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Aortic surgery anesthesia

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https://www.readbyqxmd.com/read/28727703/intrathecal-morphine-improves-hemodynamic-parameters-and-analgesia-in-patients-undergoing-aortic-valve-replacement-surgery-a-prospective-double-blind-randomized-trial
#1
Hamed Elgendy, Hatem A R Helmy
BACKGROUND: Intrathecal morphine (ITM) has been used in hopes of providing good postoperative analgesia in cardiac surgery. Little is known about its use in isolated aortic valve replacement surgery. OBJECTIVES: To evaluate the effects of 7 µ/kg ITM administration in aortic valve replacement in regards to hemodynamics, pain score, and postoperative complications when compared to general anesthesia alone. STUDY DESIGN: A randomized, double-blind trial...
July 2017: Pain Physician
https://www.readbyqxmd.com/read/28713211/early-extubation-in-pediatric-heart-surgery-across-a-spectrum-of-case-complexity-impact-on-hospital-length-of-stay-and-chest-tube-days
#2
Staci Beamer, Sunita Ferns, Lloyd Edwards, Greer Gunther, Jennifer Nelson
Early extubation is increasingly common in congenital heart surgery, but there are limited outcomes data across the spectrum of case complexity. We performed a retrospective review of 201 pediatric operations using cardiopulmonary bypass between 2012 and 2014. Patients extubated in the operating room or immediately on arrival to the ICU were compared to those extubated by traditional protocols. In-hospital mortality, major complications, need for re-intubation, hospital length of stay, and chest-tube days were compared between groups and by Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) mortality category...
June 2017: Progress in Pediatric Cardiology
https://www.readbyqxmd.com/read/28710563/an-observational-study-examining-the-effects-of-a-surgically-induced-inflammatory-response-on-the-distribution-of-morphine-and-its-metabolites-into-cerebrospinal-fluid
#3
Yan Wang, Kerry B Goralski, Derek J Roberts, Kathryn Landry, Mark E Issa, Lekha Sleno, Lisa C Julien, Jeremy Wood, Richard I Hall
PURPOSE: Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function...
July 14, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28697490/the-influence-of-blood-pressure-on-fetal-aortic-distensibility-an-animal-validation-study
#4
Christoph Wohlmuth, Kenneth J Moise, Ramesha Papanna, Ciprian Gheorghe, Anthony Johnson, Yisel Morales, Helena M Gardiner
BACKGROUND/AIMS: Aortic distension waveforms describe the change in diameter or cross-sectional area over the cardiac cycle. We aimed to validate the association of aortic fractional area change (AFAC) with blood pressure (BP) in a fetal lamb model. METHODS: Four pregnant ewes underwent open fetal surgery under general anesthesia at 107-120 gestational days. A 4-Fr catheter was introduced into the fetal femoral artery and vein, or the carotid artery and jugular vein...
July 12, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28673782/percutaneous-closure-of-periprosthetic-paravalvular-leaks-a-viable-alternative-to-surgery
#5
Ana Isabel Azevedo, Pedro Braga, Alberto Rodrigues, Lino Santos, Bruno Melica, José Ribeiro, Francisco Sampaio, Ricardo Fontes-Carvalho, Marlene Fonseca, Adelaide Dias, Vasco Gama Ribeiro
INTRODUCTION AND OBJECTIVES: Paravalvular leak (PVL) is a possible complication after prosthetic valve implantation. PVL can cause significant symptoms of congestive heart failure and/or hemolysis. Medical therapy is palliative and reoperation has a high mortality rate. Percutaneous transcatheter closure is a promising alternative for symptomatic patients at high surgical risk. We aim to review the efficacy and safety of percutaneous PVL closure in a consecutive series of patients referred to our center...
June 30, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28660196/endovascular-repair-of-traumatic-isthmic-ruptures-special-concerns
#6
REVIEW
Nikolaos Patelis, Athanasios Katsargyris, Chris Klonaris
Injury of the aortic isthmus is the second most frequent cause of death in cases of blunt traumatic injury. Conventional open repair is related to significant morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) has increasing role in traumatic isthmic rupture, as it avoids the thoracotomy-related morbidity, aortic cross clamping, and cardiopulmonary bypass. Additionally to the technical difficulties of open repair, multi-trauma patients may not tolerate the manipulations necessary to undergo open surgery, due to concomitant injuries...
2017: Frontiers in Surgery
https://www.readbyqxmd.com/read/28642176/microsurgical-bypass-training-rat-model-part-2-anastomosis-configurations
#7
Ali Tayebi Meybodi, Michael T Lawton, Sonia Yousef, Pooneh Mokhtari, Sirin Gandhi, Arnau Benet
BACKGROUND: Mastery of microsurgical anastomosis is key to achieving good outcomes in cerebrovascular bypass procedures. Animal models (especially rodents) provide an optimal pre-clinical bypass training platform. However, the existing models for practicing different anastomosis configurations have several limitations. OBJECTIVE: We sought to optimize the use of the rat's abdominal aorta and common iliac arteries (CIA) for practicing the 3 main anastomosis configurations commonly used in cerebrovascular surgery...
