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Anesthesia cardiac surgery

Pierre-Grégoire Guinot, Julien Marc, Bruno de Broca, Thomas Archange, Stéphane Bar, Osama Abou-Arab, Hervé Dupont, Marc-Olivier Fischer, Emmanuel Lorne
This study was designed to assess the association between volume of fluid challenge (FC) and predictability of respiratory variation of stroke volume (ΔrespSV) in the operating theater.Patients undergoing intermediate/high-risk surgery and monitored by esophageal Doppler monitoring (EDM) were prospectively included. All patients were under general anesthesia and mechanically ventilated. Exclusion criteria were frequent ectopic beats or preoperative arrhythmia, right ventricular failure, and spontaneous breathing...
October 2018: Medicine (Baltimore)
Benjamin J Heller, Pranav Deshpande, Joshua A Heller, Patrick McCormick, Hung-Mo Lin, Ruiqi Huang, Gregory Fischer, Menachem M Weiner
Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has well-documented benefits during cardiac surgery. The authors tested the hypothesis that NIRS technology can be used at other sites as a tissue oximeter during cardiac surgery and in the Intensive Care Unit (ICU). Aims: To establish feasibility of monitoring tissue oximetry during and after cardiac surgery, to examine the correlations between tissue oximetry values and cerebral oximetry values, and to examine correlations between oximetry values and mean arterial pressure (MAP) in order to test whether cerebral oximetry can be used as an index organ...
October 2018: Annals of Cardiac Anaesthesia
Jacopo Agrimi, Carlotta Baroni, Ekene Anakor, Vincenzo Lionetti
The number of obese patients undergoing cardiac and non cardiac surgery is rapidly increasing because they are more prone to concomitant diseases, such as diabetes, thrombosis, sleep-disordered breathing, cardiovascular and cerebrovascular diseases. Even if guidelines are already available to manage anesthesia and surgery of obese patients, the assessment of the perioperative morbidity and mortality from heart and brain disorders in morbidly obese surgical patients will be challenging in the next years. The present review will recapitulate the new mechanisms underlying the heart-brain axis vulnerability during the perioperative period in morbidly obese patients...
October 15, 2018: Current Medicinal Chemistry
Konstantin Frey, Markus Rehm, Daniel Chappell, Jana Eisenlohr, Alexander Crispin, Thomas Saller, Philipp Groene, Ben Ockert, Klaus F Hofmann-Kiefer
BACKGROUND: Hemodynamic instability frequently occurs in beach chair positioning for surgery, putting patients at risk for cerebral adverse events. This study examined whether preoperative volume loading with crystalloids alone or with a crystalloid-colloid combination can prevent hemodynamic changes that may be causative for unfavorable neurologic outcomes. METHODS: The study randomly assigned 43 adult patients undergoing shoulder surgery to 3 study groups. Each group received an infusion of 500 mL of Ringer's acetate between induction of anesthesia and being placed in the beach chair position...
October 12, 2018: Journal of Shoulder and Elbow Surgery
Eva Lorenz, Maria Blettner, Björn Lange, Marcus Schmidt, Astrid Schneider, Lukas Schwentner, Daniel Wollschläger, Hiltrud Merzenich
Background: Advances in oncological therapy have significantly improved breast cancer survival; therefore comorbid conditions are becoming more relevant. We investigated the prevalence of prior cardiovascular diseases and risk factors in patients with breast cancer compared to those in the general female population in Germany. Methods: The PASSOS heart study is a retrospective multicenter cohort study on cardiac late effects in breast cancer patients treated between 1998 and 2008...
August 2018: Breast Care
Andreas Eisenried, Raphael Klarwein, Harald Ihmsen, Andreas Wehrfritz, René Tandler, Christian Heim, Jörg Fechner
OBJECTIVE: Evaluate the accuracy and trending ability of the fourth-generation FloTrac/EV1000 (Edwards Lifesciences, Irvine, CA) system in patients with severe aortic valve stenosis by comparing FloTrac/EV1000-derived cardiac output (CCO-FT) with continuous thermodilution pulmonary artery catheter (CCO-PAC) measurements before and after surgical valve replacement. DESIGN: Prospective clinical study. SETTING: Anesthesia for cardiac surgery, operating room, single-center university hospital...
