Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2007
Comparative StudyDifferential expression in markers for thrombin, platelet activation, and inflammation in cell saver versus systemic blood in patients undergoing on-pump coronary artery bypass graft surgery.
Elimination of cardiotomy suction increases reliance on cell-saver blood-conservation techniques. Reinfusion of processed cell-saver blood (PCSB) even without using cardiotomy field suction may contribute to thrombin, cytokines, platelet activators, and hemolytic factors measured systemically. ⋯ Reinfusion of PCSB directly and independently contributes to systemic elevations in interleukin-8, polymorphonuclear elastase, neuron-specific enolase, and S-100beta, augmenting and perhaps accentuating the postoperative inflammatory response. Further evaluation and improvement in cell-salvaging technology and processing techniques are warranted.
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J. Cardiothorac. Vasc. Anesth. · Aug 2007
Comparative StudyWake-up test after carotid endarterectomy for combined carotid-coronary artery surgery: a case series.
In combined carotid-coronary artery surgery, it is important to determine patients' neurologic status after carotid endarterectomy (CEA). An initial stroke could be exacerbated by cardiopulmonary bypass required for coronary artery bypass graft (CABG) surgery. Various monitoring methods (eg, electroencephalogram) have been used to reduce neurologic deficits during CEA under general anesthesia. However, none of the methods of determining neurologic status of patients are ideal during the time between the end of CEA and the beginning of CABG surgery. In this study, patient's neurologic status was assessed after CEA with a wake-up test to identify stroke before CABG surgery. ⋯ Although this is a case series, the authors believe that performing a neurologic examination using a wake-up test may make a contribution and increases the safety of combined surgical procedures in patients with coronary and carotid artery disease.
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J. Cardiothorac. Vasc. Anesth. · Jun 2007
Patient understanding of the importance of beta-blocker use in the perioperative period.
Perioperative beta-adrenergic blockade has been shown to decrease morbidity and mortality after noncardiac surgery. The objective of this study was to determine patient knowledge of the importance of perioperative beta-blockade in a population already taking chronic therapy and to assess the effectiveness of medical and surgical providers in patient education regarding these benefits. ⋯ This study suggests low patient understanding of the potential importance and reasons for perioperative beta-blockade. Patients who recognized perioperative benefit identified antihypertensive versus cardioprotective effects. Clinicians can improve education of patients already taking daily beta-blockers regarding these potential benefits.