MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Cardiothoracic and Vascular Anesthesia' source. Wed, 08 Feb 2012 07:39:24 +0100 http://www.medworm.com/index.php?rid=5559294&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F4%2F179%3Frss%3D1 Conclusions: This case illustrates the unique challenges associated with pulmonary hypertension and right ventricular failure in the setting of noncardiac surgery. This case also demonstrates that continuous, real-time data provided by transesophageal echocardiography can be used to successfully manage a complicated patient with pulmonary hypertension. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559294 Tue, 03 Jan 2012 05:00:00 +0100 5559294 http://www.medworm.com/index.php?rid=5559293&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F4%2F176%3Frss%3D1 This report demonstrates how intraoperative transesophageal echocardiography (TEE) proved to be critical in guiding surgical management. The utility of TEE in the diagnosis and management of aortic thrombi is also discussed. In addition, currently reported management strategies for this complex condition are reviewed. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559293 Tue, 03 Jan 2012 05:00:00 +0100 5559293 http://www.medworm.com/index.php?rid=5559292&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F15%2F4%2F169%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559292 Tue, 03 Jan 2012 05:00:00 +0100 5559292 http://www.medworm.com/index.php?rid=5559291&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F4%2F163%3Frss%3D1 Conclusion. Total ischemia time of the transplanted heart may play a role in deterioration of longitudinal and circumferential shortening of the RV. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559291 Tue, 03 Jan 2012 05:00:00 +0100 5559291 http://www.medworm.com/index.php?rid=5559290&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F4%2F141%3Frss%3D1 This article discusses the endovascular approaches employed in the care of acute dissections with particular attention toward the anesthetic considerations involved in these challenging cases. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559290 Tue, 03 Jan 2012 05:00:00 +0100 5559290 http://www.medworm.com/index.php?rid=5559289&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F4%2F123%3Frss%3D1 Thoracic endovascular aortic repair (TEVAR) has decreased the morbidity and mortality associated with open surgical repair of descending thoracic aortic diseases, but important complications unique to the procedure remain. Spinal cord ischemia and infarction is a recognized complication caused by endovascular coverage or injury to spinal cord collateral vessels. Stroke is a consequence of thromboembolism or coverage of aortic arch branch vessels with insufficient collateral circulation. Understanding the risk factors and the pathophysiology of neurological complications of TEVAR are important for the successful anesthetic and surgical management and treatment of patients undergoing endovascular procedures involving the thoracic aorta. (Source: Seminars in Cardiothoracic and Vascular Anesth... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559289 Tue, 03 Jan 2012 05:00:00 +0100 5559289 http://www.medworm.com/index.php?rid=5559288&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F15%2F4%2F121%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5559288 Tue, 03 Jan 2012 05:00:00 +0100 5559288 http://www.medworm.com/index.php?rid=5313733&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F3%2F112%3Frss%3D1 The authors report the case of a patient with symptomatic early bioprosthetic mitral valve deterioration in the setting of calcium supplementation. This was further complicated by a large left atrial thrombus despite supratherapeutic anticoagulation and a previously oversewn left atrial appendage. As mechanical valves are less predisposed to calcification in comparison with bioprosthetic implants, the patient underwent a mechanical mitral valve replacement in addition to a left atrial thrombectomy. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313733 Wed, 12 Oct 2011 04:00:00 +0100 5313733 http://www.medworm.com/index.php?rid=5313732&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F15%2F3%2F105%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313732 Wed, 12 Oct 2011 04:00:00 +0100 5313732 http://www.medworm.com/index.php?rid=5313731&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F3%2F102%3Frss%3D1 Conclusion. Because of the lack of a gold standard, 2D transthoracic echocardiography remains the imaging modality of choice in assessment; however, there is increasing evidence that 3D technology can be more accurate in intracardiac mass detection and should be considered in the diagnostic algorithm. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313731 Wed, 12 Oct 2011 04:00:00 +0100 5313731 http://www.medworm.com/index.php?rid=5313730&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F3%2F98%3Frss%3D1 Conclusions. This case report illustrates that, with proper knowledge of this disease state, osteogenesis imperfecta patients can undergo a safe anesthetic during a potentially challenging combined cesarean section/colonic resection. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313730 Wed, 12 Oct 2011 04:00:00 +0100 5313730 http://www.medworm.com/index.php?rid=5313729&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F3%2F85%3Frss%3D1 Physiologic changes incurred by pregnancy can cause severe decompensation in the parturient with underlying cardiac disease. The result is increased morbidity and mortality for both mother and child. Appropriate anesthetic management can significantly impact these outcomes. This review systematically presents the pathophysiology, peripartum risk, and anesthetic management in the puerperium of specific acquired cardiac abnormalities including: valvular disease, pulmonary hypertension, cardiomyopathy, cardiac transplantation, ischemia, arrhythmias, and cardiac arrest. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313729 Wed, 12 Oct 2011 04:00:00 +0100 5313729 http://www.medworm.com/index.php?rid=5313728&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F3%2F75%3Frss%3D1 This article reviews a number of these studies that are likely to change our beliefs regarding testing and subsequent interventions as well as evolving role of medical therapy in patients undergoing vascular surgery. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313728 Wed, 12 Oct 2011 04:00:00 +0100 5313728 http://www.medworm.com/index.php?rid=5313727&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F15%2F3%2F73%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5313727 Wed, 12 Oct 2011 04:00:00 +0100 5313727 http://www.medworm.com/index.php?rid=5119547&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F1-2%2F56%3Frss%3D1 Conclusion. Only ISO improved the recovery of the ischemic myocardium during reperfusion. The effects of PRP were global in nature and involved compensatory hypercontractile state in nonischemic regions of the myocardium. Implication. PRP and ISO protect the heart against an ischemic injury, but only ISO preserves the function of the myocardium at the ischemic region. The survival rate of the PRP-treated group versus the ISO-treated group supports the claim that PRP has smaller contribution to recovery from myocardial ischemia. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119547 Wed, 10 Aug 2011 23:00:00 +0100 5119547 http://www.medworm.com/index.php?rid=5119546&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F1-2%2F49%3Frss%3D1 Conclusion. In this study, RBC transfusion was not independently associated with an increased incidence of in-hospital morbidity and mortality after EVAR. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119546 Wed, 10 Aug 2011 23:00:00 +0100 5119546 http://www.medworm.com/index.php?rid=5119545&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F15%2F1-2%2F44%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119545 Wed, 10 Aug 2011 23:00:00 +0100 5119545 http://www.medworm.com/index.php?rid=5119544&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F1-2%2F40%3Frss%3D1 This study presents the case of intraoperative thrombosis of a right coronary drug-eluting stent and subsequent right heart ischemia more than 2 years poststent placement and after recent withdrawal of clopidogrel therapy. Dual antiplatelet therapy had been continued uninterrupted since placement until 7 days prior to surgery when clopidogrel was stopped. This case highlights the emerging evidence that drug-eluting stents are susceptible to late occlusive thrombosis on acute withdrawal of antiplatelet therapy. Right heart ischemia resolved with rapid intraoperative management and emergent cardiac catheterization. This emphasizes the necessity of immediate availability to cardiac interventional facilities, which can influence outcomes. (Source: Seminars in Cardiothoracic and Vascular Anesth... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119544 Wed, 10 Aug 2011 23:00:00 +0100 5119544 http://www.medworm.com/index.php?rid=5119543&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F1-2%2F25%3Frss%3D1 As ultrasound technology improves and ultrasound availability increases, echocardiography utilization is growing within intensive care units. Although not replacing the often-needed comprehensive echocardiographic evaluation, limited bedside echocardiography promises to provide intensivists with enhanced diagnostic ability and improved hemodynamic understanding of individual patients. Routine and emergency echocardiography within the intensive care unit focuses on identifying and optimizing medically treatable conditions in a timely manner. Methods for such goal-directed assessments are presented. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119543 Wed, 10 Aug 2011 23:00:00 +0100 5119543 http://www.medworm.com/index.php?rid=5119542&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F1-2%2F14%3Frss%3D1 A decade after cardiac surgery was established, transesophageal echocardiography (TEE) was developed and used to evaluate perioperative cardiac performance. It has become an invaluable tool to provide real-time information in the cardiac operating room. TEE provides practical and useful information prior to insertion as well as after placement of the device. Additionally, during episodes of device malfunction or hemodynamic instability, TEE can be extremely useful in defining the etiology of the problem. As ventricular assist devices (VADs) have undergone evolution in design and as more VADs are being implanted, the development of specific indications for TEE use during device placement is a relevant issue. Formal guidelines for use of TEE during VAD insertion are yet to be adopted or impl... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119542 Wed, 10 Aug 2011 23:00:00 +0100 5119542 http://www.medworm.com/index.php?rid=5119541&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F15%2F1-2%2F8%3Frss%3D1 Uncorrected congenital interatrial septal defect can be found in nearly a third of all adults and are associated with significant morbidity, including pulmonary hypertension, right-heart failure, atrial arrhythmias, and paradoxical embolic stroke. With advancing technology, percutaneous closure of atrial septal defects has become a viable alternative to open surgical repair. In this review, the authors provide 3 examples in which 3-dimensional interventional transesophageal echocardiogram effectively provided more precise visualization of the dynamic surface and geometry of the atrial septum and related structures than 2-dimensional TEE, permitting accurate sizing and repair of the defects. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119541 Wed, 10 Aug 2011 23:00:00 +0100 5119541 http://www.medworm.com/index.php?rid=5119540&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F15%2F1-2%2F5%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=5119540 Wed, 10 Aug 2011 23:00:00 +0100 5119540 http://www.medworm.com/index.php?rid=4298891&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F305%3Frss%3D1 In the article by Viktor Moroz, MD, Arkady Goloubev, MD, and Artem N. Kuzovlev, MD. Acute Respiratory Distress Syndrome: New Classification (Original DOI: 10.1177/1089253210364249). Semin Cardiothorac Vasc Anesth. 2010; 14(1): 46. Table 1 was appearing incorrectly. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298891 Wed, 29 Dec 2010 00:00:00 +0100 4298891 http://www.medworm.com/index.php?rid=4298890&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F301%3Frss%3D1 Conclusion . Vancomycin concentrations in the serum were greater than the minimum inhibitory concentration for most staphylococci ranging from 4 to 19.3 µg/mL producing acceptable therapeutic serum concentrations and low rate of infectious complications. Thus postbypass dosing is acceptable in vancomycin cardiac surgical prophylaxis. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298890 Wed, 29 Dec 2010 00:00:00 +0100 4298890 http://www.medworm.com/index.php?rid=4298889&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F291%3Frss%3D1 Conclusion. We concluded that the use of NL-HFPPV is a feasible option and offers improved RV function and oxygenation during OLV for open thoracotomy. