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Adult Cardiac Anesthesia

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https://www.readbyqxmd.com/read/28393785/modifying-risks-to-improve-outcome-in-cardiac-surgery-an-anesthesiologist-s-perspective
#1
REVIEW
Murali Chakravarthy
Challenging times are here for cardiac surgical and anesthesia team. The interventional cardiologist seem to have closed the flow of 'good cases' coming up for any of the surgery,; successful percutaneous interventions seem to be offering reasonable results in these patients, who therefore do not knock on the doors of the surgeons any more . It is a common experience among the cardiac anesthesiologists and surgeons that the type of the cases that come by now are high risk. That may be presence of comorbidities, ongoing medical therapies, unstable angina, uncontrolled heart failure and rhythm disturbances; and in patients with ischemic heart disease, the target coronaries are far from ideal...
April 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28393462/current-use-of-factor-concentrates-in-pediatric-cardiac-anesthesia
#2
REVIEW
Nina A Guzzetta, Glyn D Williams
Excessive bleeding following pediatric cardiopulmonary bypass is associated with increased morbidity and mortality, both from the effects of hemorrhage and the therapies employed to achieve hemostasis. Neonates and infants are especially at risk because their coagulation systems are immature, surgeries are often complex, and cardiopulmonary bypass technologies are inappropriately matched to patient size and physiology. Consequently, these young children receive substantial amounts of adult-derived blood products to restore adequate hemostasis...
April 10, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28384188/baroreflex-sensitivity-and-outcomes-following-coronary-surgery
#3
Marco Ranucci, Alberto Porta, Vlasta Bari, Valeria Pistuddi, Maria Teresa La Rovere
Postoperative atrial fibrillation, acute kidney dysfunction and low cardiac output following coronary surgery are associated with morbidity and mortality. The purpose of this study is to determine if the preoperative autonomic control is a determinant of these postoperative complications. This is a prospective cohort study on 150 adult patients undergoing surgical coronary revascularization with cardiopulmonary bypass. The patients received an autonomic control assessment after the induction of anesthesia. Baroreflex sensitivity was computed by spectral analysis and expressed as BRSαHF and BRSαLF for measure respectively in the high and low frequency domains...
2017: PloS One
https://www.readbyqxmd.com/read/28382424/plasma-exchange-for-the-patients-with-dilated-cardiomyopathy-in-children-is-safe-and-effective-in-improving-both-cardiac-function-and-daily-activities
#4
Takeshi Moriguchi, Keiichi Koizumi, Kenichi Matsuda, Norikazu Harii, Junko Goto, Daiki Harada, Hisanori Sugawara, Minako Hoshiai, Hiroaki Kise, Akiyasu Baba
Autoantibodies against cardiac proteins play an important role in the development of dilated cardiomyopathy (DCM). The efficacy and safety of apheresis such as immunoadsorption (IA) or plasma exchange (PE) to remove such antibodies have been reported in adult DCM patients. However, apheresis for pediatric DCM has not been performed because of technical difficulty due to relatively low blood volume and instability of hemodynamics. As we have experiences of preforming apheresis on hemodynamically unstable children, we have preformed ten courses of PE on seven child DCM patients including both patients in chronic and acute phase to assess the safety and efficacy to PE...
April 5, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28372656/what-is-the-place-of-clonidine-in-anesthesia-systematic-review-and-meta-analyses-of-randomized-controlled-trials
#5
REVIEW
Miguel Carlos Sanchez Munoz, Marc De Kock, Patrice Forget
STUDY OBJECTIVE: A place for clonidine has been suggested for many indications in perioperative medicine. The aim of this systematic review and these meta-analyses is to systematically, and quantitatively, evaluate these potential indications of clonidine. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: We selected and analyzed (qualitatively and, when possible, quantitatively) the available literature published on PubMed/Medline and on the Cochrane database. Inclusion criteria included: human randomized controlled trials involving adults who received perioperative systemic (oral, intramuscular, transdermal and intravenous) clonidine for every type of surgery...
May 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28343236/effects-of-restricting-perioperative-use-of-intravenous-chloride-on-kidney-injury-in-patients-undergoing-cardiac-surgery-the-licra-pragmatic-controlled-clinical-trial
#6
David McIlroy, Deirdre Murphy, Jessica Kasza, Dhiraj Bhatia, Lisa Wutzlhofer, Silvana Marasco
PURPOSE: The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. METHODS: From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol...
