Journal of cardiothoracic and vascular anesthesia
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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.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Comparative StudyA propensity-matched comparison of the incidence of new-onset postoperative atrial arrhythmias in cardiac and noncardiac thoracic surgery patients.
The primary aim of this investigation was to compare the incidence of new-onset postoperative atrial arrhythmias (POAAs) in cardiac versus noncardiac thoracic surgery patients. A subgroup analysis also was performed in the cardiac surgery patients comparing POAAs in patients who underwent cardiac surgery on and off cardiopulmonary bypass (CPB). ⋯ The incidence of new-onset POAAs was higher in patients undergoing cardiac surgery than in patients undergoing noncardiac thoracic surgery in propensity-matched patient groups. CPB was not associated with new-onset POAAs.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Profound effects of cardiopulmonary bypass priming solutions on the fibrin part of clot formation: an ex vivo evaluation using rotation thromboelastometry.
Dilutional coagulopathy as a consequence of cardiopulmonary bypass (CPB) system priming may also be affected by the composition of the priming solution. The direct effects of distinct priming solutions on fibrinogen, one of the foremost limiting factors during dilutional coagulopathy, have been minimally evaluated. Therefore, the authors investigated whether hemodilution with different priming solutions distinctly affects the fibrinogen-mediated step in whole blood clot formation. ⋯ All studied priming solutions prolonged coagulation time and decreased clot formation, but the fibrinogen-limiting effect was the most profound for the HES-containing priming solution. These results suggest that the composition of priming solutions may distinctly affect blood clot formation, in particular with respect to the fibrinogen component in hemostasis.
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J. Cardiothorac. Vasc. Anesth. · Jun 2010
Risk factors for red blood cell transfusion after coronary artery bypass graft surgery.
Perioperative transfusion of red blood cells is associated with increased morbidity and mortality. The authors investigated the correlation between preoperative risk factors and the number of red blood cell units received in patients undergoing coronary artery bypass graft surgery. ⋯ In this study, the authors identified risk factors for receiving red blood cells in patients undergoing coronary artery bypass graft surgery. The authors were able to implement these factors in their daily practice by sharpening the criteria for the direct availability of red blood cells in the operating room.