Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyExcellent results of cardiac surgery in patients with previous kidney transplantation.
Patients with a kidney allograft are at high risk for the development of cardiovascular diseases that may require surgical intervention. Little is known about the outcome of cardiac surgery in these patients. ⋯ Cardiac surgery can be performed safely in kidney transplant recipients with low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient with early functional recovery. Late survival of kidney recipients with chronic allograft failure undergoing cardiac procedures is limited when compared with that of the general cardiac surgery population. The present data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients.
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyMicrocirculatory imaging in cardiac anesthesia: ketanserin reduces blood pressure but not perfused capillary density.
It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and alpha-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting. ⋯ SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation.
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyMajor complications related to the use of transesophageal echocardiography in cardiac surgery.
The purpose of this study was to determine the incidence of injury associated with transesophageal echocardiography (TEE injuries) in cardiac surgery. ⋯ TEE is associated with an incidence of major injuries of about 1 per 1,000 patients, with older women having a much higher risk. TEE use in cardiac surgery should be evaluated in the light of practice guidelines and morbidity and mortality data and not considered routine.