Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Dec 2006
Comparative StudyIncreased risk associated with combined carotid endarterectomy and coronary artery bypass graft surgery: a propensity-matched comparison with isolated coronary artery bypass graft surgery.
Risk associated with combined carotid endarterectomy and coronary artery bypass graft surgery (CEA/CABG) is controversial. The present study objective was to compare morbidity and mortality outcomes in well-matched patients who underwent combined CEA/CABG surgery with patients undergoing isolated CABG surgery with and without a history of a prior CEA. ⋯ Increased mortality and overall morbidity outcomes were found in the combined CEA/CABG group when compared with well-matched isolated CABG patients, but similar when compared with well-matched isolated CABG patients with a history of previous CEA. Patients undergoing combined CEA/CABG procedures had significantly longer ICU and hospital lengths of stay compared with patients undergoing isolated CABG procedures.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2006
Long-term outcome of patients with perioperative myocardial infarction as diagnosed by troponin I after routine surgical coronary artery revascularization.
Diagnosis of perioperative myocardial infarction (P-MI) after coronary artery bypass graft (CABG) surgery traditionally relied on a combination of electrocardiographic and enzyme assay changes. Patients with Q-wave P-MIs who survive to hospital discharge have a poorer long-term prognosis. Troponin assays are more sensitive and specific for detecting minor P-MI, with an increased incidence of P-MI being reported. This study investigated if P-MI after CABG surgery, as defined by troponin-I isozyme (cTn-I), correlated with long-term outcome. ⋯ It was shown that P-MI as defined by cTn-I is associated with an increased long-term incidence of adverse cardiovascular events. An elevated peak cTn-I level (>or=15 microg/L) identified patients at increased risk but did not have a powerful positive predictive value for either cardiovascular (48%) or vascular (26%) complications. However, a peak cTn-I <15 microg/L was a negative predictor of adverse vascular outcome (95%). This may have implications for postoperative patient follow-up.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2006
Calcium supplementation of saline-based colloids does not produce equivalent coagulation profiles to similarly balanced salt preparations.
The primary objective of this study was to test the hypothesis that calcium alone does not account for the observed coagulation differences between saline-based and balanced electrolyte IV fluid preparations. ⋯ The different coagulation profiles between the 2 pentastarch preparations, as well as similar profiles of pentastarch in saline and hetastarch in balanced electrolyte solution, suggest that calcium is not solely responsible for previously observed effects.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2006
Comparative Study Clinical TrialCorrelation between cerebral and mixed venous oxygen saturation during moderate versus tepid hypothermic hemodiluted cardiopulmonary bypass.
This study was undertaken to compare cerebral oxygen saturation (RsO(2)) and mixed venous oxygen saturation (SvO(2)) in patients undergoing moderate and tepid hypothermic hemodiluted cardiopulmonary bypass (CPB). ⋯ During moderate hypothermic hemodiluted CPB, there was a significant increase of SvO(2) associated with a paradoxic decrease of RsO(2) that was attributed to the low temperature-corrected PaCO(2) values. During tepid CPB after slow rewarming, regional cerebral oxygen saturation was increased in association with an increase with the temperature-corrected PaCO(2) values. The results show that during hypothermic hemodiluted CPB using the alpha-stat strategy for carbon dioxide homeostasis, cerebral oxygen saturation is significantly higher during tepid than moderate hypothermia.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2006
Staged anesthesia for combined carotid and coronary artery revascularization: a different approach.
Combined coronary artery bypass graft (CABG) surgery and carotid endarterectomy (CEA) are performed in an attempt to reduce the risk of postoperative stroke after CABG surgery in patients with significant or symptomatic carotid artery stenosis. The choice between regional and general anesthesia for CEA is still under debate. Regional anesthesia offers an excellent monitoring technique of the neurologic status of the awake patient during carotid clamping. In an attempt to improve monitoring of the neurologic status and avoid the use of temporary shunting in patients undergoing the combined procedure, a different approach is described combining regional anesthesia for CEA followed immediately by general anesthesia for CABG surgery. ⋯ This staged anesthetic approach for combined CABG and CEA surgery is an alternative in this complex subset of patients.