Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
Randomized Controlled TrialEffect of Ventilation Strategy During Cardiopulmonary Bypass on Arterial Oxygenation and Postoperative Pulmonary Complications After Pediatric Cardiac Surgery: A Randomized Controlled Study.
To compare the effects of 3 ventilation strategies during cardiopulmonary bypass (CPB) on arterial oxygenation and postoperative pulmonary complications (PPCs). ⋯ Maintaining ventilation during CPB was associated with better oxygenation and did not reduce the incidence of PPCs in pediatric patients undergoing cardiac surgery.
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Temporary epicardial pacing frequently is employed after cardiac surgery, and can have a significant impact on a patient's hemodynamics, arrhythmias, and valvulopathies. Given that anesthesiologists often are involved intimately in the initial programming and subsequent management of epicardial pacing in the operating room and intensive care unit, it is important for practitioners to have a detailed understanding of the modes, modifiable intervals, and potential complications that can occur after cardiac surgery. Because this topic has not been reviewed recently in anesthesia literature, the authors attempted to review relevant epicardial pacemaker specifics, discuss modes and parameters that apply to the perioperative period, present an algorithm for mode selection, describe the potential effects of epicardial pacing on valvulopathies and hemodynamics, and, finally, discuss some postoperative considerations.
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
ReviewAveir Leadless Pacemaker: Novel Technology With New Anesthetic Implications.
The Aveir VR Leadless Pacemaker (Abbott, Chicago, IL) recently was approved by the US Food and Drug Administration, and joined the Micra (Medtronic, Minneapolis, MN) transcatheter pacing system in the realm of nontransvenous cardiovascular implantable devices. The Aveir VR offers design improvements over its predecessor, the Nanostim (St. ⋯ There are recommendations for the perioperative management of conventional transvenous pacemakers, but leadless pacemakers add a new layer of consideration. Although there have been prior documented experiences with the Micra device, there are enough differences between the Aveir VR and the Micra that it is important to understand what makes the Aveir VR unique if an anesthesiologist were to come across one preoperatively.
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
A Pilot Study to Assess the Clinical Onset of IV Heparin in Interventional Cardiology and Cardiac Surgery.
To determine the onset of heparin anticoagulation, using 2 different measures of activated clotting times (ACT), thromboelastography (TEG; R-time), and anti-Xa levels, after administering low- (100 U/kg) and high- (300 U/kg) dose intravenous (IV) heparin to patients undergoing transcatheter aortic valve replacement (TAVR) and cardiac surgery, respectively. ⋯ In this pilot study, heparin anticoagulation was detected as early as 30 seconds after IV administration, based on ACT, anti-Xa levels, and TEG R-time.