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Intraoperative Standardization during cardiac surgery

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https://www.readbyqxmd.com/read/29745623/the-role-of-intraoperative-stroke-volume-variation-on-bleeding-during-functional-endoscopic-sinus-surgery
#1
Roberta Di Mauro, Fabiana Lucci, Federica Martino, Maria B Silvi, Eleonora Gidaro, Santo Di Lorenzo, Nicola Toschi, Stefano Di Girolamo, Mario Dauri
BACKGROUNDː Functional Endoscopic Sinus Surgery (FESS) is a minimally-invasive surgical technique for patients with paranasal sinus pathology. Surgical bleeding reduces operative field visibility and increases the incidence of serious complications. Epinephrine injection into the nasal mucosa and controlled hypotension are used to minimise bleeding. Hypotension carries risks and sometimes does not reduce surgical bleeding. The goal of this study is to discover which haemodynamic parameter better correlates with surgical bleeding...
May 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29537981/hyperinsulinemic-normoglycemia-during-cardiac-surgery-reduces-a-composite-of-30-day-mortality-and-serious-in-hospital-complications-a-randomized-clinical-trial
#2
Andra E Duncan, Daniel I Sessler, Hiroaki Sato, Tamaki Sato, Keisuke Nakazawa, George Carvalho, Roupen Hatzakorzian, Takumi Codere-Maruyama, Alaa Abd-Elsayed, Somnath Bose, Tamer Said, Maria Mendoza-Cuartas, Hyndhavi Chowdary, Edward J Mascha, Dongsheng Yang, A Marc Gillinov, Thomas Schricker
BACKGROUND: Hyperinsulinemic normoglycemia augments myocardial glucose uptake and utilization. We tested the hypothesis that hyperinsulinemic normoglycemia reduces 30-day mortality and morbidity after cardiac surgery. METHODS: This dual-center, parallel-group, superiority trial randomized cardiac surgical patients between August 2007 and March 2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital, Montreal, Canada, to intraoperative glycemic management with (1) hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant variable glucose infusion titrated to glucose concentrations of 80 to 110 mg · dl; or (2) standard glycemic management, low-dose insulin infusion targeting glucose greater than 150 mg · dl...
March 14, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29530778/a-multidisciplinary-protocol-driven-approach-to-improve-extubation-times-after-cardiac-surgery
#3
Joshua L Chan, Justin G Miller, Mandy Murphy, Ann Greenberg, Margaret Iraola, Keith A Horvath
BACKGROUND: Prolonged intubation after cardiac surgery is associated with significant morbidity. A fast-track extubation protocol primarily driven by bedside providers was instituted for all postoperative cardiac surgery patients to facilitate safe and expeditious extubation. METHODS: A retrospective review of 1,581 cardiac surgery patients over an 8-year period was performed. Before 2011, nonprotocolized standard perioperative management was utilized (n = 807)...
March 9, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29380190/comparison-of-cardiac-output-optimization-with-an-automated-closed-loop-goal-directed-fluid-therapy-versus-non-standardized-manual-fluid-administration-during-elective-abdominal-surgery-first-prospective-randomized-controlled-trial
#4
Marc Lilot, Amandine Bellon, Marine Gueugnon, Marie-Christine Laplace, Bruno Baffeleuf, Pauline Hacquard, Felicie Barthomeuf, Camille Parent, Thomas Tran, Jean-Luc Soubirou, Philip Robinson, Lionel Bouvet, Olivia Vassal, Jean-Jacques Lehot, Vincent Piriou
An intraoperative automated closed-loop system for goal-directed fluid therapy has been successfully tested in silico, in vivo and in a clinical case-control matching. This trial compared intraoperative cardiac output (CO) in patients managed with this closed-loop system versus usual practice in an academic medical center. The closed-loop system was connected to a CO monitoring system and delivered automated colloid fluid boluses. Moderate to high-risk abdominal surgical patients were randomized either to the closed-loop or the manual group...
