Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · May 2020
ReviewThe Physiology of Oxygen Transport by the Cardiovascular System: Evolution of Knowledge.
The heart, vascular system, and red blood cells play fundamental roles in O2 transport. The fascinating research history that led to the current understanding of the physiology of O2 transport began in ancient Egypt in 3000 BC, when it was postulated that the heart was a pump serving a system of distributing vessels. Over 4 millennia elapsed before William Harvey (1578-1657) made the revolutionary discovery of blood circulation, but it was not until the 20th century that a lucid and integrative picture of O2 transport finally emerged. ⋯ The authors also describe the classic studies that provided the initial description of the basic regulatory mechanisms governing heart function (Frank-Starling law) and the flow of blood through blood vessels (Poiseuille's law). The importance of technical advances, such as the pulmonary artery catheter, the blood gas analyzer and oximeter, and the radioactive microsphere technique to measure the regional blood flow in facilitating O2 transport-related research, is recognized. The authors describe how religious and cultural constraints, as well as superstition-based medical traditions, at times impeded experimentation and the acquisition of knowledge related to O2 transport.
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J. Cardiothorac. Vasc. Anesth. · May 2020
Randomized Controlled TrialA Comparison of the Arterial Blood Concentration of Isoflurane During Cardiopulmonary Bypass Between 2 Polypropylene Oxygenators.
The primary objective was to compare arterial blood concentration of isoflurane during cardiopulmonary bypass (CPB) between 2 polypropylene oxygenators of different designs. Secondary objectives were to compare levels of Bispectral Index Score (BIS) during CPB between the 2 oxygenators and to examine the relationships between oxygenator exhaust and arterial blood concentrations of isoflurane and BIS. ⋯ No significant difference in arterial blood concentration of isoflurane or BIS was found between the Inspire 8F (Sorin) and Affinity Fusion (Medtronic) oxygenators. A significant positive correlation was found between arterial blood and oxygenator exhaust concentrations of isoflurane, as well as significant negative correlations between both arterial and oxygenator exhaust concentrations of isoflurane and BIS.
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J. Cardiothorac. Vasc. Anesth. · May 2020
Randomized Controlled TrialIntraoperative Optimization of Both Depth of Anesthesia and Cerebral Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery-A Randomized Controlled Pilot Trial.
Does intraoperative optimization of both depth of anesthesia and regional cerebral tissue oxygenation (rScO2) in elderly patients reduce postoperative cognitive decline (primary outcome) or delirium (secondary outcome)? ⋯ This pilot trial demonstrates that noninvasive target-controlled depth of anesthesia monitoring is feasible. Cognitive function at 6 weeks showed no difference between the treatment and control groups; however, postoperative delirium was reduced in the intervention group.
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J. Cardiothorac. Vasc. Anesth. · May 2020
Trends and Outcomes of Mechanical Circulatory Support in Peripartum Women, 2002-2014: A Nationwide Inpatient Sample Analysis.
To systematically explore the relationship among the use of mechanical circulatory support (MCS), the timing of placement, and outcomes in pregnancy. ⋯ Similar to trends in the general population, use of MCS has increased in the peripartum period. Women receiving MCS were generally older and had more comorbidities than those not receiving MCS. Increased time to device placement may worsen mortality. Further research will help identify appropriate candidates and factors that improve survival.
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J. Cardiothorac. Vasc. Anesth. · May 2020
Multicenter StudyExtracorporeal Cardiopulmonary Resuscitation: Outcomes and Complications at a Quaternary Referral Center.
At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal cardiopulmonary resuscitation (eCPR), a database of all adult patients who underwent eCPR with venoarterial extracorporeal membrane oxygenation (ECMO) over a 10-year period was reviewed. Seventy-one eCPR patients were analyzed to compare outcomes and complication rates. The authors hypothesized that evidence of end-organ injury, such as the need for continuous renal replacement therapy, in their institution's eCPR population would be associated with increased in-hospital mortality. ⋯ In this cohort of 71 patients who underwent eCPR, outcomes were promising; however, complication rates were high, and renal failure in particular demonstrated an extremely high mortality. These are single-institution results that should be followed up with larger multicenter cohorts of eCPR patients.