Perfusion
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Reduced use of allogenic blood components is a key issue in cardiac surgery. Several methods to conserve blood have been used; reinfusion of shed mediastinal blood (RSMB) has found widespread acceptance, but the efficacy and safety are still debated. The purpose of this study was to evaluate the effects of RSMB on the use of allogenic blood components and selected complications. ⋯ Patients receiving RSMB were less transfused with allogenic blood and had less postoperative drainage, while the frequency of observed postoperative complications was not different from patients who did not receive RSMB.
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Studies designed to evaluate the association of hyperglycemia and adverse events in pediatric patients receiving open cardiac surgery have yielded inconsistent results. The aim of this retrospective, observational study was to evaluate the effects of peri-operative glucose levels on adverse events in infants receiving open-heart surgery with CPB. ⋯ In contrast to adult critically ill patients, data from the present study did not prove that hyperglycemia was detrimental to infants receiving open-heart surgery with CPB. The existing literature and findings of our present study warranted future clinical studies of strict glycemic control in critically ill children, considering a more permissive glycemic range as a desirable target.
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We report a case of reduced cerebral oxygenation which had the possibility of leading to an adverse outcome if it had not been detected by the routine use of cerebral oximetry. This case study illustrates that an inadvertent re-adjustment of a single-stage venous cannula within the superior vena cava resulted only in the cerebral oximetry device alerting to a potential problem. All other monitoring devices remained within standard operating parameters, with no deviation throughout the duration of the incident.
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Comparative Study
Correlation between cerebral tissue and central venous oxygen saturation during off-pump coronary bypass graft surgery.
We compared simultaneous regional cerebral oxygen saturation and central venous oxygen saturation at different time periods in 20 adult patients (median age, 57.9; range, 35 to 76 years) undergoing off-pump coronary artery bypass (OPCAB) graft surgery (n= 20). Mean arterial pressure (MAP), partial pressure of carbon dioxide (PcvCO(2)), heart rate, haematocrit (Hct), lactate and patient oxygen saturation (SpO(2)) were also recorded as a secondary analysis to determine independent predictors of cerebral desaturation and interactions between predictors. ⋯ Partial pressure of carbon dioxide (PcvCO(2)) was identified as a major predictor of cerebral saturation 0.59 (p < 0.001). Central venous saturation can be used as a surrogate measure of cerebral oxygen saturation during OPCAB surgery.