Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Randomized Controlled Trial Comparative StudyA preliminary study of a new tranexamic acid dosing schedule for cardiac surgery.
The authors have developed an alternative dosing schedule for tranexamic acid that incorporates the effects of renal function on tranexamic acid concentrations. The objectives of this study were to determine if this new dosing schedule can achieve the desired plasma concentration of tranexamic acid and reduce intra- and interpatient variability in tranexamic acid plasma concentrations relative to the current dosing schedule. ⋯ The new dosing protocol for tranexamic acid resulted in more consistent blood concentrations of tranexamic acid, but not stable tranexamic acid levels >20 microg/mL on cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative Study Clinical TrialAssessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter.
To verify the reliability of different markers of fluid-responsiveness during off-pump cardiac surgery (OPCAB). ⋯ Dynamic parameters of fluid responsiveness by LiDCO are highly sensitive for assessment of intravascular volume status during OPCAB surgery. In contrast, even if static parameters by TEE reflect changes in ventricular diastolic volume, they are poor indicators of fluid responsiveness. Surprisingly, no significant correlation between DeltaVAo (TEE) and DeltaCI% was found.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative StudyChronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery.
Chronic angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) therapy has been reported to result in intraoperative hypotension in patients undergoing general anesthesia. This study evaluated the association between ACE-I/ARB therapy and the hemodynamics of patients undergoing noncardiac surgery using a large patient dataset. ⋯ Chronic diuretic therapy is associated with more frequent hypotension in ACE-I/ARB-treated patients undergoing noncardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2008
Comparative StudyThe accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery.
The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables. ⋯ The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula.