Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2009
Randomized Controlled TrialThe association between the initial end-tidal carbon dioxide difference and the lowest arterial oxygen tension value obtained during one-lung anesthesia with propofol or sevoflurane.
The purpose of this study was to examine the correlation between the lowest PaO(2) value recorded during the first 45 minutes of one-lung ventilation (OLV) and the end-tidal CO(2) (ETCO(2)) difference between two-lung ventilation (TLV) and the early phase of OLV. ⋯ The present study indicates that the ETCO(2) difference between TLV and early OLV has an association with impaired oxygenation later during OLV. This would be a simple and clinically convenient predictor of the lowest PaO(2) value likely to be reached during one-lung anesthesia with either propofol or sevoflurane.
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J. Cardiothorac. Vasc. Anesth. · Dec 2009
Randomized Controlled TrialEffects of ventilatory mode during one-lung ventilation on intraoperative and postoperative arterial oxygenation in thoracic surgery.
The purpose of this study was to investigate the relationship between the ventilatory mode used during one-lung ventilation (OLV) and intraoperative and early postoperative arterial oxygenation in patients undergoing thoracic surgery. ⋯ In patients undergoing thoracic surgery, the use of PCV compared with VCV during OLV with the same Vt of 8 mL/kg does not affect arterial oxygenation during OLV or early postoperative oxygenation.
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J. Cardiothorac. Vasc. Anesth. · Dec 2009
Airway interventions in the cardiac electrophysiology laboratory: a retrospective review.
To quantify the incidence of airway interventions during cardiac electrophysiology laboratory procedures. ⋯ These results suggest that a significant proportion of the authors' patients undergoing cardiac electrophysiology laboratory procedures required deep sedation if not general anesthesia, although a non-general anesthetic was planned. The issue of depth of sedation has implications for patient safety, privileging, and regulatory compliance. Based on the present results, the authors believe sedation for these procedures is best given by anesthesia providers; furthermore, caregivers should be aware that these procedures are likely to require deep sedation if not general anesthesia.
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J. Cardiothorac. Vasc. Anesth. · Dec 2009
Predictors of prolonged postoperative endotracheal intubation in patients undergoing thoracotomy for lung resection.
The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. ⋯ Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV(1), and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.
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J. Cardiothorac. Vasc. Anesth. · Dec 2009
Meta AnalysisSpinal analgesia in cardiac surgery: a meta-analysis of randomized controlled trials.
Controversial results exist on the effects of spinal analgesia in cardiac surgery. The authors conducted a review of randomized studies to show whether there are any advantages in clinically relevant outcomes using spinal analgesia in patients undergoing cardiac surgery. ⋯ This analysis indicated that spinal analgesia does not improve clinically relevant outcomes in patients undergoing cardiac surgery, discouraging further randomized controlled trials on this topic even if changes in techniques, devices, and drugs could modify the outlook of the comparison between spinal and standard anesthesia in this setting.