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298889 Wed, 29 Dec 2010 00:00:00 +0100 4298889 http://www.medworm.com/index.php?rid=4298888&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F283%3Frss%3D1 The leading cause of perioperative morbidity and mortality after major noncardiac surgery is cardiovascular complications. Clinical trials of lipid-lowering 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have shown improved cardiovascular outcomes; therefore, statins have become a mainstay in the prevention of cardiovascular disease. Retrospective trials and a small number of prospective randomized trials indicate that statin use may be beneficial during the perioperative period. In addition to the effects on serum lipid levels, statins influence inflammatory, thrombotic, and vasodilatory cellular pathways; and thus, their beneficial effects are not limited to patients with hypercholesterolemia. This review will (1) examine the evidence for using perioperati... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298888 Wed, 29 Dec 2010 00:00:00 +0100 4298888 http://www.medworm.com/index.php?rid=4298887&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F274%3Frss%3D1 This article will serve to give a brief review of the history of CO measurement, to provide a discussion of the measurement of accuracy as it relates to CO measurement, and to discuss some of the newer methods and devices for CO measurement and how they have fared against a "practical" gold standard. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298887 Wed, 29 Dec 2010 00:00:00 +0100 4298887 http://www.medworm.com/index.php?rid=4298886&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F256%3Frss%3D1 Whereas the development of coronary stents has been a major breakthrough in the treatment of coronary artery disease, stent thrombosis, associated with myocardial infarction and death, has introduced a new challenge in the care of patients with coronary stents undergoing noncardiac surgery. This review presents the authors’ recommendations regarding the optimal management of such patients. Elective surgery should be postponed for at least 6 weeks and optimally 3 months for a bare-metal stent and at least 1 year for a drug-eluting stent. On the other hand, managing a patient undergoing non-elective surgery is more difficult and necessitates a case-by-case assessment of bleeding risk versus thrombotic risk based on patient comorbidities, type of stents present, details of the coronary ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298886 Wed, 29 Dec 2010 00:00:00 +0100 4298886 http://www.medworm.com/index.php?rid=4298885&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F248%3Frss%3D1 The authors studied changes in erythrocyte membrane nanostructure using a rodent model of hemorrhagic hypotension and resuscitation. Both macro- and microstructural elements were examined using atomic force microscopy. Membrane "roughness" was characterized using spatial Fourier transformation and was stratified according to the periodicity of the membrane. Acute hemorrhage resulted in an increase in the diameter and height of erythrocytes, which returned to baseline levels by the end of the hemorrhagic hypotensive period. The effect of hypotension on the erythrocyte surface was nonuniform. In those regions where damage was considerable, the rate of restoration of the membrane microstructure to baseline levels was prolonged. The less damaged surfaces were restored more rapidly to control v... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298885 Wed, 29 Dec 2010 00:00:00 +0100 4298885 http://www.medworm.com/index.php?rid=4298884&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F242%3Frss%3D1 In conclusion, BIPAP allowed for spontaneous ventilation during the breathing cycle and limited P peak. Its use was associated with more rapid sealing of air leaks with the ability to conduct earlier ARMs. The use of BIPAP compared with SIMV improved outcome in the presence of complex thoracic trauma. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298884 Wed, 29 Dec 2010 00:00:00 +0100 4298884 http://www.medworm.com/index.php?rid=4298883&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F231%3Frss%3D1 Acute respiratory distress syndrome (ARDS) complicates nosocomial pneumonias (NPn) in 12% to 33% of patients with associated increases in mortality of up to 80%. A timely diagnosis of ARDS with NPn is, however, problematic. The aim of this investigation was to improve the diagnosis and treatment of the early stages of ARDS with NPn. A total of 82 cancer and multiple trauma patients were enrolled in the investigation. Patients were split into 3 groups according to standard ARDS and NPn diagnostic criteria: group 1 ("ARDS + NPn"), group 2 ("NPn"), group 3 ("no ARDS, no NPn"). ARDS was diagnosed using 3 methods: the Murray score, the American—European Consensus Conference criteria, and the V. A. Negovsky Research Institute of General Reanimatology criteria. Elevation of extravascular lu... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298883 Wed, 29 Dec 2010 00:00:00 +0100 4298883 http://www.medworm.com/index.php?rid=4298882&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F4%2F226%3Frss%3D1 The objective of the present study was to examine the relationship among extravascular pulmonary water, intracranial and cerebral perfusion pressure, hemodynamic parameters (eg, cardiac index, system vascular resistance index), and brain stem function during acute ischemic stroke. The subjects were 17 comatose patients with ischemic stroke who were admitted to an intensive care unit. The results revealed an elevation in extravascular lung water in the absence of cardiac dysfunction. The absence of correlation between indices of brain vascular resistance and mean arterial pressure confirmed that a disturbance of cerebral blood flow was present. There was a correlation between auditory-evoked potential parameters and extravascular lung water during the study period. The correlation between a... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298882 Wed, 29 Dec 2010 00:00:00 +0100 4298882 http://www.medworm.com/index.php?rid=4298881&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F14%2F4%2F225%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=4298881 Wed, 29 Dec 2010 00:00:00 +0100 4298881 http://www.medworm.com/index.php?rid=3859229&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F212%3Frss%3D1 Delirium is a common complication following cardiac surgery, and the predictors of delirium remain unclear. The authors performed a prospective observational analysis to develop a predictive model for postoperative delirium using demographic and procedural parameters. A total of 112 adult postoperative cardiac surgical patients were evaluated twice daily for delirium using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Model for the ICU (CAM-ICU). The incidence of delirium was 34% (n = 38). Increased age (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.6-3.9; P < .0001, per 10 years) and increased duration of surgery (OR = 1.3; 95% CI = 1.1-1.5; P = .0002, per 30 minutes) were independently associated with postoperative delirium. Gender, BMI, diabetes mell... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859229 Thu, 12 Aug 2010 09:29:34 +0100 3859229 http://www.medworm.com/index.php?rid=3859228&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F205%3Frss%3D1 Conclusions. Based on this very small sample size, these data support a cardioprotective effect of isoflurane and ischemic preconditioning during CABG surgery. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859228 Thu, 12 Aug 2010 09:29:34 +0100 3859228 http://www.medworm.com/index.php?rid=3859227&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F201%3Frss%3D1 Pain levels after cardiac surgery are often severe and undertreated. The effects of undertreatment may be both severe and prolonged. The incidence of chronic pain after cardiac surgery varies between 21% and 55%. Pain syndromes that occur following cardiac surgery may be multiple and may be of visceral, musculoskeletal, or neurogenic origin. Risk factors for acute pain vary depending on the study but generally include younger age, longer duration of surgery, and the location of the surgery. Risk factors for chronic pain include depression and psychological vulnerability, both preoperative and postoperative. Other independent risk factors for chronic pain are more extensive surgery, surgery lasting longer than 3 hours, and ASA grade greater than III. Pain control is achieved with regular an... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859227 Thu, 12 Aug 2010 09:29:34 +0100 3859227 http://www.medworm.com/index.php?rid=3859226&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F196%3Frss%3D1 Accurate positioning of thoracic endografts in the aortic arch and the proximal descending thoracic aorta can be difficult because of the tortuous arch anatomy and the hemodynamic forces therein. Adjunctive measures are necessary and include pharmacological interventions as well as rapid ventricular pacing and right-atrial-inflow occlusion. Endograft design advances have also been instrumental in increasing the applicability of this technology to the arch. These adjunctive measures are subsequently described. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859226 Thu, 12 Aug 2010 09:29:34 +0100 3859226 http://www.medworm.com/index.php?rid=3859225&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F190%3Frss%3D1 In this review, the evidence for inflammatory processes as being of fundamental importance in end-organ dysfunction— specifically stroke and neurocognitive impairment in patients undergoing cardiac surgery—will be reviewed. The risk of central nervous system (CNS) impairment following an off-pump cardiac surgery will be contrasted with that of patients undergoing percutaneous coronary intervention (PCI) or medical management, and the role of progression of underlying cerebrovascular disease and, in particular, panvascular inflammation as an accompaniment to unstable angina with attendant risk of stroke will be explored. In addition, the various roles of preoperative comorbidities, aortic atheroma, and the use of selective avoidance of aortic instrumentation as well as carotid e... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859225 Thu, 12 Aug 2010 09:29:34 +0100 3859225 http://www.medworm.com/index.php?rid=3859224&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F186%3Frss%3D1 Cardiac surgery with cardiopulmonary bypass (CPB) is frequently complicated by vasoplegic syndrome, a vasodilatory shock state. Traditional treatment based on fluid resuscitation and catecholamine drugs is ineffective in a number of patients. Clinical trials investigating both vasopressin and methylene blue as additional rescue or preventative therapy are reviewed. Vasopressin is suggested to retain its vasoconstrictive power in hypoxemia and acidosis, lower pulmonary hypertension, reduce supraventricular arrhythmias, and accelerate intensive care unit (ICU) recovery. Safety concerns include frequent thrombocytopenia and potentially altered mesenteric and renal perfusion. Methylene blue is suggested to facilitate CPB weaning, reduce renal, respiratory, arrhythmic, and septic complications,... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859224 Thu, 12 Aug 2010 09:29:34 +0100 3859224 http://www.medworm.com/index.php?rid=3859223&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F183%3Frss%3D1 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. Cardiologists have adapted this technology and have now published guidelines on the use of ultrasound to guide interventional procedures. 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. (Source: Seminars in Cardiothoracic and Vascular ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859223 Thu, 12 Aug 2010 09:29:34 +0100 3859223 http://www.medworm.com/index.php?rid=3859222&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F165%3Frss%3D1 Every year, more than 1 million patients worldwide undergo cardiac surgery. Because of the aging of the population, cardiac surgery will increasingly be offered to patients at a higher risk of complications. The consequence is a reduced physiological reserve and hence an increased risk of mortality. These issues will have a significant impact on future health care costs because the population undergoing cardiac surgery will be older and more likely to develop postoperative complications. One of the most dreaded complications in cardiac surgery is difficult separation from cardiopulmonary bypass (CPB). When separation from CPB is associated with right-ventricular failure, the mortality rate will range from 44% to 86%. Therefore, the diagnosis and the preoperative prediction of difficult sep... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859222 Thu, 12 Aug 2010 09:29:34 +0100 3859222 http://www.medworm.com/index.php?rid=3859221&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F3%2F162%3Frss%3D1 Objective. To understand the pathophysiology of influenza A, how seasonal strains behave differently from pandemic strains of the virus, and to summarize published data on the global response to the virus focusing on illness in the critical care setting. