HSR proceedings in intensive care & cardiovascular anesthesia
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HSR Proc Intensive Care Cardiovasc Anesth · Jan 2009
Fluid responsiveness and right ventricular function in cardiac surgical patients. A multicenter study.
We investigated fluid responsiveness in a population of patients undergoing coronary artery revascularization, with respect to their right ventricular ejection fraction. ⋯ When right ventricular systolic function is depressed, the right ventricle inability to fill the left chambers results in a lack of the left-sided responsiveness predictors. When the right ventricular systolic function is preserved, all the classical fluid responsiveness predictors are confirmed. Right ventricular function is therefore to be always considered when addressing the problem of fluid responsiveness.
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HSR Proc Intensive Care Cardiovasc Anesth · Jan 2009
Cardiac protection by volatile anesthetics in non-cardiac surgery? A meta-analysis of randomized controlled studies on clinically relevant endpoints.
Volatile anesthetics improve post-ischemic recovery. A meta-analysis suggested that the cardioprotective properties of desflurane and sevoflurane could reduce mortality and cardiac morbidity in cardiac surgery. Recent American College of Cardiology / American Heart Association Guidelines recommended volatile anesthetic agents during non-cardiac surgery for the maintenance of general anesthesia in patients at risk for myocardial infarction but whether these cardioprotective properties exist in non-cardiac surgery settings is controversial. We therefore performed a meta-analysis of randomized studies to investigate this issue. ⋯ This meta-analysis highlights a weakness in the literature and the results can be used to design future studies: the cardioprotective properties of desflurane and sevoflurane have never been studied in noncardiac surgery. No randomized study, among those which compared desflurane or sevoflurane to intravenous anesthetics, has addressed major outcomes such as myocardial infarction or mortality. Large, multicentre, randomized clinical trials including patients undergoing high-risk non-cardiac surgery and reporting clinically relevant outcomes such as myocardial infarction and mortality are needed.
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Patients can show arterial pressure and cardiac index within the normal range and still be in circulatory shock if oxygen and metabolic demand is increased or blood flow distribution is altered. Lactate is produced in anaerobic environment to preserve cellular integrity and physicians use its blood concentration value as a reliable marker of tissue hypoxia and energy failure. The authors review the recent literature on the importance of mixed venous oxygen saturation (SvO(2)) as an early sign of inadequate DO(2) that precede the lactate production.
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HSR Proc Intensive Care Cardiovasc Anesth · Jan 2009
Most Care®: a minimally invasive system for hemodynamic monitoring powered by the Pressure Recording Analytical Method (PRAM).
Invasive hemodynamic monitoring is a cornerstone of the care of critically ill and hemodynamically unstable patients in both intensive care units and operating rooms. The assessment of cardiac output by means of the pulmonary artery catheter has been considered the clinical gold standard. Nevertheless, several concerns have been raised regarding its invasiveness, usefulness, and associated complica-tions. ⋯ PRAM provides the measurement of the main factors of hemodynamics, such as systemic blood pressures, stroke volume, cardiac output, and vascular resistances. Moreover, dynamic indices of fluid responsiveness are continuously displayed. In the present paper, we reviewed the current literature focusing on advantages and limitations of PRAM.
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Based upon the surgical location and indication, including redundant regions, eloquent areas, deep brain stimulation, and epilepsy foci, some patients will benefit from an awake craniotomy, which allows completion of neurocognitive testing during the intra-operative period. This paper suggests patient selection criteria through a new decision algorithm. ⋯ We describe the sequence of steps and anesthetic agents which has proved successful for our group. Finally, the use of the proposed decision algorithm simplifies preoperative anesthetic selection and prevents erroneous assignment of inappropriate patients to an awake technique.