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Anesthesia cardiac surgery

Yu-Hua Liu, Dong-Jie Qiu, Li Jia, Jun-Tao Tan, Jin-Meng Kang, Tian Xie, Hong-Meng Xu
INTRODUCTION: Whether anesthesia depth affects postoperative mortality remains uncertain. MEASUREMENTS: Several databases were systematically searched to identify all articles studying the relationship between depth of anesthesia and postoperative mortality. Post hoc subgroup analyses were conducted for follow-up period (30 days vs. longer than 90 days) and type of surgery. MAIN RESULTS: The analysis included 38,722 patients from nine studies...
February 13, 2019: Journal of Clinical Anesthesia
Arthelma C Tyson, Shailraj Parikh, Kuldeep Singh, Saqib Zia, Jonathan S Deitch, Jonathan A Schor
BACKGROUND: Routine laboratory testing to rule out myocardial infarction (MI) after carotid endarterectomy (CEA) is common in many centers. Its utility in this patient population has not been thoroughly investigated. We hypothesize that routine testing for MI in post-CEA patients is of low-yield and not cost-effective. METHODS: A retrospective review of 291 consecutive CEAs from February, 2011 to July, 2015 was performed. Two patients were excluded: one for postoperative non-cardiac death and one for preoperative MI...
February 12, 2019: Annals of Vascular Surgery
Sukhi Singh, Tor Damén, Mikael Dellborg, Anders Jeppsson, Andreas Nygren
BACKGROUND: New approaches to prevent bleeding complications during cardiac surgery are needed. OBJECTIVE: To investigate if noradrenaline (NA) enhances platelet aggregation in CABG patients. PATIENTS/METHODS: Twenty-four CABG patients were included in a prospective parallel-group randomized study. All patients but one, were treated with acetylsalicylic acid (ASA). In the treatment group (n=12), mean arterial blood pressure (MAP) was maintained at pre-induction levels by NA infusion...
February 14, 2019: Journal of Thrombosis and Haemostasis: JTH
Michael L Caparelli, Alexander Shikhman, Abdullah Jalal, Sandra Oppelt, Cari Ogg, Shyam Allamaneni
Postoperative pneumonia increases morbidity, length of stay, and hospital readmission rates. Current data support the use of perioperative chlorhexidine gluconate in elective cardiac surgery patients to prevent postoperative pneumonia. The objectives of this study were to implement a resident-driven quality improvement project and determine the efficacy of an oral care bundle in preventing postoperative pneumonia among noncardiac surgical patients. A retrospective review of postoperative pneumonia occurrences at our hospital captured by the NSQIP database from 2014 to 2016 was conducted...
January 1, 2019: American Surgeon
Taishi Okuno, Kazuyuki Yahagi, Yu Horiuchi, Yu Sato, Tetsu Tanaka, Keita Koseki, Akira Osanai, Motoi Yokozuka, Sumio Miura, Kengo Tanabe
Severe aortic stenosis (AS) is considered as an independent risk factor for perioperative cardiac complications of non-cardiac surgery. Surgical aortic valve replacement should be considered before non-cardiac surgery in patients with symptomatic severe AS. However, recently, transcatheter aortic valve replacement (TAVR) has emerged as an alternative approach for selected AS patients. We sought to determine the safety and efficacy of TAVR in preparation for major non-cardiac surgery. From our retrospective database, seven patients who underwent TAVR in preparation for major non-cardiac surgery were identified, and their clinical and hemodynamic data were collected...
February 13, 2019: Cardiovascular Intervention and Therapeutics
Troy S Wildes, Angela M Mickle, Arbi Ben Abdallah, Hannah R Maybrier, Jordan Oberhaus, Thaddeus P Budelier, Alex Kronzer, Sherry L McKinnon, Daniel Park, Brian A Torres, Thomas J Graetz, Daniel A Emmert, Ben J Palanca, Shreya Goswami, Katherine Jordan, Nan Lin, Bradley A Fritz, Tracey W Stevens, Eric Jacobsohn, Eva M Schmitt, Sharon K Inouye, Susan Stark, Eric J Lenze, Michael S Avidan
Importance: Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium. Objective: To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium. Design, Setting, and Participants: Randomized clinical trial of 1232 adults aged 60 years and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis...
