Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2019
Review Comparative StudyManagement of Arterial Hypertension: 2018 ACC/AHA Versus ESC Guidelines and Perioperative Implications.
Hypertension is the most prevalent cardiovascular risk factor worldwide and the leading cause of death and premature morbidity. Despite its prevalence, evaluation and management are nonuniform despite multiple society guidelines worldwide. ⋯ In addition, several expert-based recommendations are provided in these documents, a situation that can lead to confusion. The scope of this manuscript is to briefly compare the recent updated guidelines for the management of arterial hypertension from the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Society of Hypertension and their relevant differences, which are important to the practicing clinician.
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J. Cardiothorac. Vasc. Anesth. · Dec 2019
Review Historical ArticleHistory and Current Status of Cardiac Anesthesiology in Russia.
Anesthesiology, the branch of medicine concerning anesthesia and management of the vital functions of patients undergoing surgery, has played an important role in the development of cardiac surgery. In the middle of the last century, medical professionals had little experience in the treatment of congenital and acquired heart diseases. ⋯ Some surgeons widely accepted the use of perfusionless hypothermia (hypothermia caused by surface cooling without perfusion); others were in favor of cardiopulmonary bypass technology. This review focuses on major historic milestones of cardiac anesthesiology in Russia, including its current status and the major problems it faces today.
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Microcirculation is a system composed of interconnected microvessels, which is responsible for the distribution of oxygenated blood among and within organs according to regional metabolic demand. Critical medical conditions, e. g., sepsis, and heart failure are known triggers of microcirculatory disturbance, which usually develops early in such clinical pictures and represents an independent risk factor for mortality. Therefore, hemodynamic resuscitation aiming at restoring microcirculatory perfusion is of paramount importance. ⋯ The introduction of hand-held video-microscopy (HVM) into clinical practice has allowed real-time analysis of microcirculatory variables at the bedside and, hence, favored a more individualized approach. In the cardiac intensive care unit scenario, HVM provides essential information on patients' hemodynamic status, e. g., to classify the type of shock, to adequate the dosage of vasopressors or inotropes according to demand and define safer limits, to guide fluid therapy and red blood cell transfusion, to evaluate response to treatment, among others. Nevertheless, several drawbacks have to be addressed before HVM becomes a standard of care.
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J. Cardiothorac. Vasc. Anesth. · Dec 2019
Review Historical ArticleHistory and Pioneers of Cardiac Anesthesia in Italy.
The first use of extracorporeal circulation in Italy occurred in 1951 in Turin. In the 1960s only 12 heart surgery centers were using extracorporeal circulation to treat patients, and health professionals had to complete their training abroad. ⋯ Many results have been achieved during this period, thanks to the contribution of several pioneers. In this article, the history of Italian cardiac anesthesia and the role of Italian anesthesiologists in the development of this subspecialty in Italy and Europe are reviewed.