Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2008
Randomized Controlled TrialA randomized trial evaluating different modalities of levosimendan administration in cardiac surgery patients with myocardial dysfunction.
To evaluate the effects of 2 different administration modalities of levosimendan (start before cardiopulmonary bypass [CPB] and at the end of CPB) compared with a standard treatment with milrinone started at the end of CPB in cardiac surgery patients with a preoperative ejection fraction <30%. ⋯ In the conditions of the present study, starting the levosimendan treatment before CPB was associated with a higher initial postoperative stroke volume and a lower incidence of postoperative atrial fibrillation, but had no effect on the extent of postoperative troponin I release.
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J. Cardiothorac. Vasc. Anesth. · Oct 2008
Perioperative coagulation management and blood conservation in cardiac surgery: a Canadian Survey.
To determine which strategies are currently used for (anti)coagulation management and blood conservation during cardiac surgery in Canada. ⋯ The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period.
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J. Cardiothorac. Vasc. Anesth. · Oct 2008
Monitoring recombinant factor VIIa treatment: efficacy depends on high levels of fibrinogen in a model of severe dilutional coagulopathy.
Recombinant activated factor VII (rFVIIa) is increasingly being given to treat massive bleeding. However, there is no clear guidance on which patients are suitable for treatment and how the effects of treatment should be monitored. The aim of this in vitro study was to assess the coagulation status of severely hemodiluted blood samples before and after treatment with therapeutic doses of rFVIIa and/or fibrinogen with 2 viscoelastic point-of-care coagulation analyzers: ROTEM (Pentapharm GmbH, Munich, Germany) and Sonoclot (Sienco Inc, Arvada, CO). ⋯ ROTEM and Sonoclot were able to monitor the effects of rFVIIa and fibrinogen administration with 1:1,000 diluted tissue factor-activated tests. The efficacy of rFVIIa was largely dependent on the presence of high levels of fibrinogen in reversing this severe dilutional coagulopathy.
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J. Cardiothorac. Vasc. Anesth. · Oct 2008
Randomized Controlled TrialLevosimendan in aortic valve surgery: cardiac performance and recovery.
The aim of the present study was to test the hypothesis that levosimendan has beneficial effects on cardiac performance and that the need for other vasoactive medications during and after cardiac surgery would be reduced by levosimendan in patients with severe aortic stenosis (AS) and left ventricular (LV) hypertrophy. ⋯ Low output is a result of myocardial stunning and is common after cardiopulmonary bypass. According to the present results, levosimendan may be useful in patients with severe AS and LV hypertrophy because it may prevent LV function from dropping to a critically low level postoperatively. Levosimendan causes vasodilation and thereby decreases mean arterial pressure, but this can be controlled with the use of norepinephrine.
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J. Cardiothorac. Vasc. Anesth. · Oct 2008
The effects of vasodilation on cardiac output measured by PiCCO.
The purpose of this study was to investigate the effects of vasodilation on cardiac output (CO) measured by pulse contour method using PiCCO (Pulsion Medical Systems AG, Munich, Germany) in comparison with CO by the thermodilution method. ⋯ PiCCO may not be an alternative to thermodilution measurement without recalibration when SVR decreases by infusion of PGE1 > or = 0.02 microg/kg/min.