Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Randomized Controlled TrialLow Concentration of Dezocine in Combination With Morphine Enhance the Postoperative Analgesia for Thoracotomy.
When morphine and dezocine are mixed together, the clinical interactions with analgesic effects and adverse events remain unknown. The authors aimed to investigate the efficacy of low concentrations of dezocine in combination with morphine for postoperative pain. ⋯ The combination of morphine and dezocine at the concentrations [morphine (mg/mL)]/[dezocine (mg/mL)] of 1/0.05 (ratio 20:1) and 1/0.1 (ratio 10:1) may enhance postoperative analgesia after thoracotomy.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Observational StudyNear-Infrared Spectroscopy Hemoglobin Index Measurement During Fluid Challenge: A Prospective Study in Cardiac Surgery Patients.
Little is known about changes in near-infrared spectroscopy-derived tissue hemoglobin index (HbI). The authors tested the hypothesis that absolute values and changes in brain hemoglobin index (HbIb) and skeletal muscle hemoglobin index (HbIm) could differ from the reference arterial hemoglobin (Hb) during fluid challenge. ⋯ HbIb and HbIm cannot be used to provide continuous noninvasive estimation of Hb, and trends in HbIb and HbIm cannot be considered as noninvasive surrogates for the trend in Hb after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Comparative StudyIntraoperative Right Ventricular Fractional Area Change Is a Good Indicator of Right Ventricular Contractility: A Retrospective Comparison Using Two- and Three-Dimensional Echocardiography.
Intraoperative two-dimensional echocardiography is technically challenging, given the unique geometry of the right ventricle (RV). It was hypothesized that the RV fractional area change (RVFAC) could be used as a simple method to evaluate RV function during surgery. Therefore, the correlation between the intraoperative RVFAC and the true right ventricular ejection fraction (RVEF), as measured using newly developed three-dimensional (3D) analysis software, was evaluated. ⋯ The RVFAC was well-correlated with the RVEF calculated using 3D echocardiography; therefore, RVFAC provides a simple and useful method for anesthesiologists to evaluate intraoperative RV function.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Assessing Endothelial Responsiveness After Cardiopulmonary Bypass: Insights on Different Perfusion Modalities.
Cardiopulmonary bypass (CPB) exerts several deleterious effects on inflammatory pathways. Most of these can be related to an endothelial insult leading to endothelial dysfunction. To date, the degree of endothelial damage only has been evaluated on a cellular and molecular level, but no studies exist looking at the functional effects of CPB on the endothelium. ⋯ In conclusion, in this study population of adult patients undergoing elective coronary revascularization, continuous-flow CPB markedly impaired endothelial function, although this was not the case with pulsatile-flow CPB. This study posed the rationale for further investigations on the potential value of FMD to predict cardiovascular events in these patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Observational StudyExtravascular Lung Water and Tissue Perfusion Biomarkers After Lung Resection Surgery Under a Normovolemic Fluid Protocol.
The optimal fluid management for lung resection surgery remains undefined. Concern related to postoperative pulmonary edema has led to the practice of fluid restriction. This practice risks hypovolemia and tissue hypoperfusion. The authors examined the extravascular lung water accumulation and tissue perfusion biomarkers under protective lung ventilation and normovolemia. ⋯ In patients undergoing lesser lung resections, a fluid protocol targeting normovolemia together with protective lung ventilation did not increase extravascular lung water. These results suggest further study to identify the optimal fluid regimen to mitigate pulmonic and extrapulmonic complications after lung resection.