March 25, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28306681/anesthesia-in-adults-with-congenital-heart-disease
#7
Torsten Baehner, Richard K Ellerkmann
PURPOSE OF REVIEW: The current review focuses on patients with congenital heart disease (CHD) with regard to recent trends in global demographics, healthcare provision for noncardiac surgery, as well as anesthetic and perioperative care for these patients. RECENT FINDINGS: About 40 years after milestones of surgical innovation in CHD, the number of adults with CHD (ACHD) now surpasses those of children with CHD. This development leads to the fact that even patients with complex CHD managed for noncardiac surgery are not restricted to highly specialized centers...
March 16, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28243884/role-of-ct-in-congenital-heart-disease
#8
REVIEW
Prabhakar Rajiah, Sachin S Saboo, Suhny Abbara
Congenital heart diseases (CHD) are being increasingly encountered in cardiac imaging due to improved outcomes from surgical and interventional techniques. Imaging plays an important role in the evaluation of CHD, both prior to and after surgeries and interventions. Computed tomography (CT) has several advantages in the evaluation of these disorders, particularly its high spatial resolution, multi-planar reconstruction capabilities at sub-millimeter isotropic resolution, good temporal resolution, wide field of view, and rapid turnaround time, which minimizes the need for sedation and anesthesia in young children or children with disabilities...
January 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28183558/frequency-of-inadequate-neuromuscular-blockade-during-general-anesthesia
#9
Timur Dubovoy, Amy M Shanks, Scott Devine, Sachin Kheterpal
STUDY OBJECTIVE: We used electronic health record data to define frequency of inadequate intraoperative neuromuscular blockade (NMB). DESIGN: Retrospective observational study using electronic health record data. SETTING: Operating room in a tertiary care academic hospital. PATIENTS: A total of 129,209 adult patients with American Society of Anesthesiologists physical status 1 to 5 undergoing general anesthesia in an outpatient or inpatient setting who received nondepolarizing NMB...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28169116/utilization-and-effectiveness-of-desmopressin-acetate-after-cardiac-surgery-supplemented-with-point-of-care-hemostatic-testing-a-propensity-score-matched-analysis
#10
David Orlov, Stuart A McCluskey, Jeannie Callum, Vivek Rao, Jacobo Moreno, Keyvan Karkouti
OBJECTIVES: To explore the utilization pattern and hemostatic effectiveness of desmopressin acetate (DDAVP) supplemented with point-of-care (POC) hemostatic testing in contemporary cardiac surgery. DESIGN: Retrospective, observational study. SETTING: Single quaternary care university hospital. PARTICIPANTS: The study comprised 2,468 consecutive patients undergoing cardiac surgery-1,237 before and 1,231 after the introduction of POC testing...
November 17, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28091794/the-impact-of-liver-disorders-on-perioperative-management-of-reoperative-cardiac-surgery-a-retrospective-study-in-adult-congenital-heart-disease-patients
#11
Koko Adachi, Hiroaki Toyama, Yu Kaiho, Osamu Adachi, Hiroto Hudeta, Masanori Yamauchi
PURPOSE: We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients. METHODS: This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery. RESULTS: Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%)...
January 16, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28055991/role-of-mir-24-furin-and-transforming-growth-factor-%C3%AE-1-signal-pathway-in-fibrosis-after-cardiac-infarction
#12
Zhufeng Chen, Sumei Lu, Miao Xu, Peng Liu, Rui Ren, Wanshan Ma
BACKGROUND Cardiac fibrosis after primary infarction is a type of pathological phenomena as shown by increased collagen in myocardial cells. Transforming growth factor (TGF)-β1 is a critical factor participating in myocardial fibrosis. A previous study has shown the inhibitory role on TGF-β1 by microRNA-24 (miR-24) via targeting Furin. This study thus investigated the role of miR-24 and Furin/TGF-β1 in rat myocardial fibrosis. MATERIAL AND METHODS A total of 40 adult SD rats (both males and females) were prepared for myocardial infarction model by ligating the descending branch of left coronary artery after anesthesia...
January 5, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28006942/propofol-induced-mitochondrial-and-contractile-dysfunction-of-the-rat-ventricular-myocardium
#13
M Grundmanová, D Jarkovská, A Süß, Z Tůma, M Marková, Z Grundman, A El-Kadi, M Čedíková, M Štengl, J Kuncová
Propofol is a short-acting hypnotic agent used in human medicine for sedation and general anesthesia. Its administration can be associated with serious cardiovascular side-effects that include decrease in arterial blood pressure and cardiac output. The aim of the present study was to evaluate propofol effects on mitochondrial respiration, myocardial contractility and electrophysiology in the same samples isolated from the heart ventricles of adult rats. Mitochondrial oxygen consumption was measured in permeabilized samples dissected from free walls of both ventricles using high-resolution respirometry...
