Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
ReviewEarly Detection, Prevention, and Management of Acute Limb Ischemia in Adults Supported With Venoarterial Extracorporeal Membrane Oxygenation.
Acute limb ischemia caused by peripheral venoarterial extracorporeal membrane oxygenation (ECMO) cannulation is associated with increased mortality. Early detection of limb hypoperfusion may lead to timely intervention and prevent irreversible muscle damage. Methods to determine the adequacy of tissue oxygenation in cannulated extremities include bedside physical examination, trending serum biochemical markers, and somatic near-infrared spectroscopy. ⋯ If the limb develops early signs of ischemia, preventative measures such as distal perfusion catheter insertion or changing the location of the arterial cannula should be performed. Acute compartment syndrome requires emergency fasciotomy or amputation if the limb is unsalvageable. Opportunities for future research include improving monitoring technology and standardizing the use of the distal perfusion catheter.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
The Effect of Regional Anesthesia on Outcomes After Minimally Invasive Ivor Lewis Esophagectomy.
The objective of the present study was to determine whether regional anesthesia in addition to general anesthesia was associated with improved outcomes compared with general anesthesia alone in minimally invasive Ivor Lewis esophagectomy. ⋯ Despite potential benefits of regional anesthesia for minimally invasive Ivor Lewis esophagectomy, the present study did not show significant differences in any outcomes between regional and general anesthesia versus general anesthesia alone.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
ReviewLung Ultrasonography and Cardiac Surgery: A Narrative Review.
Pulmonary complications are common after cardiac surgery and are closely related to postoperative heart failure and adverse outcomes. Lung ultrasonography (LUS) is currently a widely accepted diagnostic approach with well-established methodology, nomenclature, accuracy, and prognostic value in numerous clinical conditions. The advantages of LUS are universally recognized and include bedside applicability, high diagnostic sensitivity and reproducibility, no radiation exposure, and low cost. ⋯ Furthermore, this review describes the methodology and the diagnostic and prognostic accuracies of LUS. A summary of ongoing clinical trials evaluating the clinical outcomes related to LUS also is provided. Finally, this review discusses the rationale for upcoming clinical research regarding whether routine use of LUS can modify current intensive care practice and potentially affect the clinical outcomes after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
Observational StudyThe Serratus Anterior Plane Study: Continuous Deep Serratus Anterior Plane Block for Mitral Valve Surgery Performed in Right Minithoracotomy.
Regional anesthesia with thoracic wall blocks could represent an opioid-sparing alternative for mitral valve surgery in right minithoracotomy (mini-MVS). For the present study, an opioid-free analgesia using continuous deep serratus anterior plane block was compared with intravenous morphine. ⋯ Continuous deep serratus anterior plane block seems to be a valid alternative to intravenous opioids in terms of efficacy for patients undergoing mini-MVS with a lower opioid requirement.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
Randomized Controlled TrialContinuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study.
The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery. ⋯ The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.