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cardiac surgery and anesthesia

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https://www.readbyqxmd.com/read/28820799/regional-anesthesia-and-analgesia-after-surgery-in-icu
#1
Mathieu Capdevila, Séverin Ramin, Xavier Capdevila
PURPOSE OF REVIEW: The aim is to demonstrate that ICU physicians should play a pivotal role in developing regional anesthesia techniques that are underused in critically ill patients despite the proven facts in perioperative and long-term pain, organ dysfunction, and postsurgery patient health-related quality of life improvement. RECENT FINDINGS: Regional anesthesia and/or analgesia strategies in ICU reduce the surgical and trauma-stress response in surgical patients as well as complications incidence...
August 17, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28820553/is-transcatheter-tricuspid-valve-in-valve-implantation-feasible-in-the-presence-of-right-atrial-thrombus
#2
Jan Henzel, Zofia Dzielińska, Marek Konka, Maciej Dąbrowski, Marcin Protasiewicz, Adam Witkowski, Marcin Demkow
The case is reported of a successful transcatheter implantation of an Edwards SAPIEN 3 valve (29 mm) into a failing tricuspid bioprosthesis (Sorin Pericarbon, 31 mm). The procedure was performed in a 69-year-old woman with post-rheumatic mitral and tricuspid valve disease. Multiple previous cardiac surgeries precluded the use of another surgical approach. A large, organized, two-piece thrombus in the enlarged right atrium was not considered an absolute contraindication to the procedure. The SAPIEN 3 valve was implanted under general anesthesia, via a femoral venous access, under three-dimensional transesophageal echocardiography guidance...
March 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28820035/changes-in-heparin-dose-response-slope-during-cardiac-surgery-possible-result-in-inaccuracy-in-predicting-heparin-bolus-dose-requirement-to-achieve-target-act
#3
Junko Ichikawa, Tetsu Mori, Mitsuharu Kodaka, Keiko Nishiyama, Makoto Ozaki, Makiko Komori
INTRODUCTION: The substantial interpatient variability in heparin requirement has led to the use of a heparin dose response (HDR) technique. The accuracy of Hepcon-based heparin administration in achieving a target activated clotting time (ACT) using an HDR slope remains controversial. METHODS: We prospectively studied 86 adult patients scheduled for cardiac surgery requiring cardiopulmonary bypass. The total dose of calculated heparin required for patient and pump priming was administered simultaneously to achieve a target ACT of 450 s for HDR on the Hepcon HMS system...
September 2017: Perfusion
https://www.readbyqxmd.com/read/28818338/spinal-anesthesia-for-pediatric-urological-surgery-reducing-the-theoretic-neurotoxic-effects-of-general-anesthesia
#4
Emmett E Whitaker, Brianne Z Wiemann, Daniel G DaJusta, Seth A Alpert, Christina B Ching, Daryl J McLeod, Joseph D Tobias, Venkata R Jayanthi
BACKGROUND: Spinal anesthesia (SA) is an effective technique that has been used in children for years. With growing concern with regard to the risks of general anesthesia (GA), we developed a SA program to provide an alternative option. We present our initial experience with this program. OBJECTIVE: To implement a SA program at a large tertiary care pediatric center and assess the safety and efficacy of the technique as an alternative to GA for urologic surgery...
July 14, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28803768/assessment-of-preoperative-anxiety-in-cardiac-surgery-patients-lacking-a-history-of-anxiety-contributing-factors-and-postoperative-morbidity
#5
Joaquín Hernández-Palazón, Diego Fuentes-García, Luis Falcón-Araña, María José Roca-Calvo, Sebastián Burguillos-López, Paloma Doménech-Asensi, Rubén Jara-Rubio
OBJECTIVES: The aim of this study was to measure the level of preoperative anxiety in patients scheduled for cardiac surgery, identify any influencing clinical factors, and assess the relationship between anxiety and postoperative morbidity. DESIGN: A prospective and consecutive study. SETTING: A single university hospital. PARTICIPANTS: The study comprised 200 patients scheduled for cardiac surgery. INTERVENTIONS: Each patient was asked to grade his or her preoperative anxiety level using the Visual Analogue Scale for Anxiety, Amsterdam Preoperative Anxiety and Information Scale, and set of specific anxiety-related questions...
April 26, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28802790/vascular-air-embolism-a-silent-hazard-to-patient-safety
#6
REVIEW
Sorin J Brull, Richard C Prielipp
PURPOSE: To narratively review published information on prevention, detection, pathophysiology, and appropriate treatment of vascular air embolism (VAE). MATERIALS AND METHODS: MEDLINE, SCOPUS, Cochrane Central Register and Google Scholar databases were searched for data published through October 2016. The Manufacturer and User Facility Device Experience (MAUDE) database was queried for "air embolism" reports (years 2011-2016). RESULTS: VAE may be introduced through disruption in the integrity of the venous circulation that occurs during insertion, maintenance, or removal of intravenous or central venous catheters...
August 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28800981/near-infrared-spectroscopy-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#7
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/28800722/randomized-comparison-of-sevoflurane-versus-propofol-remifentanil-on-the-cardioprotective-effects-in-elderly-patients-with-coronary-heart-disease
#8
Yunlong Zhang, Wendong Lin, Sheliang Shen, Hongfa Wang, Xiaona Feng, Jiehao Sun
BACKGROUND: It is skeptical about cardioprotective property of sevoflurane in patients undergoing noncardiac surgery, especially in the elderly patients with coronary heart disease. We hypothesized that long duration of sevoflurane inhalation in noncardiac surgery could ameliorate myocardial damage in such patients. METHODS: This was a randomized, prospective study. One hundred twenty-one elderly patients with coronary heart disease were randomly allocated into two groups...
August 11, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28796275/immature-platelets-as-a-novel-biomarker-for-adverse-cardiovascular-events-in-patients-after-non-cardiac-surgery
#9
Aida Anetsberger, Manfred Blobner, Bernhard Haller, Sebastian Schