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Intraoperative Standardization during cardiac surgery

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https://www.readbyqxmd.com/read/28711332/predictors-of-operating-room-extubation-in-adult-cardiac-surgery
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/27570162/simulation-based-training-in-cardiac-surgery
#10
Richard H Feins, Harold M Burkhart, John V Conte, Daniel N Coore, James I Fann, George L Hicks, Jonathan C Nesbitt, Paul S Ramphal, Sharon E Schiro, K Robert Shen, Amaanti Sridhar, Paul W Stewart, Jennifer D Walker, Nahush A Mokadam
BACKGROUND: Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons. METHODS: Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function...
January 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27550555/caudal-analgesia-and-cardiothoracic-surgery-a-look-at-postoperative-pain-scores-in-a-pediatric-population
#11
Khoa N Nguyen, Heather S Byrd, Jonathan M Tan
AIM: Caudal epidural anesthesia has been shown to reduce stress response and shorten the time to extubation in children after cardiac surgery. Combined with general anesthesia, regional anesthesia has been proven to be safe and efficacious in the pediatric population. It is not known, however, whether the use of caudal anesthesia actually reduces postoperative pain scores and decreases postoperative opioid use. METHODS: We retrospectively analyzed the charts of 199 children who underwent repair for atrial septal defect (ASD), ventricular septal defect (VSD), and Tetralogy of Fallot (TOF) at a major academic children's hospital between 2010 and 2013...
November 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27504382/comparison-of-albumin-hydroxyethyl-starch-and-ringer-lactate-solution-as-priming-fluid-for-cardiopulmonary-bypass-in-paediatric-cardiac-surgery
#12
Jigar Patel, Mrugesh Prajapati, Atul Solanki, Himani Pandya
INTRODUCTION: In paediatric cardiac surgery, there is still not any information with regard to the best choice of priming fluids for Cardiopulmonary Bypass (CPB). Albumin, Hydroxyethyl Starch (HES) & ringer lactate are equally used, but each has its advantages & disadvantages. Albumin & HES had better fluid balance which affect outcome in paediatric cardiac surgery significantly. AIM: To compare priming solution containing albumin, hydroxyethyl starch and ringer lactate during elective open-heart surgery in paediatrics aged up to 3 years...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27499818/allogeneic-blood-product-usage-in-coronary-artery-bypass-grafting-cabg-with-minimalized-extracorporeal-circulation-system-mecc-versus-standard-on-pump-coronary-artery-bypass-grafting
#13
M Lisy, E Schmid, J Kozok, P Rosenberger, U A Stock, G Kalender
AIM: Intraoperative allogeneic blood product transfusion (ABPT) in cardiac surgery is associated with worse overall outcome, including mortality. The objective of this study was to evaluate the ABPTs in minimalized extracorporeal cardiopulmonary (MECC(TM)) compared with standard open system on-pump coronary revascularization. METHODS: Data of 156 patients undergoing myocardial revascularization between September 2008 and September 2010 were reviewed. 83 patients were operated by the MECC technique and 73 were treated by standard extracorporeal circulation (sECC)...
2016: Open Cardiovascular Medicine Journal
https://www.readbyqxmd.com/read/27440627/acute-risk-change-arc-identifies-outlier-institutions-in-perioperative-cardiac-surgical-care-when-the-standardized-mortality-ratio-cannot
#14
T G Coulson, M Bailey, C M Reid, L Tran, D V Mullany, J Parker, P Hicks, D Pilcher
BACKGROUND: With improvements in short-term mortality after cardiac surgery, the sensitivity of the standardized mortality ratio (SMR) as a performance-monitoring tool has declined. We assessed acute risk change (ARC) as a new and potentially more sensitive metric to differentiate overall cardiac surgical unit performance. METHODS: Retrospective analysis of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database and Australian and New Zealand Intensive Care Society Adult Patient Database was performed...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27415436/capturing-pain-in-the-cortex-during-general-anesthesia-near-infrared-spectroscopy-measures-in-patients-undergoing-catheter-ablation-of-arrhythmias
#15
Barry D Kussman, Christopher M Aasted, Meryem A Yücel, Sarah C Steele, Mark E Alexander, David A Boas, David Borsook, Lino Becerra
The predictability of pain makes surgery an ideal model for the study of pain and the development of strategies for analgesia and reduction of perioperative pain. As functional near-infrared spectroscopy reproduces the known functional magnetic resonance imaging activations in response to a painful stimulus, we evaluated the feasibility of functional near-infrared spectroscopy to measure cortical responses to noxious stimulation during general anesthesia. A multichannel continuous wave near-infrared imager was used to measure somatosensory and frontal cortical activation in patients undergoing catheter ablation of arrhythmias under general anesthesia...
