The Annals of thoracic surgery
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Comparative Study
Routine immediate extubation for off-pump coronary artery bypass grafting without thoracic epidural analgesia.
The expansion of coronary surgery on the beating heart without cardiopulmonary bypass has led to increasing interest in ultra-fast track anesthesia, allowing extubation of the patient in the operating theater. The techniques described to date combined general anesthesia with thoracic epidural analgesia. We report the routine application of a technique that allows immediate extubation in the majority of patients undergoing off-pump coronary artery bypass grafting without thoracic epidural analgesia. ⋯ Immediate extubation is possible in most patients after off-pump coronary artery bypass grafting even without thoracic epidural analgesia. We believe this type of less invasive cardiac anesthesia is safe and promising.
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Surgeons are increasingly faced with patients suffering from complicated pathology in multiple organ systems, to which multiple therapeutic agents with complex adverse effects are often prescribed. We face a daily challenge in maintaining an up-to-date knowledge of these complications. ⋯ This is a rare but serious complication of heparin therapy, not usually reported in the context of a cardiac surgical patient. We will also discuss the renal physiology leading to hyperkalemia and the options available for its management.
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Comparative Study
Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery.
Postoperative paraplegia is one of the most dreaded complications after descending thoracic and thoracoabdominal aneurysm surgery. In this study, intraoperative monitoring was applied during resection of descending thoracic and thoracoabdominal aneurysms to detect spinal cord ischemia and help prevent paraplegia. ⋯ The results demonstrate that compared with SSEP, MEP, especially myogenic MEP, is more sensitive and specific in detection of spinal cord ischemia, and that intraoperative monitoring can indeed help prevent paraplegia.