Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
ReviewUse of Intraoperative Hemostatic Checklists for Blood Management in Patients Undergoing Cardiac Surgery: A Scoping Review.
Using intraoperative hemostatic checklists may improve rates of surgical re-exploration and utilization of allogenic blood products in patients undergoing cardiac surgery. In this review, the authors explore the current evidence describing the impact of using intraoperative hemostatic checklists on reducing rates of surgical bleeding and perioperative blood product transfusion in this group of patients. ⋯ These findings suggest that using intraoperative hemostatic checklists may reduce surgical re-exploration rates and improve blood product utilization after cardiac surgery. Large multicenter studies are needed to endorse the utilization of these checklists in routine clinical practice.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Performance of Hemochron ACT-LR and ACT+ Test Cuvettes in Monitoring Low to Moderate Heparin Concentrations: An In Vitro Study.
According to the manufacturer, the Hemochron ACT-LR cuvette is designated for heparin concentrations of 0 to 2.5 IU/mL, while the optimal concentration range for the ACT+ cartridge is 1 to 6 IU/mL. We hypothesized that at low to moderate heparin concentrations, the ACT-LR is more reliable than the ACT+. ⋯ The performance of ACT+ is equal to that of ACT-LR up to a concentration of 0.5 IU/mL, above which ACT+ is superior to ACT-LR, questioning the rationale for a specific low-range test. However, there is a significant bias between ACT-LR and ACT+ measurements that needs to be considered if switching from one test to the other.
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A circular shunt, initially described by Shone et al. in 1962, refers to abnormal blood recirculation through complete intracardiac or intra- and extracardiac communications, bypassing the capillary beds. This pathophysiological condition is most commonly associated with complex congenital heart defects, such as Ebstein's malformation, pulmonary atresia, Gerbode defect, and so on. ⋯ Diagnosis requires a high index of suspicion and careful evaluation, and its management focuses on interrupting or reducing the shunt through surgical repair or transcatheter intervention or, in some cases, medical therapy. Early diagnosis, particularly in prenatal cases, and timely intervention are crucial for improving outcomes in affected neonates.