September 13, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Makoto Komatsuzaki, Shinsuke Hamaguchi
Although there is no remarkable change of anesthetics or anesthesia methods in recent years, several new technologies are used for safety management of cardiac, lung or thoracic surgery. Stroke volume variation (SVV) monitoring indicates SVV, a parameter to optimize fluid infusion and is used to avoid edema or congestive heart damage due to over hydration. SmartPilot View, a pharmacokinetic simulator during anesthesia, represents the measured effective site concentration of anesthetics and contributes the optimization of induction and maintenance of anesthesia...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Lei Chen, Liangrong Wang, Qian Zhuo, Qiong Zhang, Feifei Chen, Liling Li, Lina Lin
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients. This study aimed to evaluate the effects of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve replacement under cardiopulmonary bypass (CPB). METHODS: This prospective, randomized, controlled trial was conducted from September 2014 to January 2017. Eighty-eight patients receiving cardiac valve replacement under CPB were randomized into the control (C) or the SMI (S) group...
October 11, 2018: BMC Anesthesiology
Théa Venet, Vincent Pichot, David Charier, Aurélien Scalabre, Hugues Patural
BACKGROUND: General anesthesia dramatically decreases the activity of the autonomic nervous system. Most of the hypnotic agents used to induce anesthesia inhibit sympathetic cardiovascular regulation and baroreflex control in a dose-dependent manner, lowering cardiac adaptability during the operation. The consequence of this effect in children during and after surgery has never been studied to date. AIM: The aim of this study was to follow the variations in autonomic cardiac indices in children younger than 8 years old after general anesthesia (6-24 hours) in programmed surgery...
October 2018: Paediatric Anaesthesia
Ann Monahan, Joanne Guay, John Hajduk, Santhanam Suresh
BACKGROUND: The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac surgery. METHODS: A search was done in May 2018 in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing RA techniques with systemic analgesia...
October 8, 2018: Anesthesia and Analgesia
Yehoshua N Schacham, Barak Cohen, Gausan R Bajracharya, Michael Walters, Nicole Zimmerman, Guangmei Mao, Marianne A Tanios, Daniel I Sessler
BACKGROUND: We tested the primary hypothesis that final intraoperative esophageal temperature is associated with increased odds of a composite of in-hospital all-cause mortality and myocardial injury within 7 days after noncardiac surgery. Secondary exposures were time-weighted average intraoperative temperature and area <37°C threshold. METHODS: Myocardial injury was defined by postoperative fourth-generation troponin T ≥0.03 ng/mL apparently due to cardiac ischemia...
October 8, 2018: Anesthesia and Analgesia
Ayhan Şahin, Onur Baran
Reports on pacemaker placement/relocation surgery under pectoralis nerve block are limited. We herein report a case involving a 74-year-old woman with an infected cardiac pacemaker generator who underwent pacemaker relocation surgery under an ultrasound-guided pectoralis nerve block. On preoperative evaluation, she had congestive heart failure, type 2 diabetes mellitus, and a pacer-dependent heart rhythm. She was considered to be at high risk for general anesthesia. Thus, an ultrasound-guided pectoralis nerve block was planned...
October 5, 2018: A&A practice
Brajesh Kaushal, Sandeep Chauhan, Kulbhushan Saini, Debesh Bhoi, Akshay K Bisoi, Tsering Sangdup, Maroof Ahmad Khan
OBJECTIVE: The aim of this study was to compare the relative efficacy of ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for the management of post-thoracotomy pain in pediatric cardiac surgery. DESIGN: A prospective, randomized, single-blind, comparative study. SETTING: Single-institution tertiary referral cardiac center. PARTICIPANTS: The study comprised 108 children with congenital heart disease requiring surgery through a thoracotomy...
August 31, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Guillaume Besch, Lucie Vettoretti, Melanie Claveau, Nathalie Boichut, Nicolas Mahr, Yannis Bouhake, Ngai Liu, Thierry Chazot, Emmanuel Samain, Sebastien Pili-Floury
INTRODUCTION: Post-operative cognitive dysfunction (POCD) is frequent in patients older than 60 years undergoing major non-cardiac surgery, and increases both morbidity and mortality. Anesthetic drugs may exert neurotoxic effects and contribute to the genesis of POCD. The hypothesis of the POCD-ELA trial was that closed-loop target-controlled infusion of propofol and remifentanil could reduce the occurrence of POCD by decreasing the risk of excessive depth of anesthesia and the dose of anesthetic drugs...
