Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Randomized Controlled TrialOutcomes and Biochemical Parameters Following Cardiac Surgery: Effects of Transfusion of Residual Blood Using Centrifugation and Multiple-Pass Hemoconcentration.
To determine whether or not there was a significant difference between the methods of centrifugation (CF) and multiple-pass hemoconcentration (MPH) of the residual cardiopulmonary-bypass volume in relation to biochemical measurements and patient outcomes. ⋯ Although the CF method provided a product in a shorter turnaround time, with consistent clearance of heparin, the MPH method trended towards enhanced biochemical and clinical patient outcomes over the 12-hour postoperative period.
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The object of this study was to conduct and analyze the output of a survey involving a cohort of all Italian hospitals performing thoracic surgery to gather data on anesthetic management, one-lung ventilation (OLV) management, and post-thoracotomy pain relief in thoracic anesthesia. ⋯ The results of this survey showed that Italian anesthesiologist follow the recommended standard of care for anesthetic management during OLV.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Methylene Blue is Associated with Poor Outcomes in Vasoplegic Shock.
The purpose of this study was to investigate whether patients who received methylene blue as treatment for vasoplegia during cardiac surgery with cardiopulmonary bypass had decreased morbidity and mortality. ⋯ The current study identified the use of methylene blue as treatment for vasoplegia to be independently associated with poor outcomes. While further studies are required, a thorough risk-benefit analysis should be applied before using methylene blue and, perhaps, it should be relegated to rescue use and not as first-line therapy.
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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
Accuracy of Noninvasive Estimated Continuous Cardiac Output (esCCO) Compared to Thermodilution Cardiac Output: A Pilot Study in Cardiac Patients.
To compare the noninvasive estimated continuous cardiac output (esCCO), device-derived cardiac output (CO) to simultaneous pulmonary artery catheter (PAC) thermodilution (TD) CO. ⋯ esCCO is easy to use and provides continuous CO measurements, but has wide limits of agreement and large percentage errors with a consistently positive bias in comparison to TD.