Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 2015
Randomized Controlled TrialRemote Ischemic Preconditioning Prevents Deterioration of Short-Term Postoperative Cognitive Function After Cardiac Surgery Using Cardiopulmonary Bypass: Results of a Pilot Investigation.
Remote ischemic preconditioning (RIPC) exerts neuroprotective effects in models of cerebral ischemia-reperfusion injury. The authors tested the hypothesis that RIPC decreases the incidence of postoperative delirium and prevents deterioration of short-term postoperative cognitive function in isoflurane-fentanyl-anesthetized patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). ⋯ The results of this pilot investigation indicated that RIPC prevented deterioration of short-term postoperative cognitive function but were unable to detect any difference in delirium in isoflurane-fentanyl-anesthetized patients undergoing cardiac surgery using CPB.
-
High-quality evidence and derived guidelines, as typically published in major academic journals, are a major process that shapes physician decision-making worldwide. However, for many aspects of medical practice, there is a lack of High-quality evidence or an overload of somewhat contradictory low-quality information, which makes decision-making a difficult, uncertain, and unpredictable process. When the issues in question are important and evidence limited or controversial, the medical community seeks to establish common ground for "best practice" through consensus conferences and consensus statements or guidelines. Such consensus statements are seen as a useful tool to establish expert agreement, define the boundaries of acceptable practice, provide priorities for the research agenda, and obtain opinions from different countries and healthcare systems. This standard approach, however, can be criticized for being elitist, noninclusive, and poorly representative of the community of clinicians who will have to make decisions about the implementation of such recommendations. ⋯ This new type of "democracy-based consensus" has the potential to increase grass-root clinician involvement, expand the reach to less-developed countries, provide a more global perspective on proposed interventions, and perhaps more importantly, increase awareness, ownership, and the statistical likelihood of subsequent implementation.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2015
Minimally Invasive Thoracic Left Ventricular Assist Device Implantation; Case Series Demonstrating an Integrated Multidisciplinary Strategy.
The present report describes the authors' initial experience with implantation of the Heartware left ventricular assist devices (HeartWare Inc., Framingham, MA). via a minimally invasive surgical approach without cardiopulmonary bypass. A detailed overview of the anesthesiologist's role during the procedure, characteristics of the patient population, and short-term clinical outcomes are provided, and the clinical considerations that influence the decision to implant this device via an off-pump minimally invasive approach are outlined. ⋯ Minimally invasive off-pump left ventricular Heartware implantation is an emerging alternative to placement by midline sternotomy. The authors speculate, based on their limited experience, that an off-pump thoracic strategy may be a desirable option for some patients and that clinical outcomes may be non-inferior to placement by midline sternotomy with cardiopulmonary bypass.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2015
Observational StudyProspective Observational Study of Hemostatic Alterations during Adult Extracorporeal Membrane Oxygenation (ECMO) Using Point-of-Care Thromboelastometry and Platelet Aggregometry.
To characterize the longitudinal hemostatic profile during adult ECMO using point-of-care tests (POCT) for coagulation and to compare these parameters to standard laboratory tests. In addition, the clinicians' responses during bleeding episodes using available information were compared to a POCT-based response. ⋯ POCT for coagulation can provide specific, reliable, and timely information during bleeding episodes and the use of targeted therapy algorithms could improve outcomes and reduce costs.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2015
Complications of Catheter-Based Electrophysiology Procedures in Adults with Congenital Heart Disease: A National Analysis.
To determine whether adult congenital heart disease patients (ACHD) undergoing catheter-based electrophysiology (EP) procedures have an increased risk for complications compared with adults without congenital heart disease. ⋯ ACHD patients experienced greater morbidity after catheter-based EP procedures. This finding will be of increasing significance as ACHD patients occupy a growing segment of the population undergoing these procedures. Further investigations are warranted to determine whether this increased risk is modifiable, with the aim of improving patient safety.