The heart surgery forum
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The heart surgery forum · Apr 2011
Case ReportsPericardial tamponade due to perforation of a posterolateral branch of the circumflex artery caused by a perforating edge of a resected rib following orthopedic surgery in a 14-year-old patient.
A 14-year-old female patient with Marfan syndrome was resuscitated because of pericardial tamponade following orthopedic surgery to correct scoliosis. The emergency sternotomy revealed injury to a posterolateral branch of the circumflex artery caused by pericardial perforation by the stump of a previously resected rib. ⋯ The small posterolateral branch was sewn over, and the sharp edge of the rib stump was smoothed by abrasion and covered with a Gore-Tex membrane. The patient recovered completely during the remainder of her postoperative stay.
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The heart surgery forum · Apr 2011
Airway management issues in the intensive care unit: revisiting old paradigms and broadening our horizons.
Airway management in the intensive care setting provides unique challenges that can be quite daunting, even for the most experienced practitioner. Airways are usually intubated for long periods, multiple comorbidities often interfere with "routine" airway management practices, and patients are often physiologically disadvantaged or hemodynamically unstable. ⋯ Airway care in the intensive care unit is a continuum-from elective or emergent intubation, to airway preservation and hygiene, to elective or unintentional extubation. Thus, familiarization with the basics of airway management in routine and "first responder" settings should bolster confidence and greatly improve patient safety and outcomes.
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The heart surgery forum · Apr 2011
Comparative StudyResource utilization in off-pump versus conventional coronary artery bypass grafting in a community hospital: a comparative analysis using propensity scoring.
At a time when cost containment in health care is under increased scrutiny, coronary artery bypass grafting remains the most widely performed cardiac surgical procedure in the world. This study compares 30-day mortality, morbidity, and resource use for off-pump coronary artery bypass (OPCAB) versus conventional coronary artery bypass (CCAB) revascularization. ⋯ These outcomes clearly demonstrate that OPCAB is a safe and effective procedure for myocardial revascularization. This retrospective, nonrandomized observational study has shown that the patients who underwent OPCAB had reduced morbidity and mortality, as well as decreased resource use, compared with those who underwent CCAB.
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The heart surgery forum · Apr 2011
Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state.
We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation. ⋯ Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.