Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Feb 2008
Review Meta AnalysisFenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: a meta-analysis.
Acute renal failure is a common and threatening complication in patients undergoing cardiovascular surgery. To determine the efficacy of fenoldopam in the prevention of acute renal failure, the authors performed a systematic review of randomized, controlled trials and propensity-matched studies in patients undergoing cardiovascular surgery. ⋯ This meta-analysis provides evidence that fenoldopam may confer significant benefits in preventing renal replacement therapy and reducing mortality in patients undergoing cardiovascular surgery.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2008
Randomized Controlled Trial Comparative StudyJugular bulb venous oxygen saturation during one-lung ventilation under sevoflurane- or propofol-based anesthesia for lung surgery.
During one-lung ventilation (OLV), systemic oxygenation can be compromised. In such a scenario, if anesthetic techniques were used that adversely affected cerebral oxygen balance, the risk for impaired cerebral oxygen balance may be increased. In this study, jugular bulb venous oxygen saturation (SjO(2)) during OLV under sevoflurane- or propofol-based anesthesia for lung surgery was investigated. ⋯ Cerebral oxygen desaturation was more frequently detected during OLV under propofol- versus sevoflurane-based anesthesia. Cerebral oxygen balance during OLV for lung surgery was less impaired under sevoflurane-based anesthesia compared with propofol; however, the clinical outcome or implications for cognitive function need to be determined.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2008
Randomized Controlled Trial Comparative StudyA comparison of activated coagulation time-based techniques for anticoagulation during cardiac surgery with cardiopulmonary bypass.
The inadequacy of heparinization during cardiopulmonary bypass (CPB) can lead to hemostatic activation with increases in postoperative blood loss and blood product requirements after cardiac surgery. Because activated coagulation time (ACT) measurements may not be accurate during CPB, the use of a heparin management system (HMS) has been advocated. This study compared the efficacy of a modified ACT-based system versus an HMS (Hepcon; Medtronic Inc, Minneapolis, MN) for CPB anticoagulation. ⋯ ACT-based heparinization was found to be as efficacious as the Hepcon HMS system.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2008
Randomized Controlled TrialAprotinin reduces cardiac troponin I release and inhibits apoptosis of polymorphonuclear cells during off-pump coronary artery bypass surgery.
In addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting. ⋯ The authors conclude that aprotinin reduces perioperative cardiac troponin I release and attenuates apoptosis in polymorphonuclear cells but has no significant effects on plasma cytokine levels in patients undergoing off-pump coronary artery bypass graft surgery.
-
J. Cardiothorac. Vasc. Anesth. · Feb 2008
Comparative StudyCardiopulmonary bypass parameters and hemostatic response to cardiopulmonary bypass in infants versus children.
Because infants have relatively more blood loss (mL/kg) than older children during cardiac surgery involving cardiopulmonary bypass (CPB), the authors compared hemostatic activation between infants and older children undergoing cardiac surgery. ⋯ Compared with children, infants had greater blood loss (mL/kg), greater drop in platelets during CPB, lower active tPA, and higher active PAI-1. Cumulative thrombin generation after CPB, indicated by F1.2 levels, correlated with early blood loss.