Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Randomized Controlled Trial Comparative StudyComparison of Effects of Thoracic Epidural and Intravenous Administration of Lidocaine on Target-Controlled Infusion of Propofol and Tracheal Intubation Response During Induction of Anesthesia.
To compare the effects of thoracic epidural anesthesia (TEA) and intravenous (IV) lidocaine on the effect-site concentration (Ce) of propofol target-controlled infusion (TCI) and the intubation-induced stress responses during general IV anesthesia induction. ⋯ Lidocaine administered via both TEA and IV decreased the induction doses of propofol and suppressed cardiovascular and stress responses to tracheal intubation. Administration of 2mg/kg of 2% lidocaine IV was better, with no side effects of lidocaine toxicity.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Case ReportsEffects of Body Surface Area-Indexed Calculations in the Morbidly Obese: A Mathematical Analysis.
Cardiac and stroke indices routinely are used to communicate the adequacy of circulation, especially by cardiac anesthesiologists. However, indexed values may be distorted when derived using conventional formulae on morbidly obese patients. In extreme cases, distortion of the raw value by the indexed value may suggest inappropriate therapeutic interventions. This study attempted to highlight threshold values of body surface area (BSA) that place morbidly obese patients at risk of being overtreated. ⋯ In morbidly obese patients, cardiac and stroke indices can be misleading relative to the underlying raw values (CO and SV) as a result of distortion by widely used BSA formulae. The authors caution against relying on threshold cardiac and stroke indices as triggers for the initiation of hemodynamic therapies in the morbidly obese. Further research on what BSA formula should be used on patients with very extreme body types is warranted.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Comparative Study Observational StudyFloTrac/Vigileo(TM) (Third Generation) and MostCare(®)/PRAM Versus Echocardiography for Cardiac Output Estimation in Vascular Surgery.
To compare the FloTrac/Vigileo(TM) cardiac output (COFT/V) and the MostCare(®)/PRAM cardiac output (COMC/P) versus transthoracic echocardiographic cardiac output estimation (reference method; CO(ECHO)). ⋯ In patients undergoing vascular surgery, the FloTrac/Vigileo(TM) did not demonstrate that it was a reliable system for CO monitoring when compared with echocardiography-derived CO. However, MostCare(®)/PRAM was shown to estimate CO with a good level of agreement with echocardiographic measures.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Perioperative Acute Myocardial Infarction Increases Mortality Following Noncardiac Surgery.
To provide insight into diagnosis, treatment, and prevention of perioperative myocardial infarction (PMI). ⋯ PMI incidence increased significantly with advanced age. PMI increased mortality following non-cardiac surgery. The independent risk factors for death in PMI patients following noncardiac surgery were lack of anticoagulation/antiplatelet therapy and cardiogenic shock.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Comparative Study Observational StudyPrediction of Responsiveness to an Intravenous Fluid Challenge in Patients After Cardiac Surgery with Cardiopulmonary Bypass: A Comparison Between Arterial Pulse Pressure Variation and Digital Plethysmographic Variability Index.
Arterial pulse pressure variation (PPV) and digital plethysmographic variability index (PVI) have been proposed to predict fluid responsiveness during anesthesia and in critically ill patients. The present study aimed to compare the clinical utility of PPV and PVI in predicting fluid responsiveness after elective cardiac surgery. ⋯ PVI is not discriminant and probably inaccurate to predict fluid responsiveness after elective cardiac surgery. PPV could be of potential interest after exclusion of patients with a low perfusion index and right ventricular dysfunction.