Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2006
Implication of the anatomy of the pericardial reflection on positioning of central venous catheters.
Central venous catheterization is associated with a significant incidence of complications (5%-20%). The incidence of perforation is approximately 0.25% to 0.4%. To prevent cardiac tamponade associated with a high risk of death, Food and Drug Administration guidelines state that the tip of a central venous catheter (CVC) should not be placed in, or allowed to migrate into, the heart. Therefore, in order to prevent cardiac tamponade, a catheter should be placed above the pericardial reflection. Thus, the intrapericardial length of the superior vena cava (SVC) was studied. Neither the pericardial reflection nor the exact entrance to the right atrium (RA) can be identified by chest x-ray. The goal of this study was to evaluate the variability of the intrapericardial section in relation to the SVC. ⋯ Catheters ending below the pericardial reflection, hence positioned in the caudal third of the SVC, are likely to run along the long axis of the vein and the risk for perforation is minimized. Therefore, the authors recommend placing all catheters below the pericardial reflection. According to the present data, CVCs placed approximately 30 mm above the RA border, thus complying with the Food and Drug Administration guidelines, still may have their tips positioned below the pericardial reflection. In this position, pericardial tamponade still may occur. Perforation above the pericardial reflection will result in a hemo- or hydrothorax/mediastinum. A bedside method to determine the position of the CVC with respect to the pericardial reflection (eg, electrocardiographic guidance) should be used.
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J. Cardiothorac. Vasc. Anesth. · Dec 2006
Randomized Controlled Trial Comparative StudyTemperature management during off-pump coronary artery bypass graft surgery: a randomized clinical trial on the efficacy of a circulating water system versus a forced-air system.
The aim of this study was to evaluate the performance of a new temperature management system specifically designed for cardiac surgery (Allon ThermoWrapping Thermoregulation System; MTRE Advanced Technologies Ltd, Or Akiva, Israel) using a circulating-water garment and to compare it with a conventional forced-air cover system in order to determine whether it could reduce the incidence of perioperative hypothermia during off-pump coronary artery bypass graft (OPCAB) surgery. ⋯ The circulating-water garment, Allon ThermoWrapping Thermoregulation System, maintained normothermia during OPCAB surgery better than forced-air systems, especially after the first 2 hours of surgery, and it was not associated with surgical field disturbance.
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J. Cardiothorac. Vasc. Anesth. · Dec 2006
Randomized Controlled Trial Comparative StudyComparison of hemodynamic changes after acute normovolemic hemodilution using Ringer's lactate versus 5% albumin in patients on beta-blockers undergoing coronary artery bypass surgery.
Acute normovolemic hemodilution (ANH) is used cautiously in coronary artery disease (CAD) patients because of concerns of compromised coronary blood flow. This study aimed to compare hemodynamic changes by using either Ringer's lactate or albumin for ANH in CAD patients receiving beta-blockers. ⋯ Hemodynamic stability was better maintained by 5% albumin than Ringer's lactate for ANH in chronic beta-blocked CAD patients. Despite an increase in cardiac index, systemic oxygen delivery was decreased irrespective of the hemodiluting fluid used. ANH to a hemoglobin value of 10 g/dL in chronically beta-blocked CAD patients was well tolerated.
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J. Cardiothorac. Vasc. Anesth. · Dec 2006
Comparative Study Clinical TrialAssessment of cerebral oxygen balance during deep hypothermic circulatory arrest by continuous jugular bulb venous saturation and near-infrared spectroscopy.
The purpose of this study was to compare jugular venous bulb saturation (SjvO(2)) and regional cerebral oximetry (rSO(2)) by near-infrared spectroscopy (NIRS) during procedures with deep hypothermic circulatory arrest (DHCA). ⋯ It was concluded that NIRS does not closely correlate with SjvO(2) in this patient population. Cerebral oximetry measured by NIRS could not replace jugular bulb saturation as an intraoperative marker of adequate metabolic suppression.
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J. Cardiothorac. Vasc. Anesth. · Dec 2006
Randomized Controlled TrialBolus administration of landiolol, a short-acting, selective beta1-blocker, to treat tachycardia during anesthesia: a dose-dependent study.
The purpose of this study was to clarify the clinical efficacy of landiolol, a selective beta(1)-blocker, in patients developing tachycardia during anesthesia. ⋯ The results showed that bolus administration of landiolol was effective in the treatment of tachycardia during anesthesia in surgical patients. Landiolol was more efficacious in reducing heart rate than blood pressure.