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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J. Cardiothorac. Vasc. Anesth. · Aug 2019
ReviewNoninvasive Continuous Hemoglobin Monitoring: Role in Cardiovascular Surgery.
Blood transfusions in the operating room are associated with increased morbidity and mortality as well as increased cost. The technology exists for continuous noninvasive hemoglobin monitoring (SpHb), which could allow for the rapid diagnosis and treatment of acute blood loss anemia secondary to surgical bleeding. ⋯ SpHb in the operating room could reduce cost by decreasing lab draws, unnecessary transfusions, and the morbidity associated with blood transfusions. This review examines the accuracy of noninvasive hemoglobin monitoring as well as the role it may play in the operating room.
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
ReviewReview of the 2017 European Society of Cardiology's Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation and Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease Developed in Collaboration with the European Association for Cardio-Thoracic Surgery.
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
Clinical Impact of Protamine Titration-Based Heparin Neutralization in Patients Undergoing Coronary Bypass Grafting Surgery.
A hemostasis management system (HMS) is a point-of-care method for heparin and protamine titration. The authors hypothesized that protamine dosing over the HMS estimate would be associated with elevated activated clotting time (ACT), increased bleeding, and transfusion owing to protamine's anticoagulant activity. ⋯ Most patients received the protamine dose sufficiently close to the HMS estimate, but protamine dosing above the HMS estimate occurred in both obese and nonobese patients, which was associated independently with prolonged ACT after adjusting for sex, BMI, and CPB time.
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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.