Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Randomized Controlled Trial Comparative StudyHigh-frequency jet ventilation as an alternative method compared to conventional one-lung ventilation using double-lumen tubes during minimally invasive coronary artery bypass graft surgery.
To optimize the conditions for the surgeon during minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB) procedures, one-lung ventilation (OLV) is required using double-lumen tubes (DLT). This prospective study was designed to compare high-frequency jet ventilation (HFJV) of both lungs with the conventional method of OLV via DLT. ⋯ HFJV in MIDCAB or TECAB procedures appears to be a feasible alternative to OLV using a DLT, although study in a larger population is required.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comparative StudyAsleep-awake-asleep technique during carotid endarterectomy: a case series.
Carotid endarterectomy (CEA) has become one of the most common vascular procedures in the world. It can be performed both under general anesthesia (GA) and regional anesthesia (RA). The aim of this study was to present results of a technique for CEA in which the patients anesthetized with target-controlled infusions of propofol and remifentanil were awake during the endarterectomy phase. Neurologic function was evaluated as if under RA. Patient satisfaction and the incidence of major complications also were investigated. ⋯ Although this is a case series, the authors believe that this technique combines the advantages of RA (good evaluation of the patients' neurologic status) and GA (patients relaxed and comfortable). Moreover, the analysis of the results of the questionnaire suggests that the patients can tolerate the operation awake under propofol and remifentanil, and major complications also were low. It can be concluded that this technique appears to be safe and well accepted by patients and could be a good alternative in patients in whom RA cannot be performed.
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In this review, the authors discussed criteria for diagnosing ALI; incidence, etiology, preoperative risk factors, intraoperative management, risk-reduction strategies, treatment, and prognosis. The anesthesiologist needs to maintain an index of suspicion for ALI in the perioperative period of thoracic surgery, particularly after lung resection on the right side. Acute hypoxemia, imaging analysis for diffuse infiltrates, and detecting a noncardiogenic origin for pulmonary edema are important hallmarks of acute lung injury. ⋯ NO is not recommended as a treatment. Strategies such as bronchodilation, smoking cessation, steroids, and recruitment maneuvers are unproven to benefit mortality although symptomatically they often have been shown to help ALI patients. Further studies to isolate biomarkers active in the acute setting of lung injury and pharmacologic agents to inhibit inflammatory intermediates may help improve management of this complex disease.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comparative StudyComparison of spectral entropy and bispectral index electroencephalography in coronary artery bypass graft surgery.
The study's aim was to compare response entropy (RE) and state entropy (SE) with bispectral index (BIS) electroencephalography (EEG) as an alternative cerebral monitoring tool in patients scheduled for coronary artery bypass graft surgery. ⋯ RE and SE are comparable with the BIS but showed significantly less interference from f-EMG and superior resistance against artifacts. Thus, spectral entropy is more suitable than the BIS during propofol-remifentanil anesthesia in cardiac surgery patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comparative StudyPreoperative dispositional optimism correlates with a reduced incidence of postoperative delirium and recovery of postoperative cognitive function in cardiac surgical patients.
To determine if preoperative psychosocial factors including dispositional optimism, perceived social support, and perceived stress correlate with the recovery of postoperative cognition. ⋯ Preoperative dispositional optimism, but not perceived social support, perceived stress, and depression positively correlated with a reduced incidence of postoperative delirium within 5 days and recovery of cognitive performance 1 week after cardiac surgery.