Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Weaning mechanical ventilation after off-pump coronary artery bypass graft procedures directed by noninvasive gas measurements.
Partial pressure of carbon dioxide and oxygen were transcutaneously measured in adults after off-pump coronary artery bypass (OPCAB) surgery. The clinical use of such measurements and interchangeability with arterial blood gas measurements for weaning patients from postoperative mechanical ventilation were assessed. ⋯ More than three fourths of the patients were weaned from mechanical ventilation and extubated based on transcutaneous gas values alone after OPCAB surgery. The noninvasive transcutaneous carbon dioxide measurement can be used as a surrogate for arterial carbon dioxide measurement to manage postoperative OPCAB patients.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Intensive care unit utilization and outcome after esophagectomy.
To establish the frequency of intensive care unit (ICU) admission after esophagectomy and to determine the associated outcomes. ⋯ A significant minority of patients will require ICU admission after esophagectomy, often for aspiration pneumonitis and arrhythmias. Despite high severity of illness scores, the perioperative mortality rate for patients after esophagectomy at a high-volume center is low.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Comparative StudyIn vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma.
The authors hypothesized that various hemostatic products may differently affect viscoelastic clot formation depending on their respective procoagulant activity and fibrinogen content. ⋯ Cryoprecipitate supports clot formation on ROTEM more efficiently than FFP because of the high fibrinogen content. Improved ROTEM variables after platelet addition are presumably caused by increased interaction among thrombin-activated platelets and fibrinogen.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Randomized Controlled TrialA new plasma-adapted hydroxyethyl starch preparation: in vitro coagulation studies.
Preparing hydroxyethyl starch (HES) in a plasma-adapted solution is supposed to improve safety with regard to coagulation. The influence of a new plasma-adapted HES preparation on coagulation was studied. ⋯ Dilution with the nonplasma-adapted HES 130/0.42 was associated with more negative effects on thromboelastometry and platelet aggregation than the same HES 130/0.4 dissolved in a plasma-adapted solution. The benefits of using a plasma-adapted modern HES preparation on blood loss and use of blood/blood products in cardiac surgery need to be studied.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Association of the 98T ELAM-1 polymorphism with increased bleeding after cardiac surgery.
Hemorrhage continues to be a major problem after cardiac surgery despite the routine use of antifibrinolytic drugs, with striking inter-patient variability poorly explained by already known risk factors. The authors tested the hypothesis that genetic polymorphisms of inflammatory mediators and cellular adhesion molecules are associated with bleeding after cardiac surgery. ⋯ The authors found a dose-related association between the 98T E-selectin polymorphism and bleeding after cardiac surgery, independent of and additive to standard clinical risk factors.