Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Mar 2008
ReviewCardiac anesthesia and surgery in geriatric patients.
The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention. ⋯ This article updates the age-related changes in organ subsystems relevant to cardiac anesthesia, perioperative issues, and intraoperative management. Early and late operative outcome in octogenarians undergoing cardiac surgery are reviewed. The data clearly indicate that no patient group is "too old" for cardiac surgery and that excellent outcomes can be achieved in selected group of elderly patients.
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Near infrared spectroscopy (NIRS) is a noninvasive method for the in vivo monitoring of tissue oxygenation. Originally used predominantly to assess cerebral oxygenation, NIRS has gained widespread popularity in many clinical settings in all age groups. ⋯ However, more studies are required to establish the ability of NIRS monitoring to improve patient outcome. This review provides a comprehensive description of NIRS in children.
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Semin Cardiothorac Vasc Anesth · Mar 2008
ReviewAnesthetic considerations in the patient with valvular heart disease undergoing noncardiac surgery.
Valvular heart disease can be an important finding in patients presenting for noncardiac surgery. Valvular heart disease and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events. ⋯ This review article aims to guide the practitioner in the various aspects of anesthetic management in the perioperative care of patients with valvular heart disease. The pharmacological approach to optimization of patient outcome with drugs, such as betablockers and lipid-lowering medications (statins), is an evolving field, and recent developments are discussed in this article.
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Semin Cardiothorac Vasc Anesth · Mar 2008
ReviewRecent advances in application of cerebral oximetry in adult cardiovascular surgery.
Cerebral oximetry is a noninvasive technology that continuously monitors cerebral tissue oxygen saturation, which is a sensitive index of global cerebral hypoperfusion. On the basis of near-infrared spectroscopy technology, information is provided on the availability of oxygen in brain tissue at risk during numerous pathological conditions. ⋯ Recently, patient management with the guidance of cerebral oximetry has resulted in improved patient outcomes. This review will briefly describe the physics behind cerebral oximetry and will provide an overview of the literature focusing primarily on articles published within the past 5 years.
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Semin Cardiothorac Vasc Anesth · Dec 2007
ReviewIntraoperative TEE assessment during mitral valve repair for degenerative and ischemic mitral valve regurgitation.
Intraoperative assessment of the mitral valve (MV) in patients undergoing repair for MV regurgitation is a valuable support for the cardiac surgical team; results can be favored by adequate assessment tailored to the main condition affecting the MV. This article will review current available data for assessment of the MV in degenerative and ischemic mitral regurgitation.