Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Nov 2022
ReviewPerioperative Management of Direct Oral Anticoagulants in Cardiac Surgery: Practice Recommendations Based on Current Evidence.
An increasing number of patients on systemic oral anticoagulants present for cardiac surgery, and cardiac anesthesiologists should be well-informed on their management in the perioperative period. Direct oral anticoagulants (DOACs), including factor Xa inhibitors and direct thrombin inhibitors, are an attractive alternative to warfarin due to fewer dietary and drug interactions, less frequent monitoring requirements, and an improved patient adherence. Since the approval of DOACs by the Food and Drug Administration in 2010, the number of patients on these medications only has increased. ⋯ The practice recommendations of various monitoring tests and new evolving point-of-care testing are examined herein. The different reversal agents were discussed by the authors for both elective and urgent procedures. The cardiac anesthesiologist needs to be intimately familiar with the management and current best practices of DOACs for safe and appropriate patient care.
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J. Cardiothorac. Vasc. Anesth. · Nov 2022
Randomized Controlled TrialA Comparative Study of Bilateral Erector Spinae Block Versus Intravenous Dexmedetomidine for Perioperative Pain Management in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting - A Single-Blind Randomized Controlled Trial.
Regional analgesia, along with general anesthesia, reduce postoperative pain. In this study, the authors compared the erector spinae plane (ESP) block having dexmedetomidine as an adjuvant with conventional pain management along with intravenous dexmedetomidine. ⋯ Erector spinae fascial plane blocks appeared to reduce postoperative pain scores in off-pump coronary artery bypass graft patients. Furthermore, ESP block was beneficial in terms of less intraoperative and postoperative opioid consumption, longer time to first rescue analgesia, and shorter ICU stay.
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J. Cardiothorac. Vasc. Anesth. · Nov 2022
ReviewPreoperative Evaluation and Care of Heart Transplant Candidates.
Heart transplantation is recommended for patients with advanced heart failure refractory to medical and device therapy, and who do not have absolute contraindications. When patients become eligible for heart transplantation, they undergo comprehensive evaluation and preparation to optimize their posttransplantation outcomes. This review provides an overview of the processes that are employed to enable the candidates to be transplant-ready when donor hearts are available.
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J. Cardiothorac. Vasc. Anesth. · Nov 2022
Association of Preoperative Pulse Pressure and Oxygen Delivery Index During Cardiopulmonary Bypass With Postoperative Acute Kidney Injury.
To investigate if oxygen delivery index during cardiopulmonary bypass (DO2I) was more strongly associated with acute kidney injury (AKI), the higher the patient's preoperative pulse pressure (PP). ⋯ A lower DO2I during cardiopulmonary bypass appeared more strongly associated with a higher likelihood of developing AKI, the higher the patient's preoperative pulse pressure.