Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewAwake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts.
Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. ⋯ Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Cerebral Oximetry Index-Guided Blood Pressure Management During Cardiopulmonary Bypass Reduces Postoperative Delirium in Patients with Acute Type A Aortic Dissection.
To investigate whether cerebral oximetry index (COx)-guided blood pressure management during cardiopulmonary bypass (CPB) could reduce postoperative delirium (POD) in patients undergoing acute type A aortic dissection (ATAAD) repair. ⋯ COx-guided blood pressure management during CPB was associated with reduced incidence and severity of POD following ATAAD surgery. This approach also showed potential benefits in reducing postoperative complications and improving early recovery outcomes. Further multicenter studies are needed to confirm these findings.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewAdvances in Anesthesia Techniques for Postoperative Pain Management in Minimally Invasive Cardiac Surgery: An Expert Opinion.
Minimally invasive cardiac surgery (MICS) often leads to severe postoperative pain. At present, multimodal analgesia schemes for MICS have attracted much attention, and the application of various chest wall analgesia techniques is becoming increasingly widespread. ⋯ This article provides an overview of the anatomy and procedures involved in these analgesic techniques, their mechanisms of action, and the latest clinical trial evidence. It also evaluates their progress in MICS, compares their advantages and disadvantages, and discusses practical challenges.