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859221 Thu, 12 Aug 2010 09:29:34 +0100 3859221 http://www.medworm.com/index.php?rid=3859220&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F14%2F3%2F161%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3859220 Thu, 12 Aug 2010 09:29:34 +0100 3859220 http://www.medworm.com/index.php?rid=3568736&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F148%3Frss%3D1 With the aging population and the increasing number of patients suffering from diabetes, the incidence of clinical manifestations of atherosclerotic disease is rising. Risk factors for development of atherosclerosis have been described and it is a challenge to develop risk scores that can be applied for individual patients. Specific predictors for progression of atherosclerosis and secondary manifestations of the disease are lacking. The search for new serological and genetic markers predictive for cardiovascular events is an emerging research field. Local plaque instability can give rise to thromboembolic cardiovascular events, which suggests that certain information might be enclosed in local atherosclerotic tissue. Because of the systemic character of atherosclerosis, it can be hypothes... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568736 Mon, 17 May 2010 11:07:28 +0100 3568736 http://www.medworm.com/index.php?rid=3568735&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F141%3Frss%3D1 Delirium is defined as a disturbance of consciousness with cognitive changes or perceptual disturbances, which has developed over a short period of time, and is caused by a medical condition or a postsurgical state. Although historically dismissed as an inconvenient and transient problem, recent studies have reported that delirium is associated with more complications, increased length of hospital stay, and higher mortality. Although delirium is a prevalent condition after cardiothoracic surgery and in the intensive care unit (ICU), the condition appears to be largely underdiagnosed. Several detection tools have been developed for routine monitoring of delirium by nonpsychiatric personnel in the ICU, such as the Confusion Assessment Method for the Intensive Care Unit and the Intensive Care... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568735 Mon, 17 May 2010 11:07:28 +0100 3568735 http://www.medworm.com/index.php?rid=3568734&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F136%3Frss%3D1 This study describes the development of a survival rat cardiopulmonary bypass (CPB) model, along with the introduction of an appropriately sized oxygenator. This model led the way for even more complicated models with CPB, facilitating full cardiac arrest with anterograde cardioplegia administration, air embolization, and deep hypothermic circulatory arrest. In addition, the results of several of those rat CPB studies are summarized and their preclinical relevance is pointed out. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568734 Mon, 17 May 2010 11:07:28 +0100 3568734 http://www.medworm.com/index.php?rid=3568733&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F123%3Frss%3D1 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. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568733 Mon, 17 May 2010 11:07:28 +0100 3568733 http://www.medworm.com/index.php?rid=3568732&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F119%3Frss%3D1 Postoperative cognitive dysfunction (POCD) is a subtle impairment of memory, concentration, and speed of information processing. It is a frequent complication following surgery and can have a debilitating effect on patients’ recovery and future prognosis. Neuropsychological testing is needed to reveal postoperative cognitive decline, and questionnaires are not useful for this purpose. There is a profound lack of consensus regarding the research methodology for detection of cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects, and the interval between test sessions, also influence test results and must be considered when designing and interpreting POCD data. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568732 Mon, 17 May 2010 11:07:28 +0100 3568732 http://www.medworm.com/index.php?rid=3568731&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F111%3Frss%3D1 Conclusion: This systematic review could neither confirm nor rule out a causal link between emboli from CPB and postoperative cognitive decline. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568731 Mon, 17 May 2010 11:07:28 +0100 3568731 http://www.medworm.com/index.php?rid=3568730&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F102%3Frss%3D1 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. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568730 Mon, 17 May 2010 11:07:28 +0100 3568730 http://www.medworm.com/index.php?rid=3568729&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F95%3Frss%3D1 The life saving benefits of cardiac surgery are frequently accompanied by negative side effects such as stroke, that occurs with an incidence of 2%-13% dependent to type of surgery. The etiology is most likely multifactorial with embolic events considered as main contributor. Although stroke presents a common complication, no guidelines for any routine use of pharmacological substances or non-pharmacological strategies exist to date. Non-pharmacological strategies include monitoring of brain oxygenation and perfusion with devices such as near infrared spectroscopy and Transcranial Doppler help. Epiaortic and transesophageal echocardiography visualize aorta pathology, enabling the surgeon to sidestep atheromatous segments. Additionally can the use of specially designed aortic cannulae and f... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568729 Mon, 17 May 2010 11:07:28 +0100 3568729 http://www.medworm.com/index.php?rid=3568728&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F2%2F86%3Frss%3D1 Aortic atheromatous disease is a common finding in the patient presenting for cardiac surgery. Adverse neurologic outcome has been closely linked to the extent of aortic atherosclerosis. In order to optimize perioperative outcomes, the location and severity of disease needs accurate characterization using multimodal techniques. Although various preoperative radiographic techniques have variably identified patients with significant atheroma, intraoperative echocardiographic imaging has proven most useful in localizing and characterizing the degree of aortic atheroma. Epiaortic assessment of the ascending aorta has been utilized in guiding surgical modifications and interventions aimed at reducing the risk of neurologic injury. Although no particular technique has been definitely studied, av... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568728 Mon, 17 May 2010 11:07:28 +0100 3568728 http://www.medworm.com/index.php?rid=3568727&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F14%2F2%2F85%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3568727 Mon, 17 May 2010 11:07:28 +0100 3568727 http://www.medworm.com/index.php?rid=3561128&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F14%2F1%2F77%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561128 Fri, 14 May 2010 09:51:21 +0100 3561128 http://www.medworm.com/index.php?rid=3561127&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F75%3Frss%3D1 This article will outline a few of these special situations, and attempt to give the practitioner an approach to the management of these patients. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561127 Fri, 14 May 2010 09:51:21 +0100 3561127 http://www.medworm.com/index.php?rid=3561126&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F73%3Frss%3D1 Heparin-induced thrombocytopenia (HIT) is an antibody-mediated reaction caused by exposure to heparin that can lead to devastating thrombotic complications. HIT usually occurs 5 to 10 days after exposure to heparin but can happen more rapidly to patients who are reexposed to heparin within 100 days. The hallmark of this disorder is a sudden drop in platelet count of greater than 50%. Once HIT is suspected the heparin must be immediately discontinued and an anticoagulant (direct thrombin inhibitor or heparinoid) started. For patients presenting for cardiac surgery and cardiopulmonary bypass that have a history of HIT and positive antibodies a direct thrombin inhibitor such as lepirudin, argatroban or bivalirudin must be used in lieu of heparin. (Source: Seminars in Cardiothoracic and Vascul... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561126 Fri, 14 May 2010 09:51:21 +0100 3561126 http://www.medworm.com/index.php?rid=3561125&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F68%3Frss%3D1 This article describes the recent advances and the state of the art of this therapy. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561125 Fri, 14 May 2010 09:51:21 +0100 3561125 http://www.medworm.com/index.php?rid=3561124&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F66%3Frss%3D1 Risk stratification in cardiac surgery is based on different models. The great majority of these models derives from a logistic regression equation, and the resulting risk score attributes a specific value to a number of risk factors. However, the number, definition, and type of risk factors included in each risk score greatly varies. Some of the existing risk models include up to 15-20 risk factors. However, it has been demonstrated that for elective patients a simple risk model based on just three factors (age, creatinine, and ejection fraction) has the same level of accuracy and a much better calibration that more complex models. The main deficiency of all the risk models is that they cannot take into consideration the presence of extreme risk conditions which have a very low prevalence... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561124 Fri, 14 May 2010 09:51:21 +0100 3561124 http://www.medworm.com/index.php?rid=3561123&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F64%3Frss%3D1 This article reviews current labor analgesia techniques and medications used during labor and delivery. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561123 Fri, 14 May 2010 09:51:21 +0100 3561123 http://www.medworm.com/index.php?rid=3561122&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F62%3Frss%3D1 Stroke is the leading cause of long-term disability in the United States. Hence immediate diagnosis must be made by CT or MRI and therapy instituted rapidly. Anesthesiologists must be aware of the concept of "penumbra" and maintain collateral flow. Blood pressure management is crucial. American Stroke Council recommends blood pressure reduction if systolic >220 mm Hg and diastolic >120 mm Hg. However if thrombolytic therapy is being used, blood pressure must be reduced to systolic <180 mmHg and diastolic < 105 mm Hg. Cerebral autoregulation may be dysfunctional in ischemic brain. Anesthesia management requires control of the airway to prevent aspiration, maintain adequate oxygenation and ventilation, and management of raised intra cranial pressure. Complications of intra-arteri... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561122 Fri, 14 May 2010 09:51:21 +0100 3561122 http://www.medworm.com/index.php?rid=3561121&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F60%3Frss%3D1 We sought to derive compliance curves of the trachea and esophagus. 16 fresh human cadavers were intubated tracheally and esophageally and cuff pressures measured at equal air volumes. Tracheal compliance was statistically less than esophageal compliance for volumes of 1, 2, and 3 mL of air, (p = 0.002, p = 0.008, and p = 0.006, respectively) but not so for volumes beyond that. This physical property is therefore not robust enough for detecting esophageal intubation. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561121 Fri, 14 May 2010 09:51:21 +0100 3561121 http://www.medworm.com/index.php?rid=3561120&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F54%3Frss%3D1 Perioperative myocardial ischemia and infarction are not only major sources of morbidity and mortality in patients undergoing surgery but also important causes of prolonged hospital stay and resource utilization. Ischemic and pharmacological preconditioning and postconditioning have been known for more than two decades to provide protection against myocardial ischemia and reperfusion and limit myocardial infarct size in many experimental animal models, as well as in clinical studies (1-3). This paper will review the physiology and pharmacology of ischemic and drug-induced preconditioning and postconditioning of the myocardium with special emphasis on the mechanisms by which volatile anesthetics provide myocardial protection. Insights gained from animal and clinical studies will be presente... