Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2010
Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety.
Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. ⋯ The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.
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Interact Cardiovasc Thorac Surg · Jan 2010
Randomized Controlled Trial Comparative StudyPerfusion temperature, thyroid hormones and inflammation during pediatric cardiac surgery.
During cardiopulmonary bypass (CPB) surgery there are several alterations in concentrations of thyroid hormones. Although hypothermia and inflammation have been implicated in the disturbed thyroid axis during CPB, these issues are far from clear. ⋯ Our findings in this randomized trial do not support a role for hypothermia as a major cause of altered thyroxin responses in children undergoing CPB. Our finding may also suggest that in addition to IL-6, other inflammatory cytokines, such as chemokines, should be further investigated for their possible influence on the thyroid axis during CPB.
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Interact Cardiovasc Thorac Surg · Jan 2010
ReviewIn patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients undergoing thoracic surgery is paravertebral block (PVB) as effective as epidural analgesia for pain management? Altogether >184 papers were found using the reported search, seven of which represented the best evidence to answer the clinical question. All studies agreed that PVB is at least as effective as epidural analgesia for pain control post-thoracotomy. ⋯ PVB was found to be of equal efficacy to epidural anaesthesia, but with a favourable side effect profile, and lower complication rate. The reduced rate of complication was most marked for pulmonary complications and is accompanied by quicker return to normal pulmonary function. We conclude intercostal analgesia, in the form of PVB, can be at least as effective as epidural analgesia.
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Interact Cardiovasc Thorac Surg · Jan 2010
Randomized Controlled TrialImpact of clonidine administration on delirium and related respiratory weaning after surgical correction of acute type-A aortic dissection: results of a pilot study.
Delirium and transient neurologic dysfunctions (TND) often complicate the postoperative course after surgery for acute type-A aortic dissection (AAD). We evaluated the role of clonidine on neurological outcome and respiratory function in 30 consecutive patients undergoing surgery for AAD. Patients were prospectively randomized to receive either clonidine (0.5 microg/kg bolus, followed by continuous infusion at 1-2 microg/kg/h) or placebo (NaCl 0.9%) in on starting and throughout the weaning period from the mechanical ventilation. ⋯ Patients weaned with clonidine showed lower f/VT and PFP, higher PaO(2)/FiO(2) and PaCO(2), lower DDS, weaning period and the related ICU length of stay (P<0.001). This was further confirmed in patients developing delirium/TND. Intravenous clonidine after surgery for AAD reduces the severity of delirium, improves the respiratory function, shortens the weaning duration and the ICU length of stay.
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Interact Cardiovasc Thorac Surg · Jan 2010
ReviewDoes a skeletonized or pedicled left internal thoracic artery give the best graft patency?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether skeletonization of the internal thoracic artery (ITA) improves graft patency in coronary artery bypass grafting (CABG). Altogether >60 papers were found using the reported search, of which 17 papers represented the best evidence to answer the clinical question. ⋯ This is an important finding because it justifies further use of skeletonized technique for CABG surgery. It adds also to a growing field of evidence that skeletonized ITA grafts are preferable to pedicled grafts because they may cause less degree of devascularization of the sternum and consequently reduction of sternal wound infection. The evidence presented here demonstrates that in terms of patency, skeletonized and pedicled left internal thoracic arteries provide excellent patency rates.