Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
ReviewPostcardiotomy Shock Syndrome: A Narrative Review of Perioperative Diagnosis and Management.
Postcardiotomy shock (PCS) is generally described as the inability to separate from cardiopulmonary bypass due to ineffective cardiac output after cardiotomy, which is caused by a primary cardiac disorder, resulting in inadequate tissue perfusion. Postcardiotomy shock occurs in 0.5% to 1.5% of contemporary cardiac surgery cases, and is accompanied by an in-hospital mortality of approximately 67%. In the last 2 decades, the incidence of PCS has increased, likely due to the increased age and baseline morbidity of patients requiring cardiac surgery. In this narrative review, the authors discuss the epidemiology and pathophysiology of PCS, the rationale and evidence behind the initiation, continuation, escalation, and discontinuation of mechanical support devices in PCS, and the anesthetic implications.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
Anesthetic Choice for Cardiovascular Implantable Electronic Device Placement and Lead Removal: A National Anesthesia Clinical Outcomes Registry Analysis.
The authors evaluated the anesthetic approach for cardiovascular implantable electronic device (CIED) placement and transvenous lead removal, hypothesizing that monitored anesthesia care is used more frequently than general anesthesia. ⋯ General anesthesia still has a strong presence in the anesthetic management of both CIED placement and transvenous lead removal. Anesthetic choice, however, varies with patient demographics, hospital characteristics, and geographic region.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
Evaluation of Cangrelor Use After Percutaneous Coronary Intervention in Patients With Mechanical Circulatory Support.
To describe cangrelor use in patients on concurrent mechanical circulatory support who underwent postpercutaneous coronary intervention. ⋯ For patients receiving cangrelor as a bridge to oral P2Y12 inhibitor therapy on mechanical circulatory support, the authors observed a low rate of major bleeding and no episodes of thrombosis. Lower starting doses appear feasible with no observed increased risk of thrombotic complications. Future studies are needed to confirm these observations.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
Observational StudyAssociation Between the Use of Midazolam During Cardiac Anesthesia and the Incidence of Postoperative Delirium: A Retrospective Cohort Study Using a Nationwide Database.
To evaluate the association between the intraoperative administration of midazolam and the incidence of postoperative delirium in patients undergoing cardiac surgery. ⋯ Intraoperative administration of midazolam may not induce postoperative delirium in patients undergoing cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
CommentCon: Can We Influence Postoperative Outcomes of Frail Patients After Cardiac Surgery?
Frail patients are scheduled routinely for elective cardiovascular surgery. Despite the proven association between frailty and postoperative outcomes, currently, there is no consistent evidence that the preoperative optimization of frail patients with preoperative nutrition support and exercise programs can alter postoperative mortality. Established frailty diagnostic tools are not sufficient to grasp the multidimensional nature of frailty in cardiovascular patients. Prehabilitation programs and preoperative nutritional support are time- and resource-consuming and, therefore, are hard to implement in routine clinical practice.