January 27, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29324489/comparing-methods-for-cardiac-output-intraoperatively-doppler-derived-cardiac-output-measured-with-3-dimensional-echocardiography-is-not-interchangeable-with-cardiac-output-by-pulmonary-catheter-thermodilution
#5
Karin Graeser, Mikhail Zemtsovski, Klaus F Kofoed, Matilde Winther-Jensen, Jens C Nilsson, Jesper Kjaergaard, Hasse Møller-Sørensen
BACKGROUND: Estimation of cardiac output (CO) is essential in the treatment of circulatory unstable patients. CO measured by pulmonary artery catheter thermodilution is considered the gold standard but carries a small risk of severe complications. Stroke volume and CO can be measured by transesophageal echocardiography (TEE), which is widely used during cardiac surgery. We hypothesized that Doppler-derived CO by 3-dimensional (3D) TEE would agree well with CO measured with pulmonary artery catheter thermodilution as a reference method based on accurate measurements of the cross-sectional area of the left ventricular outflow tract...
January 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29237016/evaluation-of-cefazolin-antimicrobial-prophylaxis-during-cardiac-surgery-with-cardiopulmonary-bypass
#6
Divna Calic, Robert E Ariano, Rakesh C Arora, Hilary P Grocott, Ted M Lakowski, Ryan Lillico, Sheryl A Zelenitsky
Objectives: Although clinical practice guidelines recommend standard cefazolin antimicrobial prophylaxis (AP) dosing for cardiac surgery, limited data exist as to whether adequate concentrations are achieved in this patient population. The goal of our study was to characterize intraoperative cefazolin concentrations particularly at wound closure with regards to maintaining target cefazolin closure concentrations ≥40 mg/L. Methods: Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) and receiving cefazolin AP according to protocol were studied...
December 8, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28989831/intraoperative-awareness-and-recall-a-comparative-study-of-dexmedetomidine-and-propofol-in-cardiac-surgery
#7
Tufail Ahmad, Nadeem A Sheikh, Nihida Akhter, Bashir A Dar, Riyaz Ahmad
Background Awareness during general anesthesia is undesired and unanticipated patient wakefulness during surgery or recall of intraoperative events. Incidence of awareness in patients undergoing cardiac surgery is significantly higher than the overall incidence of 1% during general surgery. Awareness during cardiac surgery can be prevented by a number of methods. One such method is the supplemental, intraoperative use of sedative agents. Propofol, a bisubstituted phenol, is an intravenous general anesthetic that has been shown to reduce the incidence of awareness...
August 5, 2017: Curēus
https://www.readbyqxmd.com/read/28856576/changes-in-transcranial-motor-evoked-potentials-during-hemorrhage-are-associated-with-increased-serum-propofol-concentrations
#8
Jeremy A Lieberman, John Feiner, Mark Rollins, Russ Lyon
Transcranial motor evoked potentials (TcMEPs) monitor the integrity of the spinal cord during spine surgery. Propofol-based anesthesia is favored in order to enhance TcMEP quality. During intraoperative hemorrhage, TcMEP amplitudes may be reduced. The serum concentration of propofol may increase during hemorrhage. No study has determined whether changes in TcMEPs due to hemorrhage are related to changes in propofol blood levels. We monitored TcMEPs, mean arterial pressure (MAP), and cardiac output (CO) and hemoglobin in pigs (n = 6) undergoing controlled progressive hemorrhage during a standardized anesthetic with infusions of propofol, ketamine, and fentanyl...
August 30, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28800981/near-infrared-spectroscopy-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#9
Matthew J Chan, Tricia Chung, Neil J Glassford, Rinaldo Bellomo
OBJECTIVES: To identify the normal baseline preoperative range of cerebral tissue oxygen saturation (SctO2) derived using near-infrared spectroscopy (NIRS) and the efficacy of perioperative interventions designed to modulate SctO2 in cardiac surgical patients. DESIGN: Systematic review and meta-analysis of relevant randomized controlled trials (RCTs) extracted from the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. SETTING: Hospitals performing cardiac surgery...
