Seminars in cardiothoracic and vascular anesthesia
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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.
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Semin Cardiothorac Vasc Anesth · Jun 2010
ReviewNeurocognitive dysfunction following cardiac surgery.
Postoperative neurocognitive decline (POCD) is the most frequently reported form of brain injury in the cardiac surgery setting. Even though most patients recover over a period of several months, recovery is variable and often transient, and early decline may be a marker of neurocognitive dysfunction after several years. ⋯ Large prospective, longitudinal trials with appropriate controls remain necessary to identify how patient characteristics, disease progression, and surgical and anesthetic technique contribute to aging-related neurocognitive decline. This article reviews the current literature on the etiology of POCD following cardiac surgery, discusses strategies to reduce patient risk, and provides some insight into some controversies that merit continued investigation.
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Semin Cardiothorac Vasc Anesth · Jun 2010
ReviewIs there a future for neuroprotective agents in cardiac surgery?
This article gives an overview of neuroprotective drugs that were recently tested in clinical trials in cardiac surgery. Also, recommendations are given for successful translational research and considerations for management during cardiac surgery.
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The use of cardiopulmonary bypass (CPB) is associated with cerebral microemboli. Cognitive decline after cardiac surgery has therefore always been attributed to the use of CPB. However, randomized studies comparing coronary bypass surgery with and without CPB failed to establish a clear cognitive benefit of avoiding CPB. The aim of this analysis was to systematically review the studies that directly assessed the association between cerebral microemboli and cognitive decline after cardiac surgery. ⋯ This systematic review could neither confirm nor rule out a causal link between emboli from CPB and postoperative cognitive decline.