Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Dec 2015
ReviewCognitive Dysfunction, Delirium, and Stroke in Cardiac Surgery Patients.
Neurologic injury in the form of cognitive decline, delirium, and stroke are common phenomena in patients undergoing cardiac surgery and continues to be one of the most common complication after cardiac surgery, in spite of improvements in mortality and and improved surgical and anesthetic techniques. These complications lead to a significant increase in length of stay in the intensive care unit, increased length of hospital admission, and functional impairment, resulting in not only profound negative effects on patients who experience these complications, but also to increased costs of medical care and delivery. We discuss each of these complications in regard to their risks factors, incidence, potential therapeutic modalities, and relevant intraoperative and postoperative considerations.
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Semin Cardiothorac Vasc Anesth · Dec 2015
ReviewAcute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care.
Acute kidney injury (AKI) is a serious postoperative complication following cardiac surgery. Despite the incidence of AKI requiring temporary renal replacement therapy being low, it is nonetheless associated with high morbidity and mortality. ⋯ The pathogenesis of AKI is multifactorial and many attempts to prevent or treat renal injury have been met with limited success. In this article, we will discuss the incidence and risk factors for cardiac surgery associated AKI, including the pathophysiology, potential biomarkers of injury, and treatment modalities.
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Semin Cardiothorac Vasc Anesth · Dec 2015
ReviewBlood Conservation in Cardiac Surgery: In Need of a Transfusion Revolution.
Blood transfusion is the most common procedure in cardiac surgery. Increasing evidence exists that excess transfusions are harmful to patients. ⋯ Despite the evidence for the use of restrictive transfusion triggers, its dissemination in the cardiac surgical community has met with resistance. In this review, we outline the risks of transfusion, compare restrictive and liberal transfusion strategies in cardiac surgery, and finally outline perioperative interventions to minimize transfusion in the cardiac surgical patient.
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Semin Cardiothorac Vasc Anesth · Dec 2015
ReviewExtracorporeal Membrane Oxygenation Applications in Cardiac Critical Care.
The use of extracorporeal membrane oxygenation therapy (ECMO) in cardiac critical care has steadily increased over the past decade. Significant improvements in the technology associated with ECMO have propagated this recent resurgence and contributed to improved patient outcomes in the fields of cardiac and transplant (heart and lung) surgery. ⋯ ECMO is also employed during the administration of cardiopulmonary resuscitation, known as extracorporeal life support. In this review, we examine the recent literature regarding the applications of ECMO and also describe emerging topics involving current ECMO management strategies.