Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
ReviewCombined Monitoring-Brain Function Monitoring and Cerebral Oximetry.
Peri-operative brain function monitoring is still seen by most clinicians as complex, difficult to interpret and is therefore adopted very slowly. Current available technology mainly focusses on either a processed parameter based on the electroencephalogram to titrate anesthetics and central acting agents or on cerebral oximetry, a wider term to obtain information on the cerebral oxygen balance. ⋯ However, there is scientific evidence that it is possible to combine measurements in an algorithmic approach that allows to better manage brain function in the surgical setting. Such integrated solutions should be made available to clinicians as they are likely to optimize patient care dependent on a sound health technology assessment.
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Hemodynamic monitoring is an essential part of the perioperative management of the cardiovascular patient. It helps to detect hemodynamic alterations, diagnose their underlying causes, and optimize oxygen delivery to the tissues. Furthermore, hemodynamic monitoring is necessary to evaluate the adequacy of therapeutic interventions such as volume expansion or vasoactive medications. ⋯ Less-invasive monitoring techniques use, for example, pulse contour analysis to originate flow-derived variables such as stroke volume and CO from the arterial pressure signal, or they may measure the velocity-time integral in the descending aorta to estimate the stroke volume, using, for example, the esophageal Doppler. Completely noninvasive methods such as the volume clamp method use finger cuffs to reconstruct the arterial pressure waveform, from which stroke volume and CO are calculated. All of these less-invasive CO monitoring devices have percentage errors around 40% compared with reference methods (thermodilution), meaning that the values are not interchangeable.
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
Propofol-Induced Vasodilation in Human Internal Mammary Artery: Role of Potassium Channels.
The aim of this study was to investigate the vascular effects and mechanisms of propofol in the human internal mammary artery (IMA). ⋯ This study clearly reveals that propofol relaxes the IMA, and propofol-induced vasodilation may be related to large conductance calcium ion-activated potassium ion channel activation. Propofol use in coronary artery bypass surgery can be valuable via its favorable vasodilator effect to overcome perioperative vasospasm of IMA.
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
Perioperative Acute Ischemic Stroke Increases Mortality After Noncardiac, Nonvascular, and Non-Neurologic Surgery: A Retrospective Case Series.
To identify the predictors of in-hospital mortality in patients who develop perioperative acute ischemic stroke (PAIS) associated with noncardiac, nonvascular, and non-neurologic surgery. ⋯ The risk of PAIS after noncardiac, nonvascular, and non-neurologic surgery significantly increased with age, and development of PAIS increased the mortality rate. Among these patients, the independent predictors of in-hospital mortality were preoperative atrial fibrillation, disturbance of consciousness as the first PAIS symptom, no anticoagulant/antiplatelet therapy after PAIS, diuretic treatment, and pulmonary infection.