Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Feb 2021
ReviewTo Swan or Not to Swan: Indications, Alternatives, and Future Directions.
The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed percutaneously by a flow-directed balloon-tipped technique through the venous system and the right heart to the pulmonary artery. Interest in the hemodynamic variables obtained from PACs paved the way for the development of numerous less-invasive hemodynamic monitors over the past 3 decades. ⋯ Herein, the authors review the conception, technologic advancements, and modern use of PACs, as well as the criticisms regarding the clinical utility, reliability, and safety of PACs. The authors comment on the current understanding of the benefits and limitations of alternative hemodynamic monitors, which is important for providers caring for critically ill patients. The authors also briefly discuss the use of hemodynamic monitoring in goal-directed fluid therapy algorithms in Enhanced Recovery After Surgery programs.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2021
ReviewThe Convergent Procedure: A Unique Multidisciplinary Hybrid Treatment of Atrial Fibrillation.
The convergent procedure is a hybrid ablation treatment for atrial fibrillation. It is increasingly considered as a management option for patients with persistent and long-standing atrial fibrillation. ⋯ This article provides an overview of a multidisciplinary approach to the convergent procedure, with concurrent thoracoscopic closure of the left atrial appendage, with an emphasis on perioperative management at a single institution. It provides a literature review of procedural outcomes, current data limitations, and future considerations.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2021
Randomized Controlled TrialIntraoperative Remifentanil Infusion and Postoperative Pain Outcomes After Cardiac Surgery-Results from Secondary Analysis of a Randomized, Open-Label Clinical Trial.
Report of secondary pain outcomes from a prospective, randomized, open-label clinical trial that compared remifentanil and fentanyl on perioperative hyperglycemic response in cardiac surgery. ⋯ The present study's findings suggested that intraoperative remifentanil infusion does not significantly worsen pain outcomes in patients undergoing elective cardiac surgery.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2021
Is the Obesity Paradox in Cardiac Surgery Really a Myth? Effect of Body Mass Index on Early and Late Clinical Outcomes.
The present study was conducted to investigate the obesity paradox and assess the effect of body mass index (BMI) on early and late clinical outcomes after cardiac surgery. ⋯ OW patients had a lower mortality and better outcomes after cardiac surgery. However, when other preoperative variables were taken into account, BMI did not have independent effect on in-hospital and 1-year mortality.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2021
Development of an Instrument for Preoperative Prediction of Adverse Discharge in Patients Scheduled for Cardiac Surgery.
Inability of home discharge occurs in nearly a third of patients undergoing cardiac surgery and is associated with increased mortality. The authors aimed to evaluate the incidence and risk factors for adverse discharge disposition (ADD) after cardiac surgery and develop a prediction tool for preoperative risk assessment. ⋯ The authors present an instrument for prediction of loss of the ability to live independently in patients undergoing cardiac surgery. The authors' score may be useful in identifying high-risk patients such that earlier coordination of care can be initiated in this vulnerable patient population.