Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 2010
Meta Analysis Comparative StudyEsmolol reduces perioperative ischemia in noncardiac surgery: a meta-analysis of randomized controlled studies.
Literature increasingly has suggested how beta-blockers could be associated with reductions of mortality and morbidity in noncardiac surgery. Recently, the POISE trial showed that beta-blockers could be harmful in the perioperative period. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in noncardiac surgery. ⋯ Esmolol seemed to reduce the incidence of myocardial ischemia in noncardiac surgery without increasing the episodes of hypotension and bradycardia. Large randomized trials are necessary to confirm these promising results.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2010
Randomized Controlled Trial Comparative StudyProphylactic vasopressin in patients receiving the angiotensin-converting enzyme inhibitor ramipril undergoing coronary artery bypass graft surgery.
The purpose of this study was to compare the effects of continuation versus discontinuation of the angiotensin-converting enzyme (ACE) inhibitor ramipril and assess the efficacy of prophylactic vasopressin infusion on hemodynamic stability and vasoactive drug requirements in patients undergoing coronary artery bypass graft (CABG) surgery. ⋯ Preoperative ACE inhibitor continuation predisposed to hypotension upon the induction of anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin infusion prevented post-CPB hypotension. Low-dose vasopressin can be considered as potential therapy in these patients.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2010
Comparative StudyFeasibility of measuring myocardial performance index of the right ventricle in anesthetized patients.
Myocardial performance index, the sum of the 2 isovolumic times divided by the ejection time, contains information on global systolic and diastolic function. This study was performed to determine the feasibility of right ventricular myocardial performance index measurements if measured by transesophageal echocardiography in patients under general anesthesia and positive-pressure ventilation. ⋯ This finding questions the use of right ventricular myocardial performance index measurements in anesthetized patients under positive-pressure ventilation.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2010
Comparative StudyUncalibrated radial and femoral arterial pressure waveform analysis for continuous cardiac output measurement: an evaluation in cardiac surgery patients.
Arterial pressure waveform analysis is a less invasive alternative to the pulmonary artery catheter for continuous cardiac output (CO) measurement. Uncalibrated and calibrated systems are actually available (ie, the FloTrac/Vigileo system [Edwards Lifesciences, Irvine, CA] and the PiCCOplus system [Pulsion Medical Systems, Munich, Germany]). According to the FloTrac/Vigileo manufacturer, reliable measurements can be performed using any existing arterial catheter. The aim of this study was to evaluate CO determined by the FloTrac/Vigileo system using a radial (FCO(radial)) and femoral arterial catheter (FCO(femoral)) as well as the PiCCOplus system (PCO). Intermittent pulmonary artery thermodilution (ICO) was used as primary reference technique. ⋯ Performance of the FloTrac/Vigileo system via radial as well as femoral access and the PiCCOplus monitoring for cardiac output measurement were comparable when tested against intermittent thermodilution in cardiac surgery patients.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2010
ReviewClinical update in cardiac imaging including echocardiography.
Volumetric determinations by cardiac magnetic resonance imaging after tetralogy of Fallot repair may more accurately assess significant right ventricular dilation and pulmonary regurgitation to guide timing of pulmonary valve replacement. Recent guidelines by the American and European Societies of Echocardiography have summarized the clinical approach to valvular stenosis. They emphasize aortic stenosis given its high incidence and assessment confounders such as left ventricular function, aortic regurgitation, systemic hypertension, and mitral regurgitation. ⋯ At the time of mitral surgery, moderate or greater tricuspid regurgitation should be corrected, preferably by rigid annuloplasty. Recent evidence also supports tricuspid annuloplasty for an annular diameter >35 mm regardless of regurgitation severity. Although repair is preferred, tricuspid replacement also has acceptable outcomes.