Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Aug 2020
ReviewVolatile Anesthesia Versus Total Intravenous Anesthesia During Cardiopulmonary Bypass: A Narrative Review on the Technical Challenges and Considerations.
The Mortality in Cardiac Surgery Randomized Controlled Trial of Volatile Anesthetics (MYRIAD) demonstrated that cardiac surgery with either volatile anesthesia or intravenous anesthesia techniques can be comparable with respect to morbidity and mortality. Maintaining anesthesia during cardiopulmonary bypass (CPB) with either approach requires appreciation of the nuances that are unique to each. This narrative review addresses these technical challenges and other considerations.
-
J. Cardiothorac. Vasc. Anesth. · Aug 2020
Observational StudyThrombin Generation and Antithrombin Activity in Infants Undergoing Cardiopulmonary Bypass-An Exploratory Study.
Coagulopathic bleeding is a major complication of pediatric cardiac surgery. Investigating perioperative dynamics of thrombin generation and antithrombin (AT) activity might provide more insight into the underlying mechanisms of coagulopathy. This can help develop a targeted hemostatic approach in the future. The authors hypothesized that there is a decline in both thrombin generation and AT activity in infants undergoing cardiopulmonary bypass (CPB). ⋯ In pediatric patients <10 kg undergoing cardiac surgery with CPB, thrombin generation and AT activity decline and do not recover completely after transfusion of platelets and cryoprecipitate.
-
Stroke is an uncommon presentation in young adults, with different causes and risks factors implicated. Cardiogenic cerebral embolus is one of the most common causes in younger patients and must be considered in the investigation of young patients presenting with stroke. The authors describe a case of a young patient presenting with stroke as a result of distal embolization from a previously undiagnosed congenital mitral valve defect.
-
J. Cardiothorac. Vasc. Anesth. · Aug 2020
Preliminary Experience Using Diastolic Right Ventricular Pressure Gradient Monitoring in Cardiac Surgery.
Right ventricular (RV) dysfunction in cardiac surgery is associated with increased mortality and morbidity and difficult separation from cardiopulmonary bypass (DSB). The primary objective of the present study was to describe the prevalence and characteristics of patients with abnormal RV diastolic pressure gradient (PG). The secondary objective was to explore the association among abnormal diastolic PG and DSB, postoperative complications, high central venous pressure (CVP), and high RV end-diastolic pressure (RVEDP). ⋯ Abnormal RV diastolic PG is common before cardiac surgery and is associated with a higher proportion of known preoperative risk factors. However, an abnormal RV diastolic PG gradient is not an independent predictor of DSB in contrast to RVEDP.