Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Impact of Guideline Implementation on Transfusion Practices in a Surgical Intensive Care Unit.
Anemia is a common clinical problem in cardiac surgery patients in the postoperative period and may result in transfusion in up to 90% of this population. There is tremendous variation in transfusion rates by hospital and individual physician. It is unknown if implementation of a clinical practice guideline lowers unnecessary transfusion in hospital practices that already have a restrictive transfusion culture . ⋯ This study suggests that clinical guideline implementation utilizing guideline development, education, and compliance audit/feedback may reduce unnecessary transfusion in cardiac surgery patients. A fully powered prospective trial would be necessary to validate these findings.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
ReviewPerioperative Conduction Disturbances after Transcatheter Aortic Valve Replacement.
Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population. ⋯ The current evidence base has described the incidence, risk factors, and current outcomes of this conduction disturbance in detail. As the practice of TAVR evolves and novel valve prostheses are developed, a focus on minimizing damage to the cardiac conductive system remains paramount. It remains to be seen how the next generation of TAVR prostheses will affect the incidence, risk factors, and clinical outcomes of associated conduction disturbances.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Observational StudyMyofascial Involvement of Supra- and Infraspinatus Muscles Contributes to Ipsilateral Shoulder Pain After Muscle-Sparing Thoracotomy and Video-Assisted Thoracic Surgery.
This study examined the hypothesis that ipsilateral upper extremity elevation for muscle-sparing thoracotomy procedures contributes to the postoperative shoulder pain. ⋯ These results supported the hypothesis that myofascial involvement contributed, to some extent, to shoulder pain after muscle-sparing thoracotomy with ipsilateral upper extremity elevation.