December 22, 2016: Physiological Research
https://www.readbyqxmd.com/read/27901396/effects-of-dobutamine-hydrochloride-on-cardiovascular-function-in-horses-anesthetized-with-isoflurane-with-or-without-acepromazine-maleate-premedication
#14
RANDOMIZED CONTROLLED TRIAL
Mara F Schier, Anthea L Raisis, Cristy J Secombe, Giselle Hosgood, Gabrielle C Musk, Guy D Lester
OBJECTIVE To determine the effects of acepromazine maleate premedication on cardiovascular function before and after infusion of dobutamine hydrochloride for 30 minutes in isoflurane-anesthetized horses. ANIMALS 6 healthy adult horses. PROCEDURES Each horse was anesthetized once following premedication with acepromazine (0.02 mg/kg, IV) administered 30 minutes prior to anesthetic induction (ACP+ treatment) and once without premedication (ACP- treatment). Anesthesia was induced with IV administration of xylazine hydrochloride (0...
December 2016: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/27858963/resting-state-functional-connectivity-and-cognition-after-major-cardiac-surgery-in-older-adults-without-preoperative-cognitive-impairment-preliminary-findings
#15
Jeffrey N Browndyke, Miles Berger, Todd B Harshbarger, Patrick J Smith, William White, Tiffany L Bisanar, John H Alexander, Jeffrey G Gaca, Kathleen Welsh-Bohmer, Mark F Newman, Joseph P Mathew
OBJECTIVES: To look for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition, a common complication in seniors undergoing major surgery, using resting-state functional magnetic resonance imaging. DESIGN: Objective cognitive testing and functional brain imaging were prospectively performed at preoperative baseline and 6 weeks after surgery and at the same time intervals in nonsurgical controls. SETTING: Academic medical center...
January 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27793208/myocardial-function-at-the-early-phase-of-traumatic-brain-injury-a-prospective-controlled-study
#16
RANDOMIZED CONTROLLED TRIAL
Adrien Cuisinier, Claire Maufrais, Jean-François Payen, Stephane Nottin, Guillaume Walther, Pierre Bouzat
BACKGROUND: The concept of brain-heart interaction has been described in several brain injuries. Traumatic brain injury (TBI) may also lead to cardiac dysfunction but evidences are mainly based upon experimental and clinical retrospective studies. METHODS: We conducted a prospective case-control study in a level I trauma center. Twenty consecutive adult patients with severe TBI were matched according to age and gender with 20 control patients. The control group included adult patients undergoing a general anesthesia for a peripheral trauma surgery...
October 28, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27737403/dexmedetomidine-as-an-anesthetic-adjuvant-in-cardiac-surgery-a-cohort-study
#17
Paulo Gabriel Melo Brandão, Francisco Ricardo Lobo, Serginando Laudenir Ramin, Yasser Sakr, Mauricio Nassau Machado, Suzana Margareth Lobo
Objective: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery. Methods: We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group)...
May 2016: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27725150/anesthesia-specific-differences-in-a-cardio-pulmonary-resuscitation-rat-model-halothane-versus-sevoflurane
#18
Torben Esser, Gerburg Keilhoff, Uwe Ebmeyer
OBJECTIVE: Our asphyxia cardiac arrest (ACA) rat model is well established. The original model was designed in the 1990(th) using halothane and nitrous oxide for pre-insult anesthesia. Because of its hepato-toxicity and its potential to induce severe liver failures, halothane is no longer used in clinical anesthesia for several years. In order to minimize the health risk for our laboratory staff as well as to keep the experimental settings of our model on a clinically oriented basis we decided to replace halothane by sevoflurane...
October 7, 2016: Brain Research
https://www.readbyqxmd.com/read/27703286/a-comparison-between-the-hemodynamic-effects-of-cisatracurium-and-atracurium-in-patient-with-low-function-of-left-ventricle-who-are-candidate-for-open-heart-surgery
#19
Masoud Ghorbanlo, Mahmoud Reza Mohaghegh, Forozan Yazdanian, Mehrdad Mesbah, Ziya Totonchi
BACKGROUND: The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered. METHOD: This study has been designed as a randomized prospective double-blind clinical trial...
July 27, 2016: Medical Archives
https://www.readbyqxmd.com/read/27687440/sevoflurane-induced-arrhythmia-in-healthy-adult
#20
João Santos, Vera Santos, Paula Gago, Nuno Cortez-Dias
Inhalatory anesthetic agents are frequently used for anesthesia maintenance. Sevoflurane is considered one of the safest regarding its cardiac effects. We report a case of a cardiac arrhythmia induced by sevoflurane in an otherwise healthy adult and discuss sevoflurane's cardiac effects.
November 2016: Journal of Clinical Anesthesia
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