Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Sep 2010
Randomized Controlled Trial Comparative StudyCardiac protection during on-pump coronary artery bypass grafting: ischemic versus isoflurane preconditioning.
To compare the cardioprotective effects of anesthetic preconditioning by isoflurane with ischemic preconditioning. ⋯ Based on this very small sample size, these data support a cardioprotective effect of isoflurane and ischemic preconditioning during CABG surgery.
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Semin Cardiothorac Vasc Anesth · Sep 2010
ReviewIntraoperative hemodynamic instability during and after separation from cardiopulmonary bypass.
Every year, more than 1 million patients worldwide undergo cardiac surgery. Because of the aging of the population, cardiac surgery will increasingly be offered to patients at a higher risk of complications. The consequence is a reduced physiological reserve and hence an increased risk of mortality. ⋯ One of the most dreaded complications in cardiac surgery is difficult separation from cardiopulmonary bypass (CPB). When separation from CPB is associated with right-ventricular failure, the mortality rate will range from 44% to 86%. Therefore, the diagnosis and the preoperative prediction of difficult separation from CPB will be crucial to improve the selection and care of patients and to prevent complications for this high-risk patient population.
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Semin Cardiothorac Vasc Anesth · Sep 2010
ReviewVasopressin and methylene blue: alternate therapies in vasodilatory shock.
Cardiac surgery with cardiopulmonary bypass (CPB) is frequently complicated by vasoplegic syndrome, a vasodilatory shock state. Traditional treatment based on fluid resuscitation and catecholamine drugs is ineffective in a number of patients. Clinical trials investigating both vasopressin and methylene blue as additional rescue or preventative therapy are reviewed. ⋯ Methylene blue is suggested to facilitate CPB weaning, reduce renal, respiratory, arrhythmic, and septic complications, reduce mortality, and accelerate ICU and hospital recovery. Safety concerns include oximeter interference, pulmonary hypertension, neurotoxicity, arrhythmias, and potentially altered coronary, mesenteric, and renal perfusion. Research on both molecules is ongoing and has yet to confirm on a larger scale their efficacy and safety as treatments for post-CPB vasoplegic syndrome.
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Semin Cardiothorac Vasc Anesth · Sep 2010
Predictive model for postoperative delirium in cardiac surgical patients.
Delirium is a common complication following cardiac surgery, and the predictors of delirium remain unclear. The authors performed a prospective observational analysis to develop a predictive model for postoperative delirium using demographic and procedural parameters. ⋯ Increased age (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.6-3.9; P < .0001, per 10 years) and increased duration of surgery (OR = 1.3; 95% CI = 1.1-1.5; P = .0002, per 30 minutes) were independently associated with postoperative delirium. Gender, BMI, diabetes mellitus, preoperative ejection fraction, surgery type, length of cardiopulmonary bypass, intraoperative blood component administration, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, and Charlson Comorbidity Index, were not independently associated with postoperative delirium.
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Semin Cardiothorac Vasc Anesth · Sep 2010
The use of ultrasound to guide interventions: from bench to bedside and back again.
The ultrasound machine was originally devised as a diagnostic tool to help evaluate heart structure and function. With recent advances in ultrasound, including live 3D ultrasound, its potential to guide interventions within the heart has increasingly been recognized. ⋯ Anesthesiologists have also used ultrasound with much success in cardiac operating rooms (ORs) to guide cannula placement and, to a limited extent, interventions. The focus of this article is a review of the author's work on ultrasound and virtual reality-guided cardiac interventions, both in the research laboratory and in the OR.