August 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28760476/continuous-procedural-full-lung-ventilation-during-minimally-invasive-coronary-bypass-grafting
#10
Stephan Sixt, Hug Aubin, Robert Kalb, Philipp Rellecke, Artur Lichtenberg, Alexander Albert
BACKGROUND: In the past, minimally invasive cardiac surgery (MICS)- coronary artery bypass graft surgery (CABG) alternatives have been introduced that dramatically reduce the invasiveness of standard operative procedures while still showing excellent clinical outcomes. However, in patients with high morbidity, reduced lung function impeding single-lung ventilation is one of the major concerns for MICS-CABG procedures, although those patients might reap the largest benefit from a procedure of reduced invasiveness...
December 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28741894/randomized-controlled-trial-on-the-influence-of-intraoperative-remifentanil-versus-fentanyl-on-acute-and-chronic-pain-after-cardiac-surgery
#11
Sjoerd de Hoogd, Sabine J G M Ahlers, Eric P A van Dongen, Ewoudt M W van de Garde, Edgar J Daeter, Albert Dahan, Dick Tibboel, Catherijne A J Knibbe
BACKGROUND: Remifentanil has been associated with increased acute and potentially chronic postoperative pain. The objective of this prospective randomized controlled trial was to investigate the influence of intraoperative remifentanil on acute and chronic postoperative pain after cardiac surgery. METHODS: Patients (N = 126) receiving standardized anesthesia with propofol and intermittent intravenous fentanyl at predetermined times for cardiac surgery were randomized to intraoperatively receive either a continuous remifentanil infusion or additional intermittent intraoperative fentanyl as needed...
July 25, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28711332/predictors-of-operating-room-extubation-in-adult-cardiac-surgery
#12
Kathirvel Subramaniam, Diana S DeAndrade, Daniel R Mandell, Andrew D Althouse, Rajan Manmohan, Stephen A Esper, Jeffrey M Varga, Vinay Badhwar
OBJECTIVE: The primary objective of the study was to identify perioperative factors associated with successful immediate extubation in the operating room after adult cardiac surgery. The secondary objective was to derive a simplified predictive scoring system to guide clinicians in operating room extubation. METHODS: All 1518 patients in this retrospective cohort study underwent standardized fast-track cardiac anesthetic protocol during adult cardiac surgery. Perioperative variables between patients who had successful extubation in the operating room versus in the intensive care unit were retrospectively analyzed using both univariate and multivariable logistic regression analyses...
June 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28638156/goal-directed-perfusion-methodology-for-determining-oxygenator-performance-during-clinical-cardiopulmonary-bypass
#13
Alfred H Stammers, Randi Miller, Stephen G Francis, Laszlo Fuzesi, Anthony Nostro, Eric Tesdahl
New generation oxygenators incorporate arterial line filtration either sequential to, or directly in, the gas exchange module. This unique design may affect gas exchange performance by altering the operational characteristics of the device. The present study was designed to evaluate three oxygenators in a clinical setting using a goal-directed perfusion algorithm during cardiopulmonary bypass (CPB). After institutional review board approval, 60 adult patients undergoing cardiac surgery for acquired heart disease were matched for disease state and body size into three groups based on oxygenator type: Terumo SX18™ ( n = 20), Terumo FX15™ ( n = 20), and LivaNova Inspire6F™ 6 Dual ( n = 20)...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28599629/dose-dependent-effects-of-intravenous-methoxamine-infusion-during-hip-joint-replacement-surgery-on-postoperative-cognitive-dysfunction-and-blood-tnf-%C3%AE-level-in-elderly-patients-a-randomized-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Shenghui Sun, Defeng Sun, Lin Yang, Jun Han, Ruochuan Liu, Lijie Wang
BACKGROUND: Postoperative cognitive dysfunction (POCD), common in elderly patients, is thought to be closely associated with intraoperative instability of hemodynamics and excessive excretion of tumor necrosis factor-α (TNF-α). Methoxamine is a blood-pressure increasing drug commonly used for maintaining intraoperative hemodynamics. Methoxamine potentially promotes TNF-α expression, leading to an increased risk of POCD. This study aimed to investigate the dose-dependent effect of methoxamine on the incidence of early POCD and blood TNF-α level...