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561120 Fri, 14 May 2010 09:51:21 +0100 3561120 http://www.medworm.com/index.php?rid=3561119&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F51%3Frss%3D1 Though relatively new, intraoperative neurophysiological monitoring (IONM) has become standard of care for many neurosurgical procedures. The use of IONM has substantially decreased the rate of paralysis after deformity surgery, and has been validated in cervical spine surgery, and thoracic and lumbar laminectomy ((1) (2), (3). The main modalities are: somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMGs). Each test examines a functionally separate area of the spinal cord, which test is chosen depends on the location of the surgery and the patient’s preexisting injuries and deficits (6). Inhaled anesthetics decrease the waveform amplitude and increase latency, intravenous anesthetics have the same effect but to a lesser degree. Best anes... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561119 Fri, 14 May 2010 09:51:21 +0100 3561119 http://www.medworm.com/index.php?rid=3561118&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F49%3Frss%3D1 Thyroid or parathyroid surgery may be performed using general anesthesia or regional anesthesia. Ninety-five (95) patients underwent thyroid or parathyroid surgery using general anesthesia (n=64) or bilateral superficial cervical plexus block with sedation (n=31) and completed a postoperative questionnaire regarding the perioperative experience. Patients undergoing parathyroid surgery under regional anesthesia (n=24) were more likely to experience better energy levels (p=0.012) and earlier return to work (p=0.045) postoperatively. Overall, 96% of patients undergoing either type of surgery with either type of anesthetic reported satisfaction with the anesthetic. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561118 Fri, 14 May 2010 09:51:21 +0100 3561118 http://www.medworm.com/index.php?rid=3561117&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F47%3Frss%3D1 We retrospectively reviewed the first 14 patients who received preoperative paravertebral blockade prior to minimally invasive cardiac surgical procedures. The use of paravertebral blockade along with an anesthetic technique designed to facilitate rapid recovery allowed early extubation in the operating room or intensive care unit in all but one patient. Extubated patients leaving the operating room were comfortable. No postoperative respiratory complications occurred. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561117 Fri, 14 May 2010 09:51:21 +0100 3561117 http://www.medworm.com/index.php?rid=3561116&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F46%3Frss%3D1 The article deals with acute respiratory distress-syndrome new classification which was developed at the V.A. Negovsky Research Institute of General Reanimatology (Moscow, Russia). This classification makes it possible to timely diagnose early stages of acute respiratory distress-syndrome by means of transpulmonary thermodilution method. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561116 Fri, 14 May 2010 09:51:21 +0100 3561116 http://www.medworm.com/index.php?rid=3561115&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F44%3Frss%3D1 In the past decade, concern has been raised about the safety of anesthetic agents on the developing brain. Animal studies have shown an increase in apoptosis in the developing brain when exposed to N-methyl-D-asparate receptor blockers and/or gamma-aminobutyric acid receptor agonists that is related to the dose and duration of anesthetic agents. Whether these studies can be extrapolated to humans is being investigated. The Food and Drug Administration in 2007 convened an advisory committee to look at this issue. They found that the animal data available were inadequate to extrapolate to humans and determined that human studies were necessary. Human studies are underway but the challenge they face is how to delineate the effects of anesthesia from those of the underlying medical condition a... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561115 Fri, 14 May 2010 09:51:21 +0100 3561115 http://www.medworm.com/index.php?rid=3561114&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F41%3Frss%3D1 Although perioperative macrovascular events (eg, myocardial infarction, stroke) are readily evident, their absolute incidence remains relatively low. In contrast, microvascular dysfunction and its role in perioperative morbidity is not easily measured. Microvascular dysfunction is likely to have a greater impact on noncardiovascular complications (eg, wound healing and end-organ failure), through impaired perfusion, than that which is readily appreciated. Inflammation and oxidative stress, such as that induced by surgical trauma, disrupts endothelial homeostasis thereby decreasing the bioavailability of nitric oxide. This predisposes blood vessels to vasoconstriction, inflammation, leukocyte adhesion, thrombosis—factors that contribute to perioperative cardiovascular events at both m... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561114 Fri, 14 May 2010 09:51:21 +0100 3561114 http://www.medworm.com/index.php?rid=3561113&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F38%3Frss%3D1 Prior to cardiothoracic or vascular surgery, a patient's oral health is not usually a high priority for the surgical team. Yet, oral neglect often mirrors systemic disease and the need for proper dental care is often unmet. In the perioperative period, the presence of untreated decayed teeth and periodontal disease can result in a potent odontogenic infection with significant consequences. Patients can unknowingly present for such operations with undetected oral infections that can magnify the likelihood of an adverse outcome, increase costs, morbidity, and possibly mortality. Considering scheduling constraints and the urgency of the procedure, a pre-operative dental screening is suggested for patients who undergo elective cardiothoracic or vascular surgery, to ensure that any oral infecti... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561113 Fri, 14 May 2010 09:51:21 +0100 3561113 http://www.medworm.com/index.php?rid=3561112&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F32%3Frss%3D1 Neurological dysfunction and stroke following cardiac surgery and thoracic surgery requiring hypothermic circulatory arrest is a well-defined problem. The original studies in CABG patients identified risk factors, such as prior stroke and lower educational level. There is older evidence suggesting that higher perfusion pressures during cardiopulmonary bypass are helpful. Hyperthermia during rewarming on cardiopulmonary bypass and postoperative hyperthermia have been associated with adverse cognitive outcomes. Glucose management intraoperatively remains controversial, but most now advocate for moderate glucose control using insulin, if required. The subset of patients having thoracic aortic surgery requiring periods of aortic discontinuity are particularly problematic. A cerebral protection... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561112 Fri, 14 May 2010 09:51:21 +0100 3561112 http://www.medworm.com/index.php?rid=3561111&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F29%3Frss%3D1 Congestive heart failure represents a severe health condition with unfavourable long-term prognosis despite all the progress in pharmacological therapy of heart failure. Another therapeutic option is represented by mechanical cardiac support devices. Ventricular assist devices (VAD) constitute largest subgroup of these devices. Patients supported with VAD carry many considerations which are important for successful perioperative management of these patients for noncardiac surgery. The general perioperative considerations include consultation with VAD management personnel, detailed assessment of end-organ dysfunction before surgery, appropriate antibiotic prophylaxis, deactivation of implantable cardioverter-defibrillator for the time of surgical procedure, and the choice between general an... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561111 Fri, 14 May 2010 09:51:21 +0100 3561111 http://www.medworm.com/index.php?rid=3561110&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F14%2F1%2F28%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561110 Fri, 14 May 2010 09:51:21 +0100 3561110 http://www.medworm.com/index.php?rid=3561109&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F24%3Frss%3D1 We present a case report of a patient undergoing TAAA surgery with the use of evoked potential monitoring. Intraoperatively, both sensory and motor evoked potentials were utilized and consequently the patient experienced changes in monitoring consistent with a new neurologic deficit. However, postoperatively these changes in evoked potentials never manifested in neurologic injury. We examine the utility of neurophysiologic monitoring as it pertains to TAAA surgery. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561109 Fri, 14 May 2010 09:51:21 +0100 3561109 http://www.medworm.com/index.php?rid=3561108&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F21%3Frss%3D1 Heart failure is a disease of increasing prevalence around the world. The treatment options for patients suffering from this ailment range from pharmacologic to surgical. Heart failure, however, continues to harbor a dismal prognosis despite conventional treatments. The high mortality rate among this patient population has spawned interest in alternative therapies. Mechanical circulatory support has emerged as a treatment option for patients with refractory heart failure. Over the past years a number of studies have highlighted the effectiveness of left ventricular assist devices (LVAD’s) in improving patient’s outcomes. The technologies that support these devices have evolved and provide new opportunities to manage patients suffering from this debilitating disease. Heart trans... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561108 Fri, 14 May 2010 09:51:21 +0100 3561108 http://www.medworm.com/index.php?rid=3561107&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F14%2F1%2F6%3Frss%3D1 Cardiac tumors are infrequent clinical entities with an autopsy frequency ranging from 0.001% to 0.030%. The occurrence of metastatic cardiac tumors has been reported a 100-fold more commonly than primary lesions. Three quarters of primary cardiac tumors are benign; approximately half of these are cardiac myxomas, and the rest are lipomas, papillary fibroelastomas, and rhabdomyomas. Among malignant primary cardiac tumors, the most reported are those histopathologically considered as undifferentiated, followed by angiosarcomas and leiomyosarcomas. Traditionally, cardiac tumors have been identified as curious autopsy findings resulting in a literature paucity of large clinical series, therefore, providing knowledge mostly based on case report collection. However, recent technological advance... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561107 Fri, 14 May 2010 09:51:21 +0100 3561107 http://www.medworm.com/index.php?rid=3561106&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F14%2F1%2F5%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3561106 Fri, 14 May 2010 09:51:21 +0100 3561106 http://www.medworm.com/index.php?rid=3123759&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F259%3Frss%3D1 Cardiac single photon emission computed tomography (SPECT) imaging is an established diagnostic and prognostic method for evaluation of suspected and known coronary artery disease. SPECT technology has developed over several decades. Utilization of thallium-201 decreased with the advent of technetium-based perfusion tracers. New cadmium zinc telluride (CZT)-based detectors open a new era of faster imaging and of lower radiation dose to the patient. Appropriate use of the SPECT imaging is regulated by evidence-based guidelines and appropriateness criteria as well as by third-party payers in an effort to curb unsustainable growth of testing seen in recent years. SPECT testing prior to noncardiac surgical procedures is driven by urgency of planned surgery, cardiac risk factors, and perceived ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123759 Mon, 28 Dec 2009 04:18:34 +0100 3123759 http://www.medworm.com/index.php?rid=3123758&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F249%3Frss%3D1 There is increasing evidence that the microcirculation and its regulation are severely compromised during many pathological conditions, such as hemorrhage, sepsis, or trauma. The effects of anesthetic agents on macrohemodynamics were investigated intensively in the last several decades. Research regarding modern anesthetics and anesthesia techniques has increased knowledge regarding the nonanesthetic effects of anesthetic agents, including those on organ perfusion and the microcirculation. Alterations in microvascular reactivity, nitric oxide pathways, and cytokine release are presumably the main mechanisms of anesthetic-induced tissue perfusion changes. This review summarizes current methods of microcirculatory status assessment and current knowledge regarding the microcirculatory effects... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123758 Mon, 28 Dec 2009 04:18:33 +0100 3123758 http://www.medworm.com/index.php?rid=3123757&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F241%3Frss%3D1 We report these findings along with the demographic data concerning the patients and types of surgeries evaluated in our initial experience. Finally, we discuss the preoperative evaluation including various areas of assessment provided by our PAC. