted For public:1tion September 17, 1985. Supported by No rural Sciences and Engineering l"l.esearch Council. Con ada (A-2846) and Medical l~cscarch Council Canada (MT-5043). _ Reprint requests to: Narcndranath S. R.anad1vc, Ph. D., Department ot Pathology, University of Toronto. Medical Sciences Ouilding, I King's College Circle, Toronto. Ont:u·io, Canado MSS I AS. A bbrcviations: BHM: black hair melanin EAC: Ehrlich ascites carcinoma ESH: electron spin resononce M PO: 111 yclopcroxidosc RHM: red hair melanin RHMP: red hair mclonoprotein SOD: supcroxidc dismutase
PY - 1987
Y1 - 1987
N2 - The phenomenon of a pressure gradient between central and radial arteries was evaluated in 48 patients immediately after coronary artery bypass operations. All were in stable hemodynamic condition, none receiving catecholamine support. In eight patients (Group A) mean femoral pressure was significantly higher than mean radial pressure (range 10 to 30 mm Hg). In the remaining 40 (Group B) radial and femoral pressures were equal. Mean cardiac index (thermodilution) was 3.3 ± 0.68 versus 2.1 ± 0.4 L/min/m2, systemic vascular resistance 1,181 ± 218.4 versus 2,049 ± 501 dynes/sec/cm-5, toe temperature 23.8° ± 1.2° C versus 24.02° ± 0.9° C, core temperature 33.9° ± 0.5° C versus 34.1° ± 0.6° C, mixed venous oxygen saturation 78% ± 3% versus 62% ± 5%, and peak radial dP/dt 1,485 ± 366 versus 2,028 ± 392 in Groups A and B, respectively. These data indicate, first, that the low radial pressures measured in Group A patients did not represent the true aortic pressures; that is, they were false. Second, these low pressures had nothing to do with compromised cardiac function; rather, they were due to peripheral constriction and volume factors and also probably to proximal shunting. It is therefore recommended that while the chest is still open, if a discrepancy exists between a low radial artery pressure, a high palpable aortic pressure, and a satisfactory cardiac contraction, a femoral cannula for pressure measurement should be inserted. Treatment is by blood infusion until the femoral-radial gradient has been abolished.
AB - The phenomenon of a pressure gradient between central and radial arteries was evaluated in 48 patients immediately after coronary artery bypass operations. All were in stable hemodynamic condition, none receiving catecholamine support. In eight patients (Group A) mean femoral pressure was significantly higher than mean radial pressure (range 10 to 30 mm Hg). In the remaining 40 (Group B) radial and femoral pressures were equal. Mean cardiac index (thermodilution) was 3.3 ± 0.68 versus 2.1 ± 0.4 L/min/m2, systemic vascular resistance 1,181 ± 218.4 versus 2,049 ± 501 dynes/sec/cm-5, toe temperature 23.8° ± 1.2° C versus 24.02° ± 0.9° C, core temperature 33.9° ± 0.5° C versus 34.1° ± 0.6° C, mixed venous oxygen saturation 78% ± 3% versus 62% ± 5%, and peak radial dP/dt 1,485 ± 366 versus 2,028 ± 392 in Groups A and B, respectively. These data indicate, first, that the low radial pressures measured in Group A patients did not represent the true aortic pressures; that is, they were false. Second, these low pressures had nothing to do with compromised cardiac function; rather, they were due to peripheral constriction and volume factors and also probably to proximal shunting. It is therefore recommended that while the chest is still open, if a discrepancy exists between a low radial artery pressure, a high palpable aortic pressure, and a satisfactory cardiac contraction, a femoral cannula for pressure measurement should be inserted. Treatment is by blood infusion until the femoral-radial gradient has been abolished.
UR - http://www.scopus.com/inward/record.url?scp=0023179364&partnerID=8YFLogxK
U2 - 10.1016/s0022-5223(19)36295-6
DO - 10.1016/s0022-5223(19)36295-6
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AN - SCOPUS:0023179364
SN - 0022-5223
VL - 94
SP - 286
EP - 290
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -