Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
ReviewLevosimendan in Cardiac Surgery: Evaluating the Evidence.
Levosimendan, a calcium-sensitizing and Adenosine triphosphate-sensitive potassium channel opening inodilator, has the potential to improve cardiac function without increasing oxygen consumption. The evidence supporting the use of levosimendan in the cardiac surgical perioperative period is not well-established. Recently, large-scale randomized controlled trials studying the utility of levosimendan in cardiac surgery have been conducted. This review examines the physiological and pharmacologic properties of levosimendan and evaluates the literature regarding the use of levosimendan in patients undergoing cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
Comparative Study Observational StudyComparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central Venous Catheterization With Conventional Short-Axis Out-of-Plane Approaches.
Visualizing the needle tip using the short-axis out-of-plane (SA-OOP) ultrasound-guided central venous catheterization approach is difficult and results in posterior wall puncture (PWP). To improve needle tip visualization in the long-axis view, combining the SA-OOP and the long-axis in-plane approaches has been suggested. The authors, who previously reported on the utility of this technique using a manikin model, examined the feasibility of this novel method (referred to as the combined short-axis and long-axis [CSLA] approach) and compared the CSLA approach with the SA-OOP approach in humans for the present study. ⋯ This study showed that the CSLA approach to ultrasound-guided central venous catheterization might help prevent PWP.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
ReviewPerioperative Right Ventricular Pressure Monitoring in Cardiac Surgery.
Right ventricular (RV) dysfunction is a cause of increased morbidity and mortality in both cardiac surgery and noncardiac surgery and in the intensive care unit. Early diagnosis of this condition still poses a challenge. The diagnosis of RV dysfunction traditionally is based on a combination of echocardiography, hemodynamic measurements, and clinical symptoms. ⋯ The RV pressure waveform is obtained using a pulmonary artery catheter with the capability of measuring RV pressure by connecting a pressure transducer to the pacemaker port. The authors describe how RV pressure waveform analysis can facilitate the diagnosis of systolic and diastolic RV dysfunction, the evaluation of RV-arterial coupling, and help diagnose RV outflow tract obstruction. RV pressure waveform analysis also can be used to guide pharmacologic treatment and fluid resuscitation strategies for RV dysfunction.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
Randomized Controlled Trial Comparative StudySimulation Versus Problem Based Learning for Cerebrospinal Drainage Catheter Insertion and Management: A Randomized Trial in a Large Academic Anesthesiology Residency Program.
Cerebrospinal fluid drainage catheter-related complications can be reduced by following strict guidelines during their introduction, maintenance, and removal. The authors therefore aimed to determine whether simulation-based learning would improve senior anesthesiology residents' patient care performance during the insertion and management of these catheters compared to interactive problem-based learning (PBL) using the Anaesthetists' Non-Technical Skills global rating scale (ANTS). ⋯ Compared to interactive PBL, simulation-based learning does not result in a statistically significant improvement in anesthesia resident performance during insertion and management of cerebrospinal fluid drainage catheters.