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123757 Mon, 28 Dec 2009 04:18:33 +0100 3123757 http://www.medworm.com/index.php?rid=3123756&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F238%3Frss%3D1 Real-time 3-dimensional transesophageal echocardiography (RT 3D TEE) is a novel imaging technology that is becoming more frequently encountered in the operating room environment. The authors present a case in which the availability of 3D TEE altered the surgical management of a patient presenting for mitral valve repair. Additionally, the advantages of 3D, as opposed to 2D assessment of left ventricular function, are discussed. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123756 Mon, 28 Dec 2009 04:18:33 +0100 3123756 http://www.medworm.com/index.php?rid=3123755&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F231%3Frss%3D1 Conclusions: Dexamethasone offers no renal protective effect and the drug is associated with significant improvement in A-a O2 gradient, respiratory index, PaO2/FiO 2 at 12, 24 hours postoperatively and had no effect on extubation time and lung compliance. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123755 Mon, 28 Dec 2009 04:18:33 +0100 3123755 http://www.medworm.com/index.php?rid=3123754&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F225%3Frss%3D1 Hemostatic agents (HAs) are efficacious in reducing blood loss during surgery, which may affect postoperative length of stay (LOS). The purpose of this study was to compare the expected and actual LOS by HA in cardiac procedures. Hospital claims data between 2003 and 2006 were extracted from a US service-level comparative database. Four cohorts for comparison were FLOSEAL, SURGICEL + thrombin, GELFOAM + thrombin, and other. Expected LOS was derived using 2006 Centers for Medicare and Medicaid LOS by diagnosis-related group, and 2-part regression models were created to assess outcome. A total of 36 950 discharges were included. FLOSEAL was associated with less likelihood of exceeding expected LOS compared with baseline (odds ratio = 0.791; P < .01). Among patients who did exceed expected... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123754 Mon, 28 Dec 2009 04:18:33 +0100 3123754 http://www.medworm.com/index.php?rid=3123753&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F215%3Frss%3D1 Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It occurs particularly frequently in cardiac surgical patients and is associated with significant excess mortality and morbidity. Pharmacological management of AF is relatively ineffective and associated with significant side effects and complications. Clinicians have therefore pursued more definitive treatment options, both catheter based and surgical, to treat patients with AF. Surgical techniques designed to cure AF have developed in parallel with an improved understanding of the pathophysiological processes underlying this condition. This review describes the rationale behind current surgical approaches to AF and summarizes the results achieved with current techniques. (Source: Seminars in Cardiothoracic and V... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123753 Mon, 28 Dec 2009 04:18:33 +0100 3123753 http://www.medworm.com/index.php?rid=3123752&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F4%2F206%3Frss%3D1 This article summarizes techniques used in reoperative cardiac surgery, outlines a risk-stratified approach to operative planning, and reviews the literature on outcomes after reoperative valvular and coronary surgery. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123752 Mon, 28 Dec 2009 04:18:33 +0100 3123752 http://www.medworm.com/index.php?rid=3123751&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F13%2F4%2F205%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=3123751 Mon, 28 Dec 2009 04:18:33 +0100 3123751 http://www.medworm.com/index.php?rid=2805375&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F3%2F192%3Frss%3D1 This review discusses the use of extracorporeal membrane oxygenation (ECMO) for the treatment of respiratory failure in neonates. After briefly reviewing the early history of neonatal ECMO, the authors describe the respiratory diagnoses most often treated with ECMO and the manner in which affected neonates are deemed to have "failed" conventional therapies and thus require ECMO. After reviewing the most common indications for ECMO, factors that influence the timing of conversion to extracorporeal life support, as well as criteria that may exclude patients from receiving ECMO therapy, are described. At the conclusion of this article, the authors discuss the long-term outcomes of neonates whose respiratory disease was treated with ECMO and the costs associated with that care. (Source: Semina... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805375 Thu, 17 Sep 2009 23:00:00 +0100 2805375 http://www.medworm.com/index.php?rid=2805374&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F3%2F183%3Frss%3D1 Since the first successful application of extracorporeal membrane oxygenation (ECMO) in 1972, ECMO’s role in the management of respiratory and circulatory collapse continues to be refined and debated. Randomized clinical trials aimed at establishing efficacy and patient selection criteria have been fraught with ethical challenges. Growing concerns over rising health care costs require that careful evaluations of cost, utilization, and ethical issues surrounding heroic life-saving interventions such as ECMO are undertaken. Continued analyses of ECMO’s place in the medical management of respiratory and circulatory failure will help ensure that ECMO is used for not only prolonging life but also for providing a chance for "quality of life" following recovery from near-fatal illness... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805374 Thu, 17 Sep 2009 23:00:00 +0100 2805374 http://www.medworm.com/index.php?rid=2805373&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F3%2F176%3Frss%3D1 Advances in extracorporeal life support have expanded indications for use extending beyond patients undergoing cardiac surgery. The approach to cannulation in patients requiring extracorporeal membrane oxygenation should be individualized and based on the specific clinical scenario in which the need arises. Adherence to proper techniques of vessel visualization, exposure, and cannulation along with accurate placement of cannulae will optimize flows and minimize complications in this setting. Patients in need of mechanical circulatory support require input from a multidisciplinary team approach with systematic clinical evaluation to optimize outcome. If hemodynamics do not initially permit the successful separation from mechanical support, then a systematic search for potentially reversible... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805373 Thu, 17 Sep 2009 23:00:00 +0100 2805373 http://www.medworm.com/index.php?rid=2805372&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F3%2F154%3Frss%3D1 Advances in extracorporeal membrane oxygenation (ECMO) management have helped to reduce complications compared with its inception but they remain high. The principal causes of mortality and morbidity are bleeding and thrombosis. The nonbiologic surface of an extracorporeal circuit provokes a massive inflammatory response leading to consumption and activation of procoagulant and anticoagulant components. The vast differences in neonatal and adult anticoagulation and transfusion requirements demands tremendous clinical knowledge to provide the best care. Increased use of thrombelastogram will complement other methods currently being used to improved care. Methods to recognize the level of thrombin formation at the bedside could help reduce neurologic complications. ECMO requires a multidisci... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805372 Thu, 17 Sep 2009 23:00:00 +0100 2805372 http://www.medworm.com/index.php?rid=2805371&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F3%2F146%3Frss%3D1 The technical evolution of extracorporeal membrane oxygenation (ECMO) coincides with the vast improvement in intensive care medicine of the past 4 decades. Extracorporeal circulatory technology substitutes for acutely failed cardiac or pulmonary function until these organs regain sustainable function through goal-oriented intensive care practice. The technology has been validated to improve survival in select patients who would otherwise have 100% mortality. This is by far the most complex life-sustaining technology employed and thus can contribute significant risks such that the decision to institute ECMO requires prompt risk and benefit analysis. Delaying the institution of ECMO may cause irreversible pulmonary and cardiac injuries in addition to other organs. Therefore, the optimal time... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805371 Thu, 17 Sep 2009 23:00:00 +0100 2805371 http://www.medworm.com/index.php?rid=2805370&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F3%2F138%3Frss%3D1 Though much has been surveyed and written about the equipment aspects of extracorporeal life support (ECLS) in the past 10 years, there is value in reviewing the use and nonuse of multiple safety devices and techniques. Minimally equipped ECLS circuits for adult and pediatric bridge to decision during cardiac and respiratory failure are rapidly gaining popularity to maintain simplicity and portability. ECLS circuits employed for long-term therapy are outfitted differently and should include more safety devices. The purpose of this review is to compare and contrast the spectrum of minimally equipped ECLS circuits to circuits with maximum flexibility and safety device protection. Due to the lack of high-level, well-controlled scientific studies regarding ECLS equipment and safety devices, th... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805370 Thu, 17 Sep 2009 23:00:00 +0100 2805370 http://www.medworm.com/index.php?rid=2805369&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F13%2F3%2F137%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2805369 Thu, 17 Sep 2009 23:00:00 +0100 2805369 http://www.medworm.com/index.php?rid=2617474&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F127%3Frss%3D1 This article will briefly review these developments with the hope of understanding how this abrupt turnabout took place and will attempt to understand how such events can be avoided in the future. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617474 Sun, 19 Jul 2009 23:00:00 +0100 2617474 http://www.medworm.com/index.php?rid=2617473&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F122%3Frss%3D1 Hemostasis management of the cardiac surgical patient has changed following the withdrawal of aprotinin for use in cardiac surgical patients. The challenge to minimize blood loss and reduce exposure of cardiac surgical patients to blood products continues to grow with patients presenting being older and sicker and more complex procedures being performed. The cardiac surgery team has many options available for it to consider; although current recommendations strongly support the use of cell salvage as one process to assist in this challenge, other options need to be equally critically evaluated. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617473 Sun, 19 Jul 2009 23:00:00 +0100 2617473 http://www.medworm.com/index.php?rid=2617472&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F118%3Frss%3D1 Blood has been described as the most precious and personal substance in the world. Current directions in cardiac surgery are moving away from transfusing donor "Allogeneic" blood products, and towards improving methods of saving and preserving the patient's own "autologous" blood. Nothing else comes close to the natural healing abilities and homeostasis that one's own whole blood offers. No substitute, whether it is human or artificial, will ever work as well with fluid shifts, hemostasis and homeostasis. News reports today commonly feature severe blood shortages and research documenting recognized transfusion risks such as how older stored blood can put heart surgery patients at increased risk and others that point to the morbidity and mortality associated with its use. Therefore the medi... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617472 Sun, 19 Jul 2009 23:00:00 +0100 2617472 http://www.medworm.com/index.php?rid=2617471&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F113%3Frss%3D1 Despite major improvements in perfusion techniques over the past 50 years, it is still not possible to formulate a clear definition of what is meant by optimal perfusion. In part this is due to the lack of sufficient evidence-based data and in part because of the complex pathophysiology that takes place during cardiac surgery with cardiopulmonary bypass. To find an answer we need to understand the exact mechanism of the inflammatory reaction triggered by the cardiopulmonary bypass. However, it is clear that further improvement of the cardiopulmonary bypass components alone will be sufficient. Only a combined strategy can further improve cardiopulmonary bypass—related morbidity and mortality. Such a combined strategy will embrace perfusion techniques as well as a pharmacological appro... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617471 Sun, 19 Jul 2009 23:00:00 +0100 2617471 http://www.medworm.com/index.php?rid=2617470&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F106%3Frss%3D1 Blunt traumatic thoracic aortic injury (BTTAI) is a lethal injury associated with a prehospital mortality of 80% to 90%. Patients arriving in the emergency room and considered appropriate to undergo emergency open surgical repair still have a mortality rate of 15% to 30% because of severe associated injuries. Conventional open surgical repair requires a left thoracotomy, single lung ventilation, aortic-cross clamping and unclamping, with or without the adjunct use of partial or full cardiopulmonary bypass and systemic heparinization. All this leads to significant physiological stress and surgical trauma resulting in perioperative complications such as major blood loss, coagulopathy, myocardial infarction, stroke, respiratory failure, renal failure, bowel infarction, and paraplegia. Despite... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617470 Sun, 19 Jul 2009 23:00:00 +0100 2617470 http://www.medworm.com/index.php?rid=2617469&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F99%3Frss%3D1 In this report, the principals of the analysis of heart rate and blood pressure variability will be explained and the usefulness of these methods to anesthesiologists will be discussed. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617469 Sun, 19 Jul 2009 23:00:00 +0100 2617469 http://www.medworm.com/index.php?rid=2617468&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F95%3Frss%3D1 The early postoperative care of a heart transplant recipient remains challenging, even in experienced centers with a long tradition of excellence. Approximately 10% to 20% of heart transplant recipients experience potentially life-threatening right ventricular dysfunction intraoperatively and early postoperatively due to an elevated pulmonary vascular resistance. In addition, heart transplant recipients experience a high risk of perioperative hemorrhage, as well as opportunistic infection and rejection. The authors describe a case of severe right ventricular dysfunction in a 46-year-old male several hours after heart transplantation for a dilated cardiomyopathy. This patient was salvaged by judicious multimodality therapy including the use of adrenergic agents, phosphodiesterase inhibitors... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617468 Sun, 19 Jul 2009 23:00:00 +0100 2617468 http://www.medworm.com/index.php?rid=2617467&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F87%3Frss%3D1 From the first description of the "systemic inflammatory response" in the early 1990s, it has been recognized that this is a multifaceted response of the body to the combined insult of cardiothoracic surgery with bypass, involving causation by "activation of complement, coagulation, fibrinolytic, and kallikrein cascades, activation of neutrophils with degranulation and protease enzyme release, oxygen radical production, and the synthesis of various cytokines from mononuclear cells." Yet the intervening 15 years have seen a narrowing of research into individual systems and interventions naively targeted at single pathways without achieving clinically meaningful benefits. The time has come to redefine the systemic inflammatory response so that research can be more productively focused on obj... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617467 Sun, 19 Jul 2009 23:00:00 +0100 2617467 http://www.medworm.com/index.php?rid=2617466&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F81%3Frss%3D1 Mathematical modeling, based on fundamental principles from engineering may help clinical trial design, aiding in answering problems that remain in cardiac surgery, such as management of carotid artery stenosis in patients undergoing cardiopulmonary bypass (CPB), hematocrit during CPB, adequacy of oxygen delivery during CPB, adequacy of blood pressure management during CPB, filtration during bypass for renal failure, bypass circuit pacification, carbon dioxide wound insufflation and neurological events, and pulsatile to nonpulsatile flow during CPB. In addition, mathematical modeling may help explain deficiencies of previous work that have failed to clarify what to do. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617466 Sun, 19 Jul 2009 23:00:00 +0100 2617466 http://www.medworm.com/index.php?rid=2617465&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F2%2F78%3Frss%3D1 While the number of publications each year in cardiac anesthesia is enormous there are a select group of interesting articles highlighting controversies in current practice or new techniques, medications, procedures which may change practice down the road. The purpose of this article is to review some of these articles. While by no means a systematic review, this article highlights some of the more interesting papers from the cardiac anesthesia and surgical literature from 2007. The articles focus on areas such as: methods to reduce both cerebral dysfunction and renal dysfunction, myocardial protection inhaled volatile anesthetic agents, and methods to reduce atrial fibrillation. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617465 Sun, 19 Jul 2009 23:00:00 +0100 2617465 http://www.medworm.com/index.php?rid=2617464&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F13%2F2%2F77%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2617464 Sun, 19 Jul 2009 23:00:00 +0100 2617464 http://www.medworm.com/index.php?rid=2342600&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F1%2F60%3Frss%3D1 This article reviews the epidemiology, pathophysiology, clinical features, evaluation and current therapy of these two disorders. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2342600 Mon, 20 Apr 2009 04:00:00 +0100 2342600 http://www.medworm.com/index.php?rid=2342599&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F1%2F56%3Frss%3D1 This study reports a case in which cerebral desaturation occurred after commencing cardiopulmonary bypass. Consequently, the source of air entrainment was discovered and therapeutic measures implemented. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2342599 Mon, 20 Apr 2009 04:00:00 +0100 2342599 http://www.medworm.com/index.php?rid=2342598&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F1%2F44%3Frss%3D1 Although cardiac output (CO) monitoring is usually only used in intensive care units (ICUs) and operating rooms, there is increasing evidence that CO should be determined and optimized as early as possible, even before admission to the ICU, in the care of hemodynamically compromised patients. A variety of different minimally or noninvasive CO determination techniques have been developed, but not all of them are suitable for early hemodynamic monitoring outside the ICU. In this review, the different available methods for CO monitoring are presented and their potential for early hemodynamic assessment is discussed. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2342598 Mon, 20 Apr 2009 04:00:00 +0100 2342598 http://www.medworm.com/index.php?rid=2342597&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F1%2F31%3Frss%3D1 This article describes the current status of cardiac rhythm management devices and discusses recommended perioperative management. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2342597 Mon, 20 Apr 2009 04:00:00 +0100 2342597 http://www.medworm.com/index.php?rid=2342596&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F1%2F19%3Frss%3D1 This article reviews the prevalence, etiology, and outcome of in-hospital cardiac arrest, with a focus on the determinants of outcome that are amenable to improvement. These include principally components of basic life support that may be supported by either prompting or mechanical assistance (eg, chest compression, ventilation, and defibrillation). Also reviewed are preevent and postevent effectors such as medical staff skills and recognition of impending arrest, induction of mild hypothermia, and stabilization after return of spontaneous circulation. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2342596 Mon, 20 Apr 2009 04:00:00 +0100 2342596 http://www.medworm.com/index.php?rid=2342595&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F13%2F1%2F5%3Frss%3D1 This article reviews the physiology and pharmacology of ischemic and drug-induced preconditioning and postconditioning of the myocardium with special emphasis on the mechanisms by which volatile anesthetics provide myocardial protection. Insights gained from animal and clinical studies are reviewed and recommendations given for the use of perioperative anesthetics and medications. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2342595 Mon, 20 Apr 2009 04:00:00 +0100 2342595 http://www.medworm.com/index.php?rid=2058983&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F4%2F320%3Frss%3D1 Acute kidney injury (AKI) remains a significant cause of morbidity and mortality following cardiac surgery. Through a more thorough understanding of perioperative genomics and the evolving role of early biomarkers ofAKI, the authors seek to improve meaningful outcomes among cardiac surgery patients. In this review, the focus will be on advances in risk stratification, evolving definitions and improving early diagnosis of AKI, identification of effective individualized therapies, and future directions. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058983 Tue, 23 Dec 2008 05:00:00 +0100 2058983 http://www.medworm.com/index.php?rid=2058982&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F4%2F298%3Frss%3D1 Diseases of the thoracic aorta remain among the most lethal and difficult to treat conditions. In 2005, the US Food and Drug Administration approved the first endoprosthesis for the treatment of aneurysms of the descending thoracic aorta; at present, there are 3 thoracic devices approved by the US Food and Drug Administration. Although approved only for the treatment of descending aneurysms, thoracic endografting has other potential off-label applications, including acute and chronic aortic dissection and traumatic aortic transection. Endovascular repair of thoracic aortic pathology is emerging as the preferred treatment strategy in certain patients, as increasing data suggest that endovascular repair may be performed with lower peri-operative morbidity and mortality rates and similar midt... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058982 Tue, 23 Dec 2008 05:00:00 +0100 2058982 http://www.medworm.com/index.php?rid=2058981&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F4%2F290%3Frss%3D1 Stroke and neurological injury are among the most devastating and disabling complications associated with cardiac surgery. Transesophageal echocardiography and epiaortic ultrasound allow for sensitive, point-of-care diagnosis of thoracic aortic disease, which is especially common in patients with heart disease. Unlike other operative procedures, the manipulation of the ascending aorta is routine in cardiac surgery and often unavoidable. Dislodgement and embolization from the ascending and aortic arch atheromas have been clearly associated with manipulation during cardiac surgery. Epiaortic ultrasound and transesophageal echocardiography screening are more accurate and more accessible to the operative team than any other available modality to diagnose atherosclerosis of the aorta. The goal ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058981 Tue, 23 Dec 2008 05:00:00 +0100 2058981 http://www.medworm.com/index.php?rid=2058980&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F4%2F265%3Frss%3D1 This article details recommendations to familiarize anesthesiologists with TEE technology to exploit it to its fullest potential to achieve better patient monitoring standards and eventually improve outcome. Training of greater numbers of anesthesiologists in TEE is needed to increase awareness of the indications and contraindications. Until relatively inexpensive TEE equipment is available, the initial cost of equipment acquisition remains a significant prohibitive factor limiting its widespread use. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058980 Tue, 23 Dec 2008 05:00:00 +0100 2058980 http://www.medworm.com/index.php?rid=2058979&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F4%2F248%3Frss%3D1 Real-time 3-dimensional transesophageal echocardiography (RT-3D-TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging modality. The development of RT-3D-TEE allows for live 3D imaging as it circumvents most of the disadvantages of reconstructive 3D methods. RT-3D-TEE will likely revolutionize perioperative assessment of complex 3D structures, such as the mitral valve (MV), as it provides important mechanistic insights into functional and ischemic mitral regurgitation. The MV is particularly suited to live RT-3D-TEE assessment because of the complex interrelationships among the valve, chordae, papillary muscles, and myocardial walls. The 3D en face view of the MV is in accordance with the surgical view and allows to illustrate the unique saddle sh... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058979 Tue, 23 Dec 2008 05:00:00 +0100 2058979 http://www.medworm.com/index.php?rid=2058978&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F4%2F228%3Frss%3D1 Ultrasound imaging of the heart continues to play an important role in diagnosis and management of patients with cardiovascular diseases. Recent advances in ultrasound technology and introduction of newer imaging modalities have enabled improved assessment of left ventricular myocardial function. Tissue Doppler imaging and 2-dimensional speckle tracking allow more objective quantification of myocardial function in the form of tissue velocities, displacement, strain, and strain rate. Similarly, contrast-enhanced echocardiography and 3-dimensional echocardiography have provided a unique insight into left ventricular form and function that was not possible by unenhanced 2-dimensional echocardiography. In this review, the authors discuss the clinical application of these new imaging techniques... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058978 Tue, 23 Dec 2008 05:00:00 +0100 2058978 http://www.medworm.com/index.php?rid=2058977&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F12%2F4%2F225%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=2058977 Tue, 23 Dec 2008 05:00:00 +0100 2058977 http://www.medworm.com/index.php?rid=1808500&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F203%3Frss%3D1 Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808500 Fri, 19 Sep 2008 04:00:00 +0100 1808500 http://www.medworm.com/index.php?rid=1808499&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F191%3Frss%3D1 The release of 2 landmark reports by the Institute of Medicine titled, "To Err Is Human: Building a Safer Health System" and "Crossing the Quality Chasm" were instrumental in the identification of safety and quality issues. Since their release, federal and state programs of public reporting of performance measures have attempted to close the quality gap of care that is inappropriate, not timely, or lacking an evidence base. Cardiac surgery has long been the focus of public scrutiny, and now, as we move from an era of managed care to public reporting, reimbursement for cardiac surgery procedures will be tied to performance. However, the question is whether public reporting and pay for performance will ultimately improve the quality of patient care, safety, and provide the consumer with enou... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808499 Fri, 19 Sep 2008 04:00:00 +0100 1808499 http://www.medworm.com/index.php?rid=1808498&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F184%3Frss%3D1 The high level of interest in surgical outcomes has led to the publication of mortality rates in the public domain. In cardiac surgery, the availability of quite sophisticated risk assessment has allowed these outcomes to be adjusted for risk. The European System for Cardiac Operative Risk Evaluation is a widely recognized and used risk scoring system and has been used and validated throughout Europe and beyond. The logistic version is now the most commonly applied, but recalibration may be required. The methodology and statistics for measuring risk-adjusted performance are available, and regular audit and performance monitoring should be carried out in all cardiac surgical units. In the United Kingdom, risk-adjusted outcomes are available and regularly updated on the Internet. Presentatio... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808498 Fri, 19 Sep 2008 04:00:00 +0100 1808498 http://www.medworm.com/index.php?rid=1808497&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F175%3Frss%3D1 Most performance assessments of cardiac surgery programs use models based on preoperative risk factors. Models that were primarily developed to assess performance in general intensive care unit (ICU) populations have also been used to evaluate the quality of surgical, anesthetic, and ICU management after cardiac surgery. Although there are currently 5 models for evaluating general ICU populations, only the Acute Physiology and Chronic Health Evaluation (APACHE) system has been independently validated for cardiac surgery patients. This review describes the evolution, rationale, and accuracy of APACHE models that are specific for cardiac surgery patients as well as for patients who have had vascular and thoracic procedures. In addition to performance comparisons based on observed and predict... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808497 Fri, 19 Sep 2008 04:00:00 +0100 1808497 http://www.medworm.com/index.php?rid=1808496&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F167%3Frss%3D1 This article will focus on the European System for Cardiac Operative Risk Evaluation, the Society of Thoracic Surgeons score, the Parsonnet score, Cleveland Clinic Model, the Bayes model, and the Northern New England Score. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808496 Fri, 19 Sep 2008 04:00:00 +0100 1808496 http://www.medworm.com/index.php?rid=1808495&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F153%3Frss%3D1 Logistic regression is a cornerstone of epidemiology and the method of choice for risk adjustment models in cardiac surgery and critical care. Although linear regression methods may be satisfactory to evaluate relationships between independent (predictor) variables and a outcome that is continuous, a more complex mathematical approach is required when the outcome is binary (yes/no; alive/dead). Although the odds are 4 to 1 that finding an antilogarithm may sound intimidating, once you get past the initial equations and terminology, we go on to discuss how to select variables for a model, how to deal with collinearity and interaction terms, how to use diagnostic tests to ensure the model is not adversely affected by a small number of observations, and how to assess a model's discrimination ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808495 Fri, 19 Sep 2008 04:00:00 +0100 1808495 http://www.medworm.com/index.php?rid=1808494&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F3%2F140%3Frss%3D1 The 1985 release of hospital report cards by the Health Care Financing Administration awakened the public's awareness of variations in outcomes following patient treatment. In 1972, the Department of Veterans Affairs initiated an oversight process for all VA-based cardiac surgery programs. In response to Public Law 99-166, the Continuous Improvement in Cardiac Surgery Program (CICSP) national database was developed in 1987. This CICSP effort reported variations in outcomes across VA cardiac programs. In 1997, the CICSP expanded (CICSP-X) to identify the interrelationships of risk factors with processes and structures of care, as well as clinical outcomes. Based on VA findings to date, these quality improvement endeavors appear to have positively affected short-term and longer-term cardiac ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808494 Fri, 19 Sep 2008 04:00:00 +0100 1808494 http://www.medworm.com/index.php?rid=1808493&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F12%2F3%2F137%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1808493 Fri, 19 Sep 2008 04:00:00 +0100 1808493 http://www.medworm.com/index.php?rid=1630113&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F2%2F128%3Frss%3D1 Endoscopic evaluation of the thoracic cavity was first described in 1910 when Jacobaeus used a cystoscope for pleural examination. Significant advances in thoracoscopic surgery, including the use of high-definition videoscopy and refinements in surgical technique, have created a vast array of increasingly complex procedures that can be performed. The minimally invasive nature of video-assisted thoracoscopic surgery (VATS) makes it ideal for diagnostic and therapeutic procedures in ambulatory and critically ill patients. Mediastinoscopy is often performed immediately preceding VATS to permit sampling of mediastinal lymph nodes. As the indications for thoracoscopic surgery expand, the anesthesiologist must be familiar with common anesthetic and surgical complications, which occur in up to 9%... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1630113 Wed, 16 Jul 2008 04:00:00 +0100 1630113 http://www.medworm.com/index.php?rid=1630112&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F2%2F122%3Frss%3D1 Lung transplantation is the definitive treatment for end-stage lung disease. The number of lung transplantations performed is limited by the number of donors available and is far outnumbered by the potential recipients on the waiting list. Advances in surgical methods, organ preservation, and immunosuppression have decreased the morbidity and mortality associated with this procedure during the last few decades. Specific anesthetic concerns are associated with lung transplantation, including careful preoperative assessment of pulmonary and cardiac function, adequate venous access and monitors, and ventilation techniques, such as 1-lung ventilation and lung-protective strategies to decrease the risks of reperfusion injury, barotrauma, and re-expansion pulmonary edema. Intraoperative transeso... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1630112 Wed, 16 Jul 2008 04:00:00 +0100 1630112 http://www.medworm.com/index.php?rid=1630111&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F2%2F109%3Frss%3D1 The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung ventilation leads to a significant derangement of gas exchange, and hypoxemia can develop due to increased intrapulmonary shunting. Recent advances in anesthetic managemen... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1630111 Wed, 16 Jul 2008 04:00:00 +0100 1630111 http://www.medworm.com/index.php?rid=1630110&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F2%2F97%3Frss%3D1 Mechanical ventilation of patients undergoing thoracic surgery is often challenging. These patients frequently have significant underlying comorbidities, including cardiopulmonary disease, and often must undergo 1-lung ventilation. Perioperative respiratory complications are common and are multifactorial in etiology. Increasing evidence suggests that mechanical ventilation is associated with, and may even cause, lung damage in both sick and healthy patients. Gas exchange to provide acceptable end-organ oxygenation remains a primary goal but so too is minimization of risks for acute lung injury. Every ventilator strategy is associated with potential beneficial and adverse side effects. Understanding the impact of various ventilation strategies allows clinicians to provide optimal care for p... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1630110 Wed, 16 Jul 2008 04:00:00 +0100 1630110 http://www.medworm.com/index.php?rid=1630109&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F2%2F91%3Frss%3D1 Advances in the treatment of patients with chronic pulmonary hypertension have greatly improved their functional status and longevity, and increasing numbers of these complex patients are presenting for elective noncardiac surgery. In this communication we will briefly review the classification and pathophysiology of pulmonary hypertension, summarize outpatient pharmacotherapy approaches, and discuss the perioperative preparation and management of these complex patients. With an understanding of the underlying pathophysiology of the disease and pharmacology of these new therapies, combined with careful perioperative planning and care, these patients can safely undergo elective surgical procedures. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1630109 Wed, 16 Jul 2008 04:00:00 +0100 1630109 http://www.medworm.com/index.php?rid=1630108&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Freprint%2F12%2F2%2F89%3Frss%3D1 (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1630108 Wed, 16 Jul 2008 04:00:00 +0100 1630108 http://www.medworm.com/index.php?rid=1388217&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F80%3Frss%3D1 A case in which the bispectral index monitor underwent an acute change that was most likely the earliest indicator of an intraoperative stroke during replacement of an aortic valve is discussed in this study. The timely response to this intraoperative event may have facilitated a better outcome by virtue of more rapid interventions to limit the severity of the injury. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388217 Mon, 21 Apr 2008 04:00:00 +0100 1388217 http://www.medworm.com/index.php?rid=1388216&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F70%3Frss%3D1 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. Changes in regional tissue oxygenation as detected by NIRS may reflect the delicate balance between oxygen delivery and consumption in more than one organ system. 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. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388216 Mon, 21 Apr 2008 04:00:00 +0100 1388216 http://www.medworm.com/index.php?rid=1388215&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F60%3Frss%3D1 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. Complementary to the arterial oxygen saturation measured by pulse oximetry, cerebral tissue oxygen saturation reflects regional cerebral metabolism and the balance of local cerebral oxygen supply/demand. 