October 2018: Medicine (Baltimore)
Mariusz Listewnik, Katarzyna Kotfis, Paweł Ślozowski, Krzysztof Mokrzycki, Mirosław Brykczyński
Introduction: The risk of air microembolism during cardiopulmonary bypass (CPB) is high and influences the postoperative outcome, especially in elderly patients. The use of carbon dioxide (CO2 ) atmosphere during cardiac surgery may reduce the risk of cerebral air microembolism. The aim of our study was to assess the influence of CO2 field flooding on microembolism-induced brain damage assessed by the level of S100ß protein, regarded as a marker of brain damage. Materials and methods: A group of 100 patients undergoing planned mitral valve operation through median sternotomy using standard CPB was recruited for the study...
2018: Clinical Interventions in Aging
Juei-Chii Wang, Tsorng-Shyang Yang, Po-Heng Chen, Wei-Hsiu Huang, Szu-Yun Hsiao, Chih-Shung Wong, Shu-Lin Guo
Dexmedetomidine, an α-2 adrenergic receptor agonist, provides analgesia, sedation, anxiolysis, sympatholysis and anesthetic-sparing effect, without inducing significant respiratory depression. Due to these properties, its clinical use is no longer limited to serving as a sedative agent in the intensive care unit. Proper airway management and the avoidance of cardiac and respiratory complications are common goals of everyday anesthesia practice. Ensuring airway safety is pivotal during the anesthesia stages of induction, maintenance and recovery...
June 2018: Asian Journal of Anesthesiology
Hyung-Chul Lee, Hyun-Kyu Yoon, Karam Nam, Youn Joung Cho, Tae Kyong Kim, Won Ho Kim, Jae-Hyon Bahk
Machine learning approaches were introduced for better or comparable predictive ability than statistical analysis to predict postoperative outcomes. We sought to compare the performance of machine learning approaches with that of logistic regression analysis to predict acute kidney injury after cardiac surgery. We retrospectively reviewed 2010 patients who underwent open heart surgery and thoracic aortic surgery. Baseline medical condition, intraoperative anesthesia, and surgery-related data were obtained. The primary outcome was postoperative acute kidney injury (AKI) defined according to the Kidney Disease Improving Global Outcomes criteria...
October 3, 2018: Journal of Clinical Medicine
Yuichi Morita, Tomokazu Okimoto, Yasutsugu Nagamoto, Shingo Mochizuki, Kazunori Yamada
Transcatheter aortic valve implantation (TAVI) has evolved into a standard therapy for aged patients with severe aortic valve stenosis who are not candidates for surgery. However, the reports about the safety of TAVI for patients with dextrocardia situs inversus are few. An 84-year-old man with dextrocardia situs inversus underwent a TAVI for severe aortic stenosis (AS) with an aortic valve area of 0.5 cm2 , and a mean pressure gradient of 46 mmHg. Preoperative computed tomography (CT) revealed an inverted (rightward) orientation of the ventricle apex as well as the great vessels...
June 2018: Journal of Cardiology Cases
Bharadhwaj Ranganathan, Nicole L LeBlanc, Katherine F Scollan, Katy L Townsend, Deepmala Agarwal, Milan Milovancev
OBJECTIVE To compare rates of major intraoperative complications and survival to hospital discharge between surgical ligation (SL) and canine ductal occluder (CDO) implantation for treatment of dogs with left-to-right shunting patent ductus arteriosus (PDA). DESIGN Retrospective cohort study. ANIMALS 120 client-owned dogs with left-to-right shunting PDA (62 treated by SL and 58 treated by CDO implantation). PROCEDURES Data were retrieved from medical records of included dogs regarding signalment, medical history, vertebral heart scale, preoperative echocardiographic findings, complications encountered during surgery, and durations of anesthesia and surgery (SL or CDO implantation)...
October 15, 2018: Journal of the American Veterinary Medical Association
Michael J Harrison, Christopher W Connor, David Cumin
Expected values for blood pressure are known for both unanesthetized and anesthetized children. The statistics of changes in blood pressure during anesthesia, which may have important diagnostic significance, have not been reported. The purpose of this study was to report the variation in changes in blood pressure in four pediatric age groups, undergoing both cardiac and non-cardiac surgery. An analysis of the changes in blood pressure using normalization and principal component analysis techniques was performed using an existing electronic dataset of intra-arterial pediatric blood pressure values during anesthesia...
September 28, 2018: Journal of Clinical Monitoring and Computing
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