Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Clinical TrialAre the point-of-care diagnostics MULTIPLATE and ROTEM valid in the setting of high concentrations of heparin and its reversal with protamine?
To evaluate the in vitro effects of high concentrations of heparin and its reversal with protamine on routine laboratory parameters as well as on modified thromboelastogram (ROTEM; TEM International, Munich, Germany) and impedance aggregometry (MULTIPLATE; Dynabyte, Munich, Germany). ⋯ Neither fibrinogen (Clauss) nor derived fibrinogen or FIBTEM testing is valid in the setting of high concentrations of heparin unless antagonized by heparinase. Reversal of heparin with protamine worsens platelet function at all ratios as detected by aggregometry (MULTIPLATE) and thromboelastography (ROTEM), starting at a 1:1 ratio. Therefore, appropriate coagulation testing under cardiopulmonary bypass conditions should be selected carefully according to heparin levels. In particular, fibrinogen values are falsely low at heparin levels of 2 IU/mL and above. Therefore, newer algorithms promoting the correction of fibrinogen levels on cardiopulmonary bypass should be based on appropriate testing.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
The effect of retrograde autologous priming of the cardiopulmonary bypass circuit on cerebral oxygenation.
The aim of this study was to investigate the effect of retrograde autologous priming (RAP) of the cardiopulmonary bypass (CPB) circuit on cerebral oxygenation. ⋯ The application of RAP to CPB limits the degree of hemodilution and improves cerebral oxygenation during CPB. The present findings suggest a potential benefit of RAP from a neurologic aspect.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Comparative StudyComparison of 5 different remifentanil strategies against myocardial ischemia-reperfusion injury.
The purpose of this study was to investigate the effects of various remifentanil strategies (preconditioning, postconditioning, or continuous infusion) against myocardial ischemia-reperfusion injury. ⋯ Preconditioning or postconditioning by remifentanil and the continuous infusion of remifentanil effectively reduce myocardial infarction, whereas reperfusion targeting ischemic targeting or reperfusion targeting remifentanil does not. Remifentanil preconditioning better preserves myocardial function, especially LVDP, than other remifentanil strategies.