Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2007
Randomized Controlled TrialEffects of preemptive enoximone on left ventricular diastolic function after valve replacement for aortic stenosis.
Left ventricular (LV) hypertrophy is associated with increased diastolic chamber stiffness early after aortic valve replacement for valve stenosis. Enoximone, a phosphodiesterase III inhibitor, has been shown to improve myocardial contractility and relaxation when administered as a single dose after cardiac surgery. The present study investigated, by analysis of transmitral flow velocity patterns and end-diastolic pressure-area relations, whether enoximone administered before aortic valve surgery has an effect on LV diastolic properties. ⋯ Preemptive enoximone did not change LV diastolic function based on diastolic filling patterns or LV stiffness indices (K(LV) and beta) derived from Doppler early filling deceleration time and pressure-area relations. Doppler data suggested improvement of left atrial systolic function and preservation of left atrial reservoir function with enoximone.
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J. Cardiothorac. Vasc. Anesth. · Jun 2007
Randomized Controlled TrialEffects of alveolar recruitment on arterial oxygenation in patients after cardiac surgery: a prospective, randomized, controlled clinical trial.
Pulmonary atelectasis and hypoxemia remain considerable problems after cardiac surgery. The objective of this study was to determine the efficacy of consecutive vital capacity maneuvers (C-VCMs) to improve oxygenation in patients after cardiac surgery. ⋯ C-VCM is an effective method to reduce hypoxemia associated with the formation of atelectasis after cardiac surgery with CPB.
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J. Cardiothorac. Vasc. Anesth. · Jun 2007
Atrial fibrillation after aortic arch repair requiring deep hypothermic circulatory arrest: incidence, clinical outcome, and clinical predictors.
To delineate the incidence, outcome impact, and clinical predictors of atrial fibrillation (AF) after adult aortic arch repair requiring deep hypothermic circulatory arrest (AAR-DHCA) AIMS: To determine the incidence of AF after AAR-DHCA, to determine whether AF after AAR-DHCA affects mortality or stay in the intensive care unit (ICU), to determine multivariate predictors for AF after AAR-DHCA, and to determine whether aprotinin protects against AF after AAR-DHCA. ⋯ AF after AAR-DHCA is common but does not independently increase mortality or ICU stay. The risk of AF after AAR-DHCA increases with age but decreases with the degree of hypothermia during DHCA. Aprotinin does not appear to affect the risk of AF after AAR-DHCA.
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J. Cardiothorac. Vasc. Anesth. · Jun 2007
Predictors of perioperative beta-blockade use in vascular surgery: a mail survey of United States anesthesiologists.
It was hypothesized that anesthesiologists' decisions to provide perioperative beta-blockade during vascular surgery would be influenced more by physician factors than by those of their patients. ⋯ Preferences for perioperative beta-blockade use in vascular surgery patients are influenced by anesthesiologists' demographics as well as patient comorbidities or degree of surgical stress. This finding suggests that efforts to increase perioperative beta-blockade in high-risk vascular patients face significant barriers from some groups of clinicians.
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J. Cardiothorac. Vasc. Anesth. · Jun 2007
Establishing extracorporeal membrane oxygenation in a university clinic: case series.
Although extracorporeal membrane oxygenation (ECMO) is well established for respiratory failure in neonates, application in adults is still considered controversial. The survival of patients with acute respiratory distress syndrome and ECMO therapy is 50% to 70%. ⋯ ECMO has been shown to be a successful therapy for acute respiratory distress syndrome when conventional strategies have failed. Pre-ECMO risk assessment may be useful in the evaluation of patients.