February 5, 2019: JAMA: the Journal of the American Medical Association
Ludmil Mitrev, Kelly G Speich, Spencer Ng, Albina Shapiro, Talia Ben-Jacob, Majid Khan, Vineeth Nagubandi, John Gaughan
OBJECTIVE: To investigate whether pulse pressure (PP) in anesthetized patients undergoing cardiac surgery before and after cardiopulmonary bypass (CPB) is associated with higher postoperative acute kidney injury (AKI) stage. DESIGN: Retrospective cohort of 597 patients undergoing cardiac surgery. SETTING: Single academic health care center. PARTICIPANTS: Adult patients undergoing cardiac surgery requiring CPB (coronary artery bypass grafting, valve, aortic, or combined surgery)...
January 7, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Dan Taylor, Walid Habre
Database analysis has proved that peri-operative cardiac arrest occurs with increased frequency in children with congenital heart disease. Several case series and bigger data from ACS NSQIP, have elucidated subgroups at the highest risk. Consistently patients with single ventricle physiology (especially prior to cavo-pulmonary anastomosis), severe/supra-systemic pulmonary hypertension, complex lesions and cardiomyopathy with significantly reduced ventricular function have been shown to be of the greatest concern...
February 1, 2019: Paediatric Anaesthesia
Mary Lyn Stein, Luis G Quinonez, James A DiNardo, Morgan L Brown
Neonates undergoing congenital heart surgery require central venous access for diagnostic information and medication administration. There are multiple options for central access including peripherally inserted central catheters, umbilical, central venous, and transthoracic intracardiac lines. We retrospectively identified all patients younger than 30 days who underwent cardiac surgery in a 1-year period. Data were collected on demographic and medical characteristics, adverse events, pre-emptive transfusion of blood products prior to line removal, and transfusion of blood products following removal of transthoracic intracardiac lines and central venous lines...
January 30, 2019: Pediatric Cardiology
Asha Tyagi, Gaurav Verma, Ankit Luthra, Shubham Lahan, Shukla Das, Gargi Rai, Ashok Kumar Sethi
Background: Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI. Materials and Methods: Adults scheduled for orthopedic surgery under general anesthesia with >200-300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0...
January 2019: Saudi Journal of Anaesthesia
Faheem Sheriff, Joshua Hirsch, Kenneth Shelton, David D'Alessandro, Chris Stapleton, Matthew Koch, James Rabinov, Arminder Jassar, Aman Patel, Thabele Leslie-Mazwi
OBJECTIVES: Ischemic stroke due to large-vessel occlusion (LVO) is a complication after cardiothoracic surgery (CTS). Recently published endovascular stroke trials have major implications for treating LVO strokes; we evaluated our experience in patients undergoing CTS. METHODS: Our prospective institutional CTS database was reviewed between July 2013 and April 2018 for ischemic strokes. Patients with LVO were identified and their course and outcomes analyzed. RESULTS: A total of 5947 patients were reviewed; 148 (2...
December 11, 2018: Journal of Thoracic and Cardiovascular Surgery
Hong Pu, Gordon S Doig, Philippa T Heighes, Matilde J Allingstrup, Andy Wang, John Brereton, Carol Pollock, Douglas Chesher, Rinaldo Bellomo
OBJECTIVE: To determine whether a continuous intravenous infusion of standard amino acids could preserve kidney function after on-pump cardiac surgery. METHODS: Adult patients scheduled to receive cardiac surgery lasting longer than 1 hour on-pump were randomized to standard care (n = 36) or an infusion of amino acids initiated immediately after induction of anesthesia (n = 33). The study's primary outcome measurements assessed renal function. These assessments included duration of renal dysfunction, duration and severity of acute kidney injury (AKI), estimated glomerular filtration rate (eGFR) over time, urine output, and use of renal-replacement therapy...
December 15, 2018: Journal of Thoracic and Cardiovascular Surgery
Jeroen Wink, Bernadette T Veering, Leon P H J Aarts, Patrick F Wouters
Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia-induced sympatholysis and cardiovascular control mechanisms...
