Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Dec 2010
Review Case ReportsThe management of antiplatelet therapy in patients with coronary stents undergoing noncardiac surgery.
Whereas the development of coronary stents has been a major breakthrough in the treatment of coronary artery disease, stent thrombosis, associated with myocardial infarction and death, has introduced a new challenge in the care of patients with coronary stents undergoing noncardiac surgery. This review presents the authors' recommendations regarding the optimal management of such patients. ⋯ On the other hand, managing a patient undergoing non-elective surgery is more difficult and necessitates a case-by-case assessment of bleeding risk versus thrombotic risk based on patient comorbidities, type of stents present, details of the coronary intervention, and type of surgical procedure. Patients with a risk of bleeding that outweighs the risk of stent thrombosis should discontinue at least clopidogrel, whereas all other patients should continue dual antiplatelet therapy throughout the perioperative period.
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Semin Cardiothorac Vasc Anesth · Dec 2010
ReviewA review of perioperative statin therapy for noncardiac surgery.
The leading cause of perioperative morbidity and mortality after major noncardiac surgery is cardiovascular complications. Clinical trials of lipid-lowering 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have shown improved cardiovascular outcomes; therefore, statins have become a mainstay in the prevention of cardiovascular disease. ⋯ This review will (1) examine the evidence for using perioperative statin therapy in the noncardiac surgical patient (2) explore the possible consequences of statin withdrawal, and (3) revisit the evidence for the safety of statin use. Further studies are still needed to establish the optimal dosage as well as timing and length of statin therapy perioperatively.
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Semin Cardiothorac Vasc Anesth · Dec 2010
Randomized Controlled TrialEffects of nondependent lung ventilation with continuous positive-pressure ventilation and high-frequency positive-pressure ventilation on right-ventricular function during 1-lung ventilation.
Background. The application of volume-controlled high frequency positive pressure ventilation (HFPPV) to the nondependent lung (NL) may have comparable effects to continuous positive airway pressure (CPAP) on the right ventricular (RV) function, oxygenation, and surgical conditions during one lung ventilation (OLV) for thoracotomy. Methods. ⋯ The application of NL-HFPPV resulted in improved REF by 33%, SVI and DO2 (P < 0.01) and reduced RVEDVI, RVSWI, PVRI, oxygen uptake, and shunt fraction by 24.8% (P < 0.01) than in the NL-CPAP groups. Conclusion. We concluded that the use of NL-HFPPV is a feasible option and offers improved RV function and oxygenation during OLV for open thoracotomy.
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Semin Cardiothorac Vasc Anesth · Dec 2010
ReviewCardiac output monitoring: is there a gold standard and how do the newer technologies compare?
As a principal determinant of oxygen delivery and of blood pressure, cardiac output (CO) represents an important hemodynamic variable. Its accurate measurement, therefore, is important to the clinician caring for critically ill patients in a variety of care environments. ⋯ The last decade has seen the introduction of several such devices into the clinical arena. This article will serve to give a brief review of the history of CO measurement, to provide a discussion of the measurement of accuracy as it relates to CO measurement, and to discuss some of the newer methods and devices for CO measurement and how they have fared against a "practical" gold standard.
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Semin Cardiothorac Vasc Anesth · Dec 2010
The efficacy of post-cardiopulmonary bypass dosing of vancomycin in cardiac surgery.
Objective. Vancomycin is administered widely to patients undergoing cardiac surgery as prophylaxis against resistant Gram-positive sternal wound and venous donor site infections. The purpose of this study was to determine the efficacy of a standardized prebypass and postbypass dosing regimen of vancomycin by assessing plasma concentrations in the immediate postoperative period and postoperative surgical site infections (SSIs). ⋯ Conclusion. Vancomycin concentrations in the serum were greater than the minimum inhibitory concentration for most staphylococci ranging from 4 to 19.3 µg/mL producing acceptable therapeutic serum concentrations and low rate of infectious complications. Thus postbypass dosing is acceptable in vancomycin cardiac surgical prophylaxis.