Journal of cardiothoracic and vascular anesthesia
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This is the first annual highlights in coagulation article to be published in the Journal of Cardiothoracic and Vascular Anesthesia. Its purpose is to review the most important coagulation literature from 2019. In the review, the authors discuss the recent Society of Cardiovascular Anesthesiologists clinical practice advisory on the management of perioperative bleeding and hemostasis, heparin monitoring, protamine dosing, antiplatelet therapy, factor concentrate therapy, and coagulopathy during mechanical circulatory support.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Randomized Prospective Study Evaluating Single-Injection Paravertebral Block, Paravertebral Catheter, and Thoracic Epidural Catheter for Postoperative Regional Analgesia After Video-Assisted Thoracoscopic Surgery.
Video-assisted thoracoscopic surgery (VATS) has improved patient outcomes; however, postoperative pain remains potentially severe. The objective of this study was to compare adjunct analgesic modalities for VATS, including paravertebral nerve blockade (PVB) and thoracic epidural anesthesia (TEA). ⋯ TEA led to lower pain scores and opioid requirement for VATS procedures compared with PVB techniques. Single-injection PVB was faster and equally as effective as PVB catheter, and it led to similar patient satisfaction as TEA; therefore, it should be considered in patients who are not ideal candidates for TEA.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Vitamin D and Postoperative Delirium After Coronary Artery Bypass Grafting: A Prospective Cohort Study.
Postoperative delirium is the most common neuropsychiatric complication after cardiac surgery. Vitamin D contributes to numerous brain processes, regulation of neurotrophic factors, neuroprotection, neuroplasticity, and brain development, which could play a role in delirium pathophysiology. The authors evaluated the association of admission serum levels of 25-hydroxyvitamin D [25(OH)D] with the occurrence of delirium after coronary artery bypass surgery. ⋯ Preoperative severe vitamin D deficiency was associated with the occurrence of delirium after coronary artery bypass grafting surgery.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Hydroxocobalamin Versus Methylene Blue for Vasoplegic Syndrome in Cardiothoracic Surgery: A Retrospective Cohort.
To compare methylene blue with hydroxocobalamin as a rescue therapy for vasoplegic syndrome. ⋯ Methylene blue and hydroxocobalamin increased mean arterial pressures and systemic vascular resistance without significantly decreasing time-averaged norepinephrine exposure in the hour after administration.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations.
To develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB). ⋯ Consensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.