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cardiac surgery and anesthesia

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https://www.readbyqxmd.com/read/29915955/population-pharmacokinetic-modeling-of-remifentanil-in-infants-with-unrepaired-tetralogy-of-fallot
#1
Jing Chang, Yang Shen, Yue Huang, Ying Sun, Mei-Hua Cai, Jing Niu, Li-Ming Zhang, Ji-Jian Zheng, Ma-Zhong Zhang
BACKGROUND: Although there is literature suggesting that pathophysiologic changes in children with congenital heart disease alter the pharmacokinetics of anesthetics and may result in dosage adjustment, limited information exists regarding the pharmacokinetics of remifentanil in infants with unrepaired tetralogy of Fallot (TOF). The objectives of the current analysis were to characterize the population pharmacokinetics of remifentanil in infants, and to evaluate the effects of TOF on remifentanil's pharmacokinetics...
June 19, 2018: European Journal of Drug Metabolism and Pharmacokinetics
https://www.readbyqxmd.com/read/29913033/comparison-of-propofol-based-versus-volatile-based-anaesthesia-and-postoperative-sedation-in-cardiac-surgical-patients-a-prospective-randomized-study
#2
Marcin Wąsowicz, Angela Jerath, Warren Luksun, Vivek Sharma, Nicholas Mitsakakis, Massimilaino Meineri, Rita Katznelson, Terrence Yau, Vivek Rao, William Scott Beattie
BACKGROUND: Clinical trials have shown conflicting results regarding the use of volatile anesthesia before or after the ischemic insult in cardiac surgical patients and effect on myocardial injury. This may be attributable to the failure of continuing volatile agents into the early postoperative period. We hypothesized that combined volatile-based anesthesia and postoperative sedation would decrease the extent of myocardial injury after coronary artery bypass grafting (CABG) when compared to intravenous, propofol-based approach...
June 18, 2018: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29889708/a-prospective-observational-study-of-anesthesia-related-adverse-events-and-postoperative-complications-occurring-during-a-surgical-mission-in-madagascar
#3
Michelle C White, Brian J Barki, Stephen A Lerma, Sarah Kate Couch, Dennis Alcorn, Richard G Gillerman
BACKGROUND: Two-thirds of the world's population lack access to safe anesthesia and surgical care. Nongovernmental organizations (NGOs) play an important role in bridging the gap, but surgical outcomes vary. After complex surgeries, up to 20-fold higher postoperative complication rates are reported and the reasons for poor outcomes are undefined. Little is known concerning the incidence of anesthesia complications. Mercy Ships uses fully trained staff, and infrastructure and equipment resources similar to that of high-income countries, allowing the influence of these factors to be disentangled from patient factors when evaluating anesthesia and surgical outcomes after NGO sponsored surgery...
June 8, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29880427/dobutamine-and-nitroglycerin-versus-milrinone-for-perioperative-management-of-pulmonary-hypertension-in-mitral-valve-surgery-a-randomized-controlled-study
#4
Ashraf M Eskandr, Ahmed A Metwally, Montasser S Abu Elkassem, Sadik A Sadik, Ashraf E Elmiligy, Mohamed Mourad, Lamiaa Hussein
OBJECTIVE: To compare the effects of dobutamine and nitroglycerin to milrinone in young patients with severe pulmonary hypertension undergoing mitral valve replacement. DESIGN: A prospective randomized, double-blinded, controlled study. SETTING: Single university hospital. PARTICIPANTS: Forty patients had systolic pulmonary arterial pressure ≥60 mmHg and were scheduled for elective mitral valve replacement. The patients were divided randomly into 2 equal groups according to the drugs given during the study...
April 18, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29874956/does-the-type-of-cardioplegia-used-during-valve-surgery-influence-operative-nadir-hematocrit-and-transfusion-requirements
#5
Alfred H Stammers, Eric A Tesdahl, Linda B Mongero, Andrew Stasko
INTRODUCTION: Myocardial protection is performed using diverse cardioplegic (CP) solutions with various combinations of chemical and blood constituents. Newer CP formulations that extend ischemic intervals may require greater asanguineous volume, contributing to hemodilution. METHODS: We evaluated intraoperative hemodilution and red blood cell (RBC) transfusion rates among three common CP solutions during cardiac valve surgery. Data from 5,830 adult cardiac primary valve procedures where either four-to-one blood CP (4:1), del Nido solution (DN) or microplegia (MP) was used at 173 United States surgical centers...
June 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29872966/effect-of-preoperative-warming-on-intraoperative-hypothermia-a-randomized-controlled-trial
#6
Aaron Lau, Nasim Lowlaavar, Erin M Cooke, Nicholas West, Alexandra German, Dan J Morse, Matthias Görges, Richard N Merchant
PURPOSE: The purpose of this study was to evaluate the effects of preoperative forced-air warming on intraoperative hypothermia. METHODS: In this randomized-controlled trial, adult patients scheduled for elective, non-cardiac surgery under general anesthesia were stratified by scheduled surgical duration (< 2.5 hr or ≥ 2.5 hr) and then randomized to a pre-warming group using a BairPaws™ forced-air warming system for at least 30 min preoperatively or to a control group with warmed blankets on request...
