Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2009
Clinical TrialPredicted and measured plasma propofol concentration and bispectral index during deep sedation in patients with impaired left ventricular function.
To evaluate the ability of the Schnider pharmacokinetic model to predict plasma propofol concentration during target-controlled propofol infusion in patients with impaired left ventricular function and to investigate the predictive value of the bispectral index (BIS) to indicate deep sedation in this patient group. ⋯ The pharmacokinetic model used markedly underestimated propofol plasma levels in the patient group studied. The large variability among patients suggests that BIS monitoring is not suitable for indicating an exact endpoint corresponding to deep sedation.
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J. Cardiothorac. Vasc. Anesth. · Apr 2009
Decreased nitric oxide products in the urine of patients undergoing cardiac surgery.
Renal vasoconstriction has been blamed as a cause of perioperative renal dysfunction after cardiac surgery. Endothelial function is a critical determinant of vascular tonus, including vasoconstriction. The objective of this study was to establish whether the release of the endothelial vasodilator nitric oxide (NO) or NO products is altered in patients undergoing surgery with cardiopulmonary bypass in 3 different clinical conditions. ⋯ Cardiac surgery with cardiopulmonary bypass is associated with a significant decrease of NO products. In the absence of kidney damage, decreased NO products could represent a physiologic response to cardiopulmonary bypass; however, endothelial dysfunction cannot be excluded.
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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.
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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.