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 ar... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388215 Mon, 21 Apr 2008 04:00:00 +0100 1388215 http://www.medworm.com/index.php?rid=1388214&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F33%3Frss%3D1 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. Appropriate preoperative assessment, adequate perioperative monitoring, and early intervention, should hemodynamic disturbances occur, may help prevent adverse events and improve patient outcome. 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 βblockers and lipid-lowering medications (statins), is an evolving field, and recent deve... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388214 Mon, 21 Apr 2008 04:00:00 +0100 1388214 http://www.medworm.com/index.php?rid=1388213&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F29%3Frss%3D1 Conclusions: Carotid endarterectomy with regional anesthesia can be performed safely in the elderly population with low mortality and morbidity. Regional anesthesia may have advantages over general anesthesia and could potentially aid in avoiding complications related to shunt use. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388213 Mon, 21 Apr 2008 04:00:00 +0100 1388213 http://www.medworm.com/index.php?rid=1388212&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F18%3Frss%3D1 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. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388212 Mon, 21 Apr 2008 04:00:00 +0100 1388212 http://www.medworm.com/index.php?rid=1388211&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F12%3Frss%3D1 Systematic collection and electronic storage of data can assist in improving quality and efficiency of patient care and can provide a data set to interrogate for subsequent performance improvement and clinical research purposes. In this article, an electronic perioperative pediatric cardiac surgery database to be used by a multidisciplinary care team was designed, developed, and implemented. Technical goals for the design included low cost, rapid development and implementation, adequate security, and potential for internal and external distribution. Implementation of the described database has proved to be invaluable for quality assurance and statistical analysis of data relevant to patient care. From the overall positive experience, it was concluded that the electronic data management doe... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388211 Mon, 21 Apr 2008 04:00:00 +0100 1388211 http://www.medworm.com/index.php?rid=1388210&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F7%3Frss%3D1 Evidence-based medicine depends on research that is reliable, well conducted, and free of influence from interest groups (which are not confined to industry). There are many ways to influence the outcome of clinical research, and the history of influence in research related to tobacco is illuminating in this regard. Health care depends on industry, and if properly managed, the relationship between industry and medical academia can be symbiotic. Achieving positive outcomes from such relationships depends on ensuring the presence of the elements needed for reasonable independence on the part of investigators, and on understanding the ways in which influence can be exerted over the production and publication of evidence. Regulation cannot substitute for integrity, particularly the integrity o... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388210 Mon, 21 Apr 2008 04:00:00 +0100 1388210 http://www.medworm.com/index.php?rid=1388209&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F12%2F1%2F5%3Frss%3D1 Unfortunately, the data were statistically nonsignificant due to insufficient power and poor experimental design. Conversely, many large clinical trials obtain a high level of statistical significance with miniscule differences between groups, which are completely clinically irrelevant. However, with proper marketing, billions can be made from results of dubious clinical importance. In this article, the differences between statistical and clinical significance are briefly discussed. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1388209 Mon, 21 Apr 2008 04:00:00 +0100 1388209 http://www.medworm.com/index.php?rid=1223210&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F301%3Frss%3D1 This article will review current available data for assessment of the MV in degenerative and ischemic mitral regurgitation. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223210 Mon, 11 Feb 2008 05:00:00 +0100 1223210 http://www.medworm.com/index.php?rid=1223209&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F288%3Frss%3D1 Intraoperative transesophageal echocardiography (TEE) is currently being used routinely during aortic valve replacement (AVR). TEE provides information that can lead to modifications of anesthetic and surgical care that leads to improved outcome. Numerous studies have shown that modifications in therapy occur from 10% to more than 40% of cases. The impact of TEE can be divided among modifications of therapy before, during, and after cardiopulmonary bypass. Before cardiopulmonary bypass, TEE can provide prognostic information, optimize hemodynamics, and diagnose conditions that were not appreciated before surgery, including patient—prosthesis mismatch. TEE can guide and modify the placement of various bypass cannulae. After bypass, TEE verifies the surgical result, rules out left and ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223209 Mon, 11 Feb 2008 05:00:00 +0100 1223209 http://www.medworm.com/index.php?rid=1223208&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F282%3Frss%3D1 As we enter the fifth decade in cardiac surgery, traditionally cardiac surgery has been performed using a median sternotomy with cardiopulmonary bypass providing great access to the heart and all the surrounding structures. During the last decade, there has been a paradigm shift in the methods by which surgery has been performed. The invasiveness of many procedures has been dramatically reduced, with significantly superior outcomes, as evidenced by improved survival, fewer complications, and quicker return to functional health and productive life. This resulted in significant interest and excitement in adopting less invasive techniques in cardiac surgery. Unfortunately, this was an unrealistic expectation due to the limitations that existed in cardiac surgical techniques and conventional e... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223208 Mon, 11 Feb 2008 05:00:00 +0100 1223208 http://www.medworm.com/index.php?rid=1223207&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F274%3Frss%3D1 Near-infrared spectroscopy (NIRS) is a technique that can be used as a noninvasive and continuous monitor of the balance between cerebral oxygen delivery and consumption. The authors develop and propose an algorithm for the use of NIRS based on optimizing factors that can affect cerebral oxygen supply/demand. These factors are the position of the vascular cannula, perfusion pressure, arterial oxygen content, partial pressure of carbon dioxide, haemoglobin, cardiac output, and the cerebral metabolic rate of oxygen. Dissemination of a useful treatment algorithm is the primary purpose of this article. Further multicenter studies are necessary to confirm the benefits and cost-effectiveness of this promising monitoring modality. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223207 Mon, 11 Feb 2008 05:00:00 +0100 1223207 http://www.medworm.com/index.php?rid=1223206&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F269%3Frss%3D1 In this review the role of PaCO2 in regulating cerebral blood flow and flow/metabolism coupling, as well as its impact on intracellular metabolic processes are discussed. Starting with a discussion of alpha-stat versus pH-stat ventilatory management, the apparently contradictory finding of exacerbation of ischemic injury by extracellular acidosis in some experimental models versus others in which neuroprotection is evidenced is discussed and contrasted with the conclusion that the relatively small degree of change in pH associated with clinical changes in PaCO2 is unlikely to directly impact ischemia/reperfusion processes. However, examples of susceptible patients in whom relatively small changes in PaCO2 can produce adverse effects on cerebral perfusion are also illustrated re-emphasizing... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223206 Mon, 11 Feb 2008 05:00:00 +0100 1223206 http://www.medworm.com/index.php?rid=1223205&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F265%3Frss%3D1 Acute renal failure is one of the most frequent and life-threatening complications after cardiac surgery. There is a recent growing deal of information suggesting that during the time of cardiopulmonary bypass kidneys may suffer from an imbalance between oxygen supply and oxygen needs. A low hematocrit during cardiopulmonary bypass is associated with an increase risk of acute renal failure, mainly due to a low oxygen delivery. An inadequate oxygen delivery during cardiopulmonary bypass is associated with lactate production, and under normothermic conditions, hyperlactatemia appears for an oxygen delivery below 260 mL min– 1 m–2. The risk of acute renal failure significantly increases for an oxygen delivery approximately at the same value (272 mL min–1 m– 2). During ... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223205 Mon, 11 Feb 2008 05:00:00 +0100 1223205 http://www.medworm.com/index.php?rid=1223204&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F261%3Frss%3D1 Postoperative hemorrhage following cardiac surgery increases morbidity, mortality, and costs. Several case reports have described the successful use of recombinant factor VIIa to decrease or stop bleeding in patients undergoing cardiac surgery. The mechanism of action of recombinant factor VIIa is thought to be increased site-specific thrombin generation by tissue factor—mediated activation of coagulation or from activated platelets. However, there have also been many reports of thrombotic complications after recombinant factor VIIa administration. Randomized clinical trials and further laboratory studies should help better clarify the efficacy, safety, cost-effectiveness, and optimal dosing of recombinant factor VIIa in the cardiac surgical setting. (Source: Seminars in Cardiothorac... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223204 Mon, 11 Feb 2008 05:00:00 +0100 1223204 http://www.medworm.com/index.php?rid=1223203&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F256%3Frss%3D1 Unfractionated heparin and protamine have been integral to cardiopulmonary bypass since cardiac surgery was first undertaken. These drugs are inexpensive and well understood but are contraindicated in some individuals, and resistance to heparin can be problematic in others. The interplay between the endothelium, anticoagulants, the coagulation cascade, and the inflammatory response that characterizes cardiac surgery may contribute to some of the complications associated with cardiopulmonary bypass. Various alternative drugs and strategies have been used to manage patients unsuitable for heparin or protamine, but each has its own disadvantages. At present, direct thrombin inhibitors may offer the best available alternative to heparin in cardiac surgery, particularly the short-acting bivalir... Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223203 Mon, 11 Feb 2008 05:00:00 +0100 1223203 http://www.medworm.com/index.php?rid=1223202&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F252%3Frss%3D1 There are several perfusion techniques that can contribute to blood conservation. Minimizing existing circuit components, using mini-circuits and the maneuver of retrograde autologous priming can be considered steps in prime reduction. Microplegia systems may also reduce systemic as well as cardiac hemodilutional effects. Cell savers can scavenge shed blood, wash the red cells, and may return the red cells to the patient in a concentrated form. When a patient is already hemodiluted, ultrafiltation can be used to hemoconcentrate the patient and to drive their existing hemoglobin levels up. Ultimately, the optimal form of blood conservation comes from team-work, communication, and a combination of efforts. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223202 Mon, 11 Feb 2008 05:00:00 +0100 1223202 http://www.medworm.com/index.php?rid=1223201&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F247%3Frss%3D1 This article outlines some of the POC platelet function monitors available as well as their potential applications. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223201 Mon, 11 Feb 2008 05:00:00 +0100 1223201 http://www.medworm.com/index.php?rid=1223200&cid=s_28803_5_f&fid=28803&url=http%3A%2F%2Fscv.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F11%2F4%2F242%3Frss%3D1 This article describes some of the modalities currently used in patients undergoing cardiac surgery. (Source: Seminars in Cardiothoracic and Vascular Anesthesia) Seminars in Cardiothoracic and Vascular Anesthesia journals http://www.medworm.com/rss/comments.php?id=1223200 Mon, 11 Feb 2008 05:00:00 +0100 1223200