Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Randomized Controlled TrialEffect of Increasing Heart Rate and Tidal Volume on Stroke Volume Variability in Vascular Surgery Patients.
Because heart rate affects ventricular filling, the aim of the present study was to assess the effects of increasing heart rate and tidal volume on stroke volume variability to determine whether this dynamic index is heart-rate dependent. ⋯ Stroke volume variability is sensitive to increases in heart rate in addition to tidal volume. Increasing heart rate caused stroke volume variability to increase significantly, although not to the same magnitude as increasing tidal volume. When using dynamic volume indices, clinicians should be aware of increases in heart rate, although its clinical impact may be relatively minor compared with changes in tidal volume.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
ReviewThe PhysiologicPerspective in FluidManagement in VascularAnesthesiology.
Vascular surgery patients frequently suffer from atherosclerosis and peripheral arterial occlusive disease generating endothelial dysfunction. Furthermore, ischemia and reperfusion during surgery damage endothelial cells and, especially, the endothelial glycocalix. The damage of the glycocalix promotes an increase in permeability. ⋯ From a theoretical physiologic point of view, iso-osmolar albumin is the best choice regarding volume effect, antioxidative properties, and protection against destruction of the glycocalix. Nonetheless, albumin experimentally has not lived up to its promise in the clinical setting. Thus, further well-conducted large randomized clinical trials are necessary to ascertain the optimal fluid therapy in vascular surgery patients.