January 22, 2019: Anesthesiology
Zhenghuan Song, Jing Tan, Jia Fang, Qingming Bian, Lianbing Gu
Endotracheal intubation (ETI) and laryngeal mask airway (LMA) in terms of hemodynamics and reaction were compared. A total of 54 general anesthesia patients were randomized into two groups with 27 cases in each group. Acceleration index (ACI), cardiac index (CI), cardiac output (CO), left cardiac work (LCW), systemic circulation resistance (SVR), mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at 12 time-points: before surgery (T0), start effect (T1), lost consciousness (T2), before ETI or LMA (T3), 1 min (T4), 3 min (T5), 5 min (T6) after ETI or LMA, the beginning of surgery (T7), 30 min (T8), 1 hour (T9) after surgery, the end of surgery (T10) and extubation (T11)...
February 2019: Oncology Letters
Philippe Macaire, Nga Ho, Tan Nguyen, Binh Nguyen, Viet Vu, Chinh Quach, Vicente Roques, Xavier Capdevila
OBJECTIVES: Open cardiac surgery may cause severe postoperative pain. The authors hypothesized that patients receiving a bundle of care using continuous erector spinae plane blocks (ESPB) would have decreased perioperative opioid consumption and improved early outcome parameters compared with standard perioperative management. DESIGN: A consecutive, patient-matched, controlled before-and-after study. SETTING: Two tertiary teaching hospitals...
November 19, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Judson B Williams, Gina McConnell, J Erin Allender, Patricia Woltz, Kathy Kane, Peter K Smith, Daniel T Engelman, William T Bradford
OBJECTIVE: Our enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States. METHODS: The Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen...
December 8, 2018: Journal of Thoracic and Cardiovascular Surgery
Alexandre Almeida Guedes, Felipe Ladeira Pereira, Eric Guimarães Machado, Marcello Fonseca Salgado Filho, Leandro Fellet Miranda Chaves, Fernando de Paiva Araújo
BACKGROUND: Trigeminocardiac reflex is a physiological phenomenon that may occur in head and neck surgery, and is usually benign. However, it may present with exaggerated responses with severe morbidity. CASE REPORT: Male patient, 26 years old, candidate for surgical treatment of zygomatic-orbital complex fracture. The surgery with bilateral nasal packing placed at the end of the procedure was uneventful. After being admitted to the post-anesthesia care unity, the patient complained of shortness of breath and nausea...
January 18, 2019: Revista Brasileira de Anestesiologia
Ayça T Dumanlı Özcan, Elvin Kesimci, Cemile Altın Balcı, Orhan Kanbak, Hülya Kaşıkara, Abdulkadir But
Background: Bone cement implantation syndrome (BCIS) is characterized by hypoxia hypotension cardiac arrest. There is not any research that investigated the hemodynamic effects of colloid use during and before cement implantation regarding BCIS development. Aims: We aimed to compare the effects of colloid preloading before or coloading simultaneously at cement implantation on BCIS development and hemodynamic parameters in patients who underwent total knee arthroplasty...
October 2018: Anesthesia, Essays and Researches
Eric M Schrauben, Brahmdeep Singh Saini, Jack R T Darby, Jia Yin Soo, Mitchell C Lock, Elaine Stirrat, Greg Stortz, John G Sled, Janna L Morrison, Mike Seed, Christopher K Macgowan
BACKGROUND: To date it has not been possible to obtain a comprehensive 3D assessment of fetal hemodynamics because of the technical challenges inherent in imaging small cardiac structures, movement of the fetus during data acquisition, and the difficulty of fusing data from multiple cardiac cycles when a cardiac gating signal is absent. Here we propose the combination of volumetric velocity-sensitive cardiovascular magnetic resonance imaging ("4D flow" CMR) and a specialized animal preparation (catheters to monitor fetal heart rate, anesthesia to immobilize mother and fetus) to examine fetal sheep cardiac hemodynamics in utero...
January 21, 2019: Journal of Cardiovascular Magnetic Resonance
Thomas E Schulte, Amy L Duhachek-Stapelman, Austin J Adams, Tara R Brakke, Ellen K Roberts
Surgical patients with complex cardiac disease often require noncardiac surgery. There have been recent articles written concerning the role of the cardiothoracic anesthesiologist as a consultant in the operating room as well as outside the operating theatre.1,2 With the evolution of the cardiothoracic anesthesia consult service (CACS), there are many issues regarding medical billing, financial reimbursement, and Medicare rules that anesthesiologists may not be familiar with. This paper will discuss the financial implications of starting a CACS...
December 5, 2018: Journal of Cardiothoracic and Vascular Anesthesia
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