Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2021
ReviewPredicting Readmission to Intensive Care After Cardiac Surgery Within Index Hospitalization: A Systematic Review.
Readmission to the cardiac intensive care unit after cardiac surgery has significant implications for both patients and healthcare providers. Identifying patients at risk of readmission potentially could improve outcomes. The objective of this systematic review was to identify risk factors and clinical prediction models for readmission within a single hospitalization to intensive care after cardiac surgery. ⋯ The majority of readmissions occurred due to respiratory and cardiac complications. Four models were identified for predicting readmission, with one external validation study. As all models developed to date had limitations, further work on larger datasets is required to develop clinically useful models to identify patients at risk of readmission to the cardiac intensive care unit after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Jul 2021
ReviewReducing Opioid Use in Patients Undergoing Cardiac Surgery - Preoperative, Intraoperative, and Critical Care Strategies.
Patients undergoing cardiothoracic surgery are exposed to opioids in the operating room and intensive care unit and after hospital discharge. Opportunities exist to reduce perioperative opioid use at all stages of care and include alternative oral and intravenous medications, novel intraoperative regional anesthetic techniques, and postoperative opioid-sparing sedative and analgesic strategies. In this review, currently used and investigational strategies to reduce the opioid burden for cardiothoracic surgical patients are explored.
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J. Cardiothorac. Vasc. Anesth. · Jul 2021
ReviewAnesthesia for Pregnant Women with Pulmonary Hypertension.
Despite advances in the therapy for pulmonary hypertension over the past decades, the prognosis of pregnant patients with pulmonary hypertension remains poor, with high maternal mortality. This poses a particular challenge for the mother and her medical team. In the present review, the authors have updated the classification and definition of pulmonary hypertension, summarized the current knowledge with regard to perioperative management and anesthesia considerations for these patients, and stressed the importance of a "pregnancy heart team" to improve long-term outcomes of pregnant women with pulmonary hypertension.
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J. Cardiothorac. Vasc. Anesth. · Jul 2021
ReviewThe Role of Novel Transcatheter Procedures in Patients With Congenital Heart Disease.
The development of percutaneous structural interventions in patients with acquired heart disease is happening at an exponential rate, and some of this technology is being used to treat patients with congenital heart disease. This review describes the pathophysiology of valvular abnormalities specific to congenital heart disease and discusses the application of structural procedures in this population. Although the overall experience has been encouraging, especially in high-risk patients, this article will highlight the reasons that a cautious approach to adoption of this technology is necessary in these patients.
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J. Cardiothorac. Vasc. Anesth. · Jul 2021
Randomized Controlled TrialSyringe-Free, Long-Axis in-Plane Versus Short-Axis Classic out-of-Plane Approach for Ultrasound-Guided Internal Jugular Vein Catheter Placement in Critically Ill Children: A Prospective Randomized Study.
Although pediatric central venous catheterization is performed using ultrasound guidance, it is still a challenge. This study aimed to investigate the efficacy of the syringe-free, long-axis in-plane approach and compared the short-axis classic out-of-plane approach for ultrasound-guided central venous catheter placement in critically ill pediatric patients. ⋯ The syringe-free, long-axis in-plane approach can be a safe and fast alternative for pediatric catheterization.