June 5, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29862088/unexpected-exacerbation-of-tracheal-stenosis-in-a-patient-with-hunter-syndrome-undergoing-cardiac-surgery
#7
Nobue Terabe, Soichiro Yamashita, Makoto Tanaka
We report unexpected exacerbation of tracheal stenosis during general anesthesia in a 50-year-old patient with Hunter syndrome undergoing cardiac surgery for valvular disease. He had undergone cervical laminoplasty 3 months previously; at that time, his airway had been uneventfully managed. Preoperative flexible fiberoptic laryngoscopy showed a normal upper respiratory tract, but chest computed tomography showed tracheal stenosis that had flattened the lumen. The narrowest part above the tracheal bifurcation was 2 cm long and the anteroposterior diameter was ≤6 mm...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29846461/hemodynamic-evaluation-of-elderly-patients-during-laparoscopic-cholecystectomy
#8
Luiz Paulo Jacomelli Ramos, Rodrigo Barcellos Araújo, Maria DO Carmo Valente Castro, Maria Roberta Meneguetti Seravalli Ramos, José Antonio Cunha-E-Silva, Antonio Carlos Iglesias
OBJECTIVE: to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. METHODS: we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3)...
2018: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/29844213/positive-correlation-between-regional-cerebral-oxygen-saturation-and-mixed-venous-oxygen-saturation-during-off-pump-coronary-artery-bypass-surgery
#9
Zheng Guan, Jing-Jie Liu, Hui Yuan, Yan-Feng Gao
BACKGROUND: The balance of oxygen delivery and consumption is essential in patients who are critically ill. Mixed venous oxygen saturation (Sv̄O2 ) is a standard method to evaluate oxygen delivery and consumption during anesthesia. However, Sv̄O2 is monitored through a pulmonary artery catheter, which is invasive. Regional cerebral oxygenation (rScO2 ) reflects oxygen saturation in a small region of the frontal lobes and is monitored noninvasively through near-infrared spectroscopy...
May 29, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29794944/use-of-serratus-plane-block-for-repair-of-coarctation-of-aorta-a-report-of-3-cases
#10
Abhijit Biswas, Igor Luginbuehl, Elod Szabo, Monica Caldeira-Kulbakas, Mark W Crawford, Tobias Everett
OBJECTIVES: The practice of regional anesthesia techniques (thoracic, epidural, paravertebral) in pediatric cardiac surgery enhances perioperative outcomes such as improved perioperative analgesia, decreased stress response, early extubation, and shortened hospital stay. However, these blocks can be technically challenging and can be associated with unacceptable failure rate and complications in infants. For these reasons, regional anesthesia is sometimes avoided in pediatric cardiac surgery...
May 23, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29788801/perioperative-noninvasive-cardiac-output-monitoring-in-parturients-with-singleton-and-twin-pregnancies-undergoing-caesarean-section-under-spinal-anesthesia-with-prophylactic-phenylephrine-drip-a-prospective-observational-cohort-study
#11
S Orbach-Zinger, E Razinsky, I Bizman, S Firman, R Gat, A Davis, E Ashwal, A Shmueli, M Vaturi, R Gabbay-Benziv, L A Eidelman
INTRODUCTION: Spinal anesthesia is considered the gold standard anesthetic technique for cesarean deliveries (CD) but is associated with a high rate of hypotension. The recent international consensus recommends continuous prophylactic phenylephrine infusion (PPI) administered throughout CD to prevent hypotension. However little information is available on the hemodynamic profiles of women with twin pregnancies as compared to singleton pregnancies perioperatively. Therefore, in this study we aim we compare maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICAS bio impendence monitor in healthy singleton versus twin parturients undergoing CD deliveries with spinal anesthesia with PPI...