June 19, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28583731/risk-factors-for-postoperative-delirium-in-patients-undergoing-vascular-surgery
#8
REVIEW
George C Galyfos, Georgios E Geropapas, Argiri Sianou, Fragiska Sigala, Konstantinos Filis
OBJECTIVE: Postoperative delirium (PODE) remains a common complication after vascular surgery procedures although the exact pathogenesis remains unclear, mainly because of its multifactorial character. The aim of this systematic review was to evaluate pooled data on potential risk factors for PODE in patients undergoing vascular surgery procedures. METHODS: A systematic literature review was conducted conforming to established criteria to identify eligible articles published from 1990 to 2016...
June 2, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28537661/effect-of-urinary-trypsin-inhibitor-on-inflammatory-cytokines-and-organ-function-in-patients-with-cardiopulmonary-bypass
#9
H-Y Xu, X-S Rong, D-P Wang, S-Y Jiang, Z-D Zang, W Xia, F Zhang, J Yan
OBJECTIVE: This research is to study the effect of urinary trypsin inhibitor (UTI) on inflammatory cytokines and organ function in patients with cardiopulmonary bypass. PATIENTS AND METHODS: From February 2015 to February 2016, 40 patients that had undergone cardiopulmonary bypass surgery in our hospital were selected and randomly divided into the observation group and the control group with 20 patients in each group. Patients in the control group were intravenously injected with 5000 U/kg normal saline during the operation and 5000 U/kg•d-1 at 1-3 days postoperatively, while the patients in the observation group received intravenous injection of the same amount of UTI at pre-operation (T0), post-anesthesia (T1), after aortic opening (T2), after cardiopulmonary bypass 4h (T3), 8h (T4), 24h (T5), 48h (T6), and 72h (T7)...
May 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28523031/myocardial-protection-with-glucose-insulin-potassium-infusion-during-adult-cardiac-surgery
#10
Suhail Ahmad, Rana Altaf Ahmad, Bilal Ahsan Qureshi, Mirza Ahmad Raza Baig
BACKGROUND & OBJECTIVE: Recent meta-analysis reports have called for more randomized trials to evaluate the effectiveness of GIK solution in patients of cardiac surgery. So this study was conducted to evaluate the effectiveness of Glucose-insulin-potassium (GIK) solutions in non-diabetic patients undergoing coronary artery bypass grafting. METHODS: A total number of one hundred and sixty (160) patients were randomized into two equal groups; GIK Group and non-GIK group...
March 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28506542/coronary-sinus-isoflurane-concentration-in-cardiac-surgery
#11
Ka Ting Ng, R Peter Alston, George Just, Chris McKenzie
OBJECTIVE: Volatile anesthetic agents such as isoflurane may be associated with fewer adverse myocardial events compared with total intravenous anesthesia in cardiac surgery. The authors aimed to determine whether reasonable isoflurane concentrations at tissue level were being achieved to protect the myocardium using this agent. The isoflurane concentration in myocardium has never been measured. The primary aim was to sample coronary sinus (CS) blood and measure its isoflurane concentration...
March 9, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28441850/-clinical-application-of-one-stage-operation-of-epicardial-permanent-pacemaker-implantation-and-cardiac-surgery
#12
C L Ren, S L Jiang, C S Xiao, R Wang, C Q Gao
Objective: To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. Methods: From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach...
April 25, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28408933/endovascular-stent-grafting-for-aortic-arch-aneurysm-in-aortoiliac-occlusive-disease-following-aortic-arch-debranching-and-aortobifemoral-reconstruction
#13
Didem Melis Oztas, Cagla Canbay, Yilmaz Onal, Metin Onur Beyaz, Omer Ali Sayin, Mehmet Barburoglu, Mehmet Buget, Mesut Yornuk, Aziz Ari, Murat Ugurlucan, Bulent Acunas, Ufuk Alpagut, Enver Dayioglu
Treatment of thoracic aortic aneurysms constitutes high mortality and morbidity rates despite improvements in surgery, anesthesia, and technology. Endovascular stent grafting may be an alternative therapy with lower risks when compared with conventional techniques. However, sometimes the branches of the aortic arch may require transport to the proximal segments prior to successful thoracic aortic endovascular stent grafting. Atherosclerosis is accounted among the etiology of both aneurysms and occlusive diseases that can coexist in the same patient...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28300680/evaluation-by-magnetic-resonance-imaging-of-silent-brain-infarcts-in-preoperative-and-postoperative-asymptomatic-carotid-surgery
#14
Remy Pascot, Anne Daoudal, Alain Cardon, Gilles Godet, Antoine Lucas, Elodie Clochard, Jean-Yves Gauvrit, Yann Le Teurnier, Adrien Kaladji
BACKGROUND: To report the prevalence of silent brain infarcts (SBI) at magnetic resonance imaging (MRI) before and after surgery for asymptomatic high grade carotid stenosis. METHODS: This is a single center retrospective observational study. Asymptomatic patients who underwent carotid endarterectomy between October 2012 and October 2014 were included. The preoperative assessment included a Doppler and a computed tomographic (CT) scan dating less than 3 months...