June 9, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28205344/utility-of-a-standardized-postcardiopulmonary-bypass-epicardial-echocardiography-protocol-for-stage-i-norwood-palliation
#15
Kenan W D Stern, Kimberlee Gauvreau, Sitaram Emani, Tal Geva
OBJECTIVE: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known...
May 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/27999663/implementation-of-goal-directed-fluid-therapy-during-hip-revision-arthroplasty-a-matched-cohort-study
#16
Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer, Michael Sander
BACKGROUND: Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27822310/anaphylactic-shock-during-cement-implantation-of-a-total-hip-arthroplasty-in-a-patient-with-underlying-mastocytosis-case-report-of-a-rare-intraoperative-complication
#17
Anita Ten Hagen, Pieter Doldersum, Tom van Raaij
BACKGROUND: Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE). CASE PRESENTATION: We describe the rare case of a 70-year old patient who underwent an elective total hip replacement. Before surgery he was diagnosed with underlying systemic indolent mastocytosis, a rare pathological disorder that may result in anaphylaxis after massive systemic mast cell activation...
2016: Patient Safety in Surgery
https://www.readbyqxmd.com/read/27741149/blood-conservation-strategies-in-cardiac-valve-replacement-a-retrospective-analysis-of-1645-patients
#18
Junnan Zheng, Liangwei Chen, Linfeng Qian, Jianjie Jiang, Yinglian Chen, Jue Xie, Liping Shi, Yiming Ni, Haige Zhao
We aimed to evaluate whether blood conservation strategies including intraoperative autologous donation (IAD) could reduce perioperative blood transfusion for patients undergoing cardiac valve replacement including mitral valve replacement, aortic valve replacement (AVR), and double valve replacement (DVR).A total of 726 patients were studied over a 3-year period (2011-2013) after the implementation of IAD and were compared with 919 patients during the previous 36-month period (January 2008-December 2010). The method of small-volume retrograde autologous priming, strict blood transfusion standard together with IAD constituted a progressive blood-saving strategy...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27726114/surgical-resection-of-recurrent-extrahepatic-hepatocellular-carcinoma-with-tumor-thrombus-extending-into-the-right-atrium-under-cardiopulmonary-bypass-a-case-report-and-review-of-the-literature
#19
Mineto Ohta, Chikashi Nakanishi, Naoki Kawagishi, Yasuyuki Hara, Kai Maida, Toshiaki Kashiwadate, Koji Miyazawa, Satoru Yoshida, Shigehito Miyagi, Yukihiro Hayatsu, Shunsuke Kawamoto, Yasushi Matsuda, Yoshinori Okada, Yoshikatsu Saiki, Noriaki Ohuchi
BACKGROUND: Recurrent hepatocellular carcinoma accompanied by a right atrial tumor thrombus is rare. No standard treatment modality has been established. Surgical treatment may be the only curative treatment; however, surgery has been considered high risk. We herein describe a patient who underwent resection of a recurrent right atrial tumor thrombus under normothermic cardiopulmonary bypass on a beating heart. CASE PRESENTATION: A 60-year-old man underwent a right hepatectomy for hepatocellular carcinoma with diaphragm invasion...
December 2016: Surgical Case Reports
https://www.readbyqxmd.com/read/27716699/perioperative-management-of-patients-with-left-ventricular-assist-devices-undergoing-noncardiac-surgery
#20
Meredith Degnan, Jessica Brodt, Yiliam Rodriguez-Blanco
AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality...
October 2016: Annals of Cardiac Anaesthesia
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