Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Observational StudyComparison of ROTEM Sigma to Standard Laboratory Tests and Development of an Algorithm for the Management of Coagulopathic Bleeding in a Tertiary Center.
The ROTEM sigma whole blood viscoelastic test uses different technology than the former delta model. Existing ROTEM based algorithms use cutoff values based on the delta model, and cannot be applied to the sigma model. The authors tested sensitivity and specificity of ROTEM sigma parameters to detect specific hemostatic deficiencies and established cutoff values with the aim of developing a treatment algorithm. ⋯ The authors present the first ROTEM sigma-based algorithm for the treatment of coagulopathic bleeding. The algorithm uses parameters with optimal sensitivity and specificity for critical values of SLTs determined from a heterogenous group of donors.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Meta AnalysisPreoperative Pulse Pressure and Adverse Postoperative Outcomes: A Meta-Analysis.
To evaluate the association between preoperative pulse pressure (PP) and the incidences of renal, neurologic, cardiac, and mortality outcomes after surgery. ⋯ Patients with higher-than-normal preoperative PP are at increased risk for adverse postoperative outcomes.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
ReviewAssessment of Spinal Cord Ischemia With Near-Infrared Spectroscopy: Myth or Reality?
Non-invasive near-infrared spectroscopy is gaining popularity in the detection of spinal cord ischemia following aortic aneurysm repair. However, practical recommendations are lacking. This review focuses on the physiological and anatomical background, as well as on the clinical implementations of near-infrared spectroscopy as a tool for monitoring ischemia of the spinal cord. Clinical recommendations based on the currently available evidence are rendered.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
ReviewThrombocytosis: Perioperative Considerations for Patients Undergoing Cardiac Surgery.
Thrombocytosis is an uncommon yet important laboratory abnormality with significant considerations for patients undergoing cardiac surgery. The etiology of thrombocytosis can be categorized by those related to reactive processes; acquired platelet disorders (ie, myeloproliferative neoplasms, hematologic malignancies); or inherited platelet disorders (ie, hereditary thrombocythemia). A foundational understanding of the normal physiologic function of platelets and the abnormalities associated with each of these disorders is critical when considering implications and optimization to prevent perioperative complications. This review systematically outlines the platelet disorders that cause thrombocytosis with an emphasis on how the disorder affects normal physiologic processes, summarizes the literature related to the disorder, and the describes the implications and recommendations for patients undergoing cardiac surgery.