March 11, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28285473/a-modern-case-series-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa-in-an-out-of-hospital-combat-casualty-care-setting
#15
Justin D Manley, Benjamin J Mitchell, Joseph J DuBose, Todd E Rasmussen
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to mitigate bleeding and sustain central aortic pressure in the setting of shock. The ER-REBOA™ catheter is a new REBOA technology, previously reported only in the setting of civilian trauma and injury care. The use of REBOA in an out-of-hospital setting has not been reported, to our knowledge. METHODS: We present a case series of wartime injured patients cared for by a US Air Force Special Operations Surgical Team at an austere location fewer than 3km (5-10 minutes' transport) from point of injury and 2 hours from the next highest environment of care-a Role 2 equivalent...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28259141/comparison-of-the-myocardial-protective-effect-of-sevoflurane-versus-propofol-in-patients-undergoing-heart-valve-replacement-surgery-with-cardiopulmonary-bypass
#16
Xiao-Lin Yang, Dan Wang, Guo-Yuan Zhang, Xiao-Lan Guo
BACKGROUND: This study aimed to compare myocardial protective effects of anaesthesia with intravenous infusion of propofol versus inhalation of sevoflurane in patients undergoing heart valve replacement surgery with cardiopulmonary bypass. METHODS: Seventy-six patients undergoing valve replacement with cardiopulmonary bypass were randomly assigned to propofol or sevoflurane anesthesia during the surgery, respectively. For assessing myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme (CK-MB) were determined before induction (T0), 0...
March 4, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28255219/open-abdominal-aortic-aneurysm-replacement-in-the-awake-patient
#17
L Meecham, A Torrance, S Vijay, A Burtenshaw, R Downing
Nonintubated aortic surgery using various techniques has been reported, but despite publication of favorable outcomes in select patient groups, awake aortic surgery remains unpopular. Our patient had an abdominal aortic aneurysm that was unsuitable for endovascular repair. Because of the significant respiratory disease, general anesthesia represented an unacceptably high risk. As a result, he underwent open AAA repair via a retroperitoneal approach with the aid of epidural anesthesia. Here, we highlight the benefits of the procedure which offer a select cohort of patients the chance of life-saving surgery...
March 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28238250/atrial-septostomy-as-a-bridge-to-replace-a-thrombosed-mechanical-aortic-valve-requiring-extracorporeal-membrane-oxygenation
#18
Adarsh Katamreddy, David F Snipelisky, Mackram F Eleid
Atrial septostomy is an infrequently used percutaneous technique to decompress either side of the heart. Here, a case is reported of atrial septostomy performed as an emergency 'bridge' procedure in a hemodynamically unstable 62-year-old man with acute mechanical prosthetic aortic valve thrombosis requiring peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO). ECMO was placed emergently as the patient suffered cardiac arrest during anesthesia induction for surgical replacement of the thrombosed prosthetic aortic valve...
September 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28223056/transcatheter-aortic-valve-in-valve-implantation-using-lotus-valve-for-failed%C3%A2-surgical-bioprostheses
#19
Fausto Castriota, Roberto Nerla, Antonio Micari, Caterina Cavazza, Francesco Bedogni, Luca Testa, Matteo Montorfano, Mauro Del Giglio, Alberto Cremonesi
BACKGROUND: Patients with failed bioprostheses are an increasing population at high risk for redo surgery. Valve-in-valve transcatheter aortic valve implantation is a promising alternative but a limited number of first-generation devices have proven efficacy in all cases. METHODS: Patients with degenerated bioprostheses at high risk for redo surgery were included in the registry after being assigned to valve-in-valve intervention by a local heart team. Main basal and follow-up data (at 1 month and 6 months) of patients undergoing valve-in-valve transcatheter aortic valve implantation with the Lotus valve system (Boston Scientific, Natick, MA) in three high-volume Italian centers were entered in the registry...
February 18, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28074788/comparison-of-two-doses-of-heparin-on-outcome-in-off-pump-coronary-artery-bypass-surgery-patients-a-prospective-randomized-control-study
#20
RANDOMIZED CONTROLLED TRIAL
Murali Chakravarthy, Dattatreya Prabhakumar, Patil Thimmannagowda, Jayaprakash Krishnamoorthy, Antony George, Vivek Jawali
INTRODUCTION: While off pump coronary artery bypass surgery is practiced with an intention to reduce the morbidity associated with cardiopulmonary bypass, the resultant 'hypercoagulability' needs to be addressed. Complications such as cavitary thrombus possibly due to the hyper coagulability after off pump coronary artery bypass surgery have been described. Many clinicians use higher doses of heparin - up to 5 mg/kg in order to thwart this fear. Overall, there appears to be no consensus on the dose of heparin in off pump coronary artery bypass surgeries...
January 2017: Annals of Cardiac Anaesthesia
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