Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2015
ReviewGlycemic control and outcome related to cardiopulmonary bypass.
Perioperative hyperglycemia, aggravated by cardiopulmonary bypass, is associated with adverse outcome in adult and pediatric patients. Whereas hyperglycemia was originally perceived as an adaptive response to surgical stress, it is now clear that glycemic control is a strategy to reduce adverse outcomes after cardiac surgery and cardiopulmonary bypass. ⋯ However, it remains controversial whether brief episodes of hypoglycemia, rapidly corrected during glycemic control, have adverse effects on outcome. This review gives an overview of the currently available literature on glycemic control during and after cardiac surgery and focuses on the indicated open questions about this intervention for this specific patient population.
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Best Pract Res Clin Anaesthesiol · Jun 2015
ReviewNeurocognitive outcomes after extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) has been a therapy of last resort for the treatment of severe cardiorespiratory failure since the 1970s [1]. In recent years, ECMO has seen a resurgence in its use in adults. ⋯ This review aims to summarize recent findings as they pertain to pathophysiology, monitoring techniques, prevention, therapy, and emerging experimental concepts in the context of ECMO for adult patients. Given that neurocognitive outcomes after cardiac surgery have been recently reviewed [3,4], we will limit the discussion of findings from the cardiac surgery/CPB literature to those especially relevant for ECMO.
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Best Pract Res Clin Anaesthesiol · Jun 2015
ReviewPulmonary complications of cardiopulmonary bypass.
Pulmonary complications after the use of extracorporeal circulation are common, and they range from transient hypoxemia with altered gas exchange to acute respiratory distress syndrome (ARDS), with variable severity. Similar to other end-organ dysfunction after cardiac surgery with extracorporeal circulation, pulmonary complications are attributed to the inflammatory response, ischemia-reperfusion injury, and reactive oxygen species liberated as a result of cardiopulmonary bypass. ⋯ There is no magic bullet to prevent or treat pulmonary complications, but supportive care with protective ventilation is important. Targets for the prevention of pulmonary complications include mechanical, surgical, and anesthetic interventions that aim to reduce the contact activation, systemic inflammatory response, leukocyte sequestration, and hemodilution associated with extracorporeal circulation.
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Best Pract Res Clin Anaesthesiol · Jun 2015
Historical ArticleHistory of cardiopulmonary bypass (CPB).
The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal.
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Best Pract Res Clin Anaesthesiol · Jun 2015
ReviewInflammatory response and extracorporeal circulation.
Patients undergoing cardiac surgery with extracorporeal circulation (EC) frequently develop a systemic inflammatory response syndrome. Surgical trauma, ischaemia-reperfusion injury, endotoxaemia and blood contact to nonendothelial circuit compounds promote the activation of coagulation pathways, complement factors and a cellular immune response. ⋯ Multiple organ dysfunction after cardiac surgery with EC is associated with an increased morbidity and mortality. In addition to the pathogenesis of organ dysfunction after EC, this review deals with different therapeutic interventions aiming to alleviate the inflammatory response and consequently multiple organ dysfunction after cardiac surgery.