2016: PloS One
https://www.readbyqxmd.com/read/27372236/cervical-repair-of-congenital-tracheoesophageal-fistula-complications-lurking
#16
COMPARATIVE STUDY
Andrea Conforti, Chiara Iacusso, Laura Valfrè, Marilena Trozzi, Sergio Bottero, Pietro Bagolan
AIM: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) consist of a spectrum of rare congenital abnormalities. Although EA surgical treatment is well established, the outcome of EA with proximal fistula (type B and D EA) or isolated H-type fistula (type E EA) is poorly explored. These forms of EA shared a common surgical step: the need of a cervical approach to close the fistula. Therefore, the aim of present study is to evaluate postoperative outcomes of patients treated for Gross type B-D and E EA, on regards of their cervical surgery...
October 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27160113/effect-of-perioperative-inadvertent-hypothermia-on-the-ecg-parameters-in-patients-undergoing-transurethral-resection
#17
H Bayir, I Yildiz, F Erdem, U Y Tekelioglu, M E Ozyalvacli, M Bilgi, H Kocoglu
OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 °C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study...
April 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27097025/optimized-outcomes-using-a-standardized-approach-for-the-treatment-of-patients-with-carcinoid-heart-disease
#18
Miriam Silaschi, James Barr, Sanjay Chaubey, Niki Nicou, Raj Srirajaskanthan, Jonathan Byrne, John Ramage, Philip MacCarthy, Olaf Wendler
BACKGROUND: Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported peri-operative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience. METHODS: All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus...
2017: Neuroendocrinology
https://www.readbyqxmd.com/read/26971164/reccas-removal-of-cytokines-during-cardiac-surgery-study-protocol-for-a-randomised-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Andreas Baumann, Dirk Buchwald, Thorsten Annecke, Martin Hellmich, Peter K Zahn, Andreas Hohn
BACKGROUND: On-pump cardiac surgery triggers a significant postoperative systemic inflammatory response, sometimes resulting in multiple-organ dysfunction associated with poor clinical outcome. Extracorporeal cytokine elimination with a novel haemoadsorption (HA) device (CytoSorb®) promises to attenuate inflammatory response. This study primarily assesses the efficacy of intraoperative HA during cardiopulmonary bypass (CPB) to reduce the proinflammatory cytokine burden during and after on-pump cardiac surgery, and secondarily, we aim to evaluate effects on postoperative organ dysfunction and outcomes in patients at high risk...
March 12, 2016: Trials
https://www.readbyqxmd.com/read/26948465/acute-pain-and-analgesic-requirements-after-pulmonary-endarterectomy-with-deep-hypothermic-circulatory-arrest
#20
Marc Giménez-Milà, Sebastian Videla, David Jenkins, Andrew A Klein, Caroline Gerrard, Jacinta Nalpon, Kamen Valchanov
OBJECTIVES: To assess postoperative pain intensity and the analgesic requirements in the postoperative period in patients undergoing sternotomy for pulmonary endarterectomy involving deep hypothermic circulatory arrest. DESIGN: Retrospective cohort study. SETTING: Single-center hospital study. PARTICIPANTS: Patients 18 years and older undergoing sternotomy for cardiac surgery between August 2012 and August 2014. INTERVENTIONS: No modification to usual clinical practice...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
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