Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
ReviewPrognostic Impact of Anemia and Blood Transfusions on Cardiovascular Outcomes in Patients Undergoing Vascular Surgery: A Scoping Review.
Prior studies suggest an association of anemia and blood transfusion with increased morbidity and mortality in patients undergoing cardiac surgery. However, the impact of perioperative anemia and blood transfusion on clinical outcomes in patients undergoing major vascular surgery has been poorly defined yet. The primary objectives of this scoping review were to determine the extent of the evidence base that links anemia and blood transfusions to mortality and cardiovascular outcomes in patients undergoing major vascular surgery, and identify recurring themes or gaps in the literature to guide future research. ⋯ The weight of the evidence suggests that anemia carries a substantial burden of cardiovascular complications, mortality, and multiorgan complications, resulting in increased health care costs. Peripheral and endovascular aortic surgery are affected deeply by the impact of anemia. Anemia itself stands out as a crucial predictor for requiring transfusions. In turn, the effect of transfusion of blood products is associated with worse outcomes and complications.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Multicenter StudyThe Use of Methadone and Ketamine for Intraoperative Pain Management in Cardiac Surgery: A Retrospective Cohort Study.
To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients. ⋯ Adding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyAnesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation: A Retrospective Observational Cohort Study.
To summarize anesthetic and perioperative considerations in patients undergoing the convergent procedure for atrial fibrillation (AF). ⋯ This retrospective analysis of medical records showed that many patients with recurrent AF presenting for convergent procedure carry a burden of multiple comorbidities (eg, obesity, obstructive sleep apnea), and history of unsuccessful ablations. Multistage multidisciplinary convergent procedure might be lengthy and potentially complicated and requires meticulous preparation (eg, endotracheal intubation, lung isolation, advanced cardiac monitoring, central venous access) to ensure optimal outcomes. Anesthesiologists and perioperative physicians should tailor their approach to this multimorbid population while anticipating perioperative respiratory events, rapid hemodynamic shifts, blood loss, and the possibility of CPB.