Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Feb 2009
ReviewThe year in cardiothoracic and vascular anesthesia: selected highlights from 2008.
The 2008 highlights in cardiovascular and thoracic anesthesia include the ultimate departure of aprotinin from clinical practice. However, a new antihypertensive drug, clevidipine, was approved for perioperative control of hypertension. There were also advances in pharmacologic myocardial conditioning with agents such as cyclosporine, sodium nitroprusside, and levosimendan. ⋯ Important advances in percutaneous coronary intervention included drug-eluting bioabsorbable stents and further insights into the clinical consequences of platelet resistance. These 2008 themes represent a sampling of the total highlights for the year. Many of the advances not covered have been reviewed and discussed in the literature review sections of the Journal in 2008.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2009
Meta Analysis Comparative StudyRecombinant activated factor VII in cardiac surgery: a meta-analysis.
Perioperative microvascular bleeding is associated with increased morbidity and mortality and could be reduced by hemostatic drugs such as recombinant activated factor VII (rFVIIa). Few trials have investigated rFVIIa and each individually lacked power to detect a beneficial effect on transfusion of blood products or thromboembolic side effects. ⋯ This analysis suggests that the hemostatic properties of rFVIIa could reduce the rate of surgical reexploration after cardiac surgery even if an increase of hazardous side effects (eg, perioperative stroke) could not be excluded. Because meta-analyses are hypothesis generating, this issue should be investigated further in large randomized controlled trials.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2009
Randomized Controlled Trial Comparative StudyNeurocognitive function in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass: the effect of two different rewarming strategies.
Hypothermia followed by rewarming during cardiopulmonary bypass can lead to cerebral hyperthermia, which has been implicated as 1 of the causes for postoperative deterioration in neurocognitive function in patients undergoing coronary revascularization. Hence, the authors studied the effects of 2 different rewarming strategies on postoperative neurocognitive function in adult patients undergoing coronary artery bypass graft surgery with the aid of cardiopulmonary bypass. ⋯ Weaning from CPB at 33 degrees C may be a simple and useful strategy to lower the postoperative impairment of neurocognitive function and may be used as a tool to decrease morbidity after coronary revascularization.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyRecombinant factor VIIa treatment of severe bleeding in cardiac surgery patients: a retrospective analysis of dosing, efficacy, and safety outcomes.
To describe rFVIIa dosing and clinical outcomes in cardiovascular surgery patients with refractory bleeding. ⋯ rFVIIa effectively reduces blood product use in cardiovascular surgery patients having massive blood loss. Although the optimal dose of rFVIIa for use in cardiovascular surgery remains undetermined, these data provide evidence that dosing regimens using <90 microg/kg are effective in this population and may provide guidance for centers establishing standardized protocols for rFVIIa use in cardiovascular surgery patients.