Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Randomized Controlled Trial Comparative StudyHuman atrial natriuretic peptide prevents the increase in pulmonary artery pressure associated with aortic unclamping during abdominal aortic aneurysmectomy.
To assess the effect of human atrial natriuretic peptide (HANP) on the pulmonary and systemic circulations during infrarenal abdominal aortic aneurysmectomy. ⋯ HANP, infused during aortic clamping and abdominal aortic aneurysmectomy, attenuates the rises in pulmonary artery pressure and vascular resistance without severe systemic hypotension. This may result from direct and/or indirect pulmonary vascular effects of HANP because no HANP-induced changes in endothelin-1, angiotensin-II, and thromboxane B(2) were detected.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative Study Clinical TrialAssessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter.
To verify the reliability of different markers of fluid-responsiveness during off-pump cardiac surgery (OPCAB). ⋯ Dynamic parameters of fluid responsiveness by LiDCO are highly sensitive for assessment of intravascular volume status during OPCAB surgery. In contrast, even if static parameters by TEE reflect changes in ventricular diastolic volume, they are poor indicators of fluid responsiveness. Surprisingly, no significant correlation between DeltaVAo (TEE) and DeltaCI% was found.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative StudyChronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery.
Chronic angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) therapy has been reported to result in intraoperative hypotension in patients undergoing general anesthesia. This study evaluated the association between ACE-I/ARB therapy and the hemodynamics of patients undergoing noncardiac surgery using a large patient dataset. ⋯ Chronic diuretic therapy is associated with more frequent hypotension in ACE-I/ARB-treated patients undergoing noncardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative StudyThe accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery.
The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables. ⋯ The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative StudyPerioperative statin therapy and renal outcomes after major vascular surgery: a propensity-based analysis.
To evaluate how the presence and timing of statin therapy affect perioperative renal outcomes after major vascular surgery. ⋯ In the present investigation, neither the presence nor timing of perioperative statin therapy was associated with improved renal outcomes in patients undergoing a range of major vascular procedures. A possible exception is early postoperative reinitiation of statin therapy in chronic statin users. The discrepant results of available literature preclude a definitive statement on the use of statin therapy as a means of preventing postoperative renal dysfunction. An adequately powered prospective trial is needed before advocating the routine use of statin therapy for perioperative renal protection.