May 22, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29786598/-hypertrophic-cardiomyopathy-an-intraoperative-death-case-analysis-and-substantiation-of-the-standards-of-perioperative-anesthetic-management-in-a-non-cardiosurgery-clinic
#12
Roman N Fedosiuk, Liliia O Shchupachynska
The article is based on the case analysis of a sudden and unexpected intraoperative death of a 51-year-old female patient with hypertrophic cardiomyopathy, who was undergoing a non-cardiac operation in a non-cardiosurgery clinic, from acute precipitation of left ventricular outflow tract obstruction provoked by surgery and anesthesia. It emphasizes the importance of raising non-cardiac anesthesiologists' awareness of the issue and having clear standards of pre-operative evaluation and perioperative management of patients with hypertrophic cardiomyopathy in order to avoid fatal medical errors...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29780726/operative-techniques-for-improving-surgical-exposure-in-basic-cardiac-surgery
#13
Dawn S Hui, Jason M Lizalek, Vikram S Chawa, Richard Lee
Operative exposure is key to ensuring surgical efficiency and patient safety in cardiac surgery. As the population ages and the prevalence of obesity increases, cardiac surgeons will be challenged to consider obese patient physiology and body habitus, surgical exposure and sternotomy closure techniques, and postoperative medical management to ensure optimal outcomes. In this article, we describe techniques to improve operative exposure in both obese and non-obese patients undergoing basic cardiac surgery and highlight the roles of surgical team members to ensure patient safety and provide optimal anesthetic management...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29776668/-fatal-cardiac-tamponade-that-developed-in-the-post-anesthesia-care-unit-a-rare-complication-after-lung-lobectomy
#14
Hyung Mook Lee, Young Jae Jeon, Hye Won Chung, Hyo Min Yun, Mi Hyun Kim
BACKGROUND AND OBJECTIVES: Cardiac tamponade is potentially fatal medical condition, which rarely occurs as a complication of lung lobectomy. We present the first case of cardiac tamponade to develop in a Post-Anesthesia Care Unit following a lung lobectomy. CASE REPORT: A 54-year-old man with pulmonary squamous cell carcinoma underwent an apparently uncomplicated lung lobectomy. His hemodynamics was unremarkable throughout the surgery and initially in the Post-Anesthesia Care Unit...
May 15, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29772591/-monitoring-and-modern-hemodynamic-concepts-in-cardiac-anesthesia
#15
Matthias Heringlake, Christian Schmidt, Sebastian Brandt
Patients undergoing cardiac surgery are growing older, present with more comorbidities, and are frequently scheduled for more complex and prolonged surgical procedures. Routine application of neurological as well as extended hemodynamic monitoring combined with goal-directed perioperative hemodynamic optimization, targeting optimization of systemic and cerebral oxygen balance, show promise to reduce postoperative complications and to improve mortality in this high risk population. Expert recommendations suggest to avoid synthetic colloids for fluid optimization...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29771722/detection-of-deteriorating-patients-on-surgical-wards-outside-the-icu-by-an-automated-mews-based-early-warning-system-with-paging-functionality
#16
Axel R Heller, Sören T Mees, Benjamin Lauterwald, Christian Reeps, Thea Koch, Jürgen Weitz
BACKGROUND: The establishment of early warning systems in hospitals was strongly recommended in recent guidelines to detect deteriorating patients early and direct them to adequate care. Upon reaching predefined trigger criteria, Medical Emergency Teams (MET) should be notified and directed to these patients. The present study analyses the effect of introducing an automated multiparameter early warning score (MEWS)-based early warning system with paging functionality on 2 wards hosting patients recovering from highly complex surgical interventions...
May 16, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29770180/factors-impacting-arthroscopic-rotator-cuff-repair-operational-throughput-time-at-an-ambulatory-care-center
#17
Emily J Curry, Catherine Logan, Kaytelin Suslavich, Kaitlyn Whitlock, Eric Berkson, Elizabeth Matzkin
Identifying patient factors influencing operational throughput time is becoming more imperative due to an increasing focus on value and cost savings in healthcare. The primary objective of this study was to determine patient factors influencing throughput time for primary rotator cuff repairs. Demographic information, medical history and operative reports of 318 patients from one ambulatory care center were retrospectively reviewed. Operating room set up, incision to closure and recovery room time were collected from anesthesia records...
March 29, 2018: Orthopedic Reviews
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#18
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29753669/does-the-weekend-effect-for-postoperative-mortality-stand-up-to-scrutiny-association-for-cardiothoracic-anesthesia-and-critical-care-cohort-study-of-110-728-cardiac-surgical-patients
#19
Olympia Papachristofi, Andrew A Klein, John Mackay, Samer Nashef, Nick S Fletcher, Linda D Sharples
OBJECTIVE: Ongoing debate focuses on whether patients admitted to the hospital on weekends have higher mortality than those admitted on weekdays. Whether this apparent "weekend effect" reflects differing patient risk, care quality differences, or inadequate adjustment for risk during analysis remains unclear. This study aimed to examine the existence of a "weekend effect" for risk-adjusted in-hospital mortality after cardiac surgery. DESIGN: Retrospective analysis of prospectively collected cardiac registry data...
April 5, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29745073/hemodynamic-stability-achievement-by-application-of-goal-directed-fluid-therapy-with-different-infusion-solutions-in-colorectal-surgery
#20
Ana Cvetkovic, Nevena Kalezic, Biljana Milicic, Srdjan Nikolic, Milan Zegarac, Dejan Stojiljkovic, Merima Goran, Marina Stojanovic
PURPOSE: To determine whether there was a correlation between the type of administered infusion solutions intraoperatively with the quantity of administered infusion solutions, differences in values of cardiac output (CO) and cardiac index (CI) and need to use vasopressors and inotropes, between control and research groups. METHODS: This randomized prospective study included 55 patients with colorectal cancer. Subjects in the control group received only crystalloid solutions intraoperatively and postoperatively...
March 2018: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
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