Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Pro: intraoperative transesophageal echocardiography is a cost-effective strategy for cardiac surgical procedures.
TEE is an expensive but useful intraoperative diagnostic strategy for cardiac surgical procedures. It can alter surgical management with tremendous potential benefits to the patient. It also has the potential to avoid unnecessary surgery and reduce the risk of complications such as reoperation, thromboembolism, and stroke. ⋯ Based on the information presented in this report, it can be concluded that TEE is a cost-effective strategy for valvular and congenital heart repairs. Current data are very convincing that TEE has the potential to be cost-effective in reducing the risk of stroke in selected populations of cardiac surgical patients. As experience with the use of TEE in its various applications increases and the technology itself continues to improve, it will undoubtedly become a more valuable and cost-effective strategy for cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of lumbar and thoracic epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair.
To determine whether there is an advantage of thoracic over lumbar epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair. ⋯ There is no advantage of thoracic over lumbar epidural analgesia using morphine in patients undergoing abdominal aortic aneurysm repair.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
ReviewAnesthesia information-management systems: their role in risk-versus cost assessment and outcomes research.
Computerized clinical information systems clearly have a role in this era of managed care when outcomes research and cost/benefit analyses are becoming crucial. Despite anesthesiologists' leadership in developing physician-entry systems, automated recordkeeping systems have been underused. This report reviews the problems and possible solutions associated with establishing more effective and user-friendly systems in the anesthesia specialty. ⋯ To filter the vast amount of data collected by electronic medical-records systems in the ordinary course of care that are not applicable to a specific study, some form of filtering or data reduction on transfer to research or administrative databases will be needed. To allow careful analysis of possible correlations of outcome to care choices requires both the capture of the clinical context-a detailed description of all relevant conditions extending well beyond merely the objective vital signs-throughout a specific medical episode and the establishment of postoperative evaluation systems to allow outcomes capture. Connections to new as well as existing outcome data will provide vast new opportunities for outcomes research.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Evaluation of an approach to choosing a left double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter.
Evaluation of an approach to choosing left double-lumen tube size based on chest computed tomographic (CT) scan measurement of left bronchial diameter. ⋯ Chest CT scan measurement of left bronchial diameter can successfully guide the choice of left double-lumen tube size for an individual patient. In individuals with a small left bronchus measuring less than 10.0 mm in diameter, currently available adult double-lumen tube sizes will tightly wedge in their bronchus.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
ReviewCardiopulmonary bypass and the inflammatory response: a role for serine protease inhibitors?
Cardiopulmonary bypass has been shown to activate various inflammatory cascades in the body, resulting in pathophysiological changes that may affect patient outcome after cardiac surgery. Many of these inflammatory cascades are enzyme mediated, involving serine proteases. ⋯ Experimental data are reviewed on the action of aprotinin in inhibiting the intrinsic coagulation system and in limiting the contact activation of blood platelets and leukocytes. Also reviewed is the role of aprotinin in impacting the incidence of perioperative myocardial ischemia and the central nervous system dysfunction and stroke that are not infrequent complications of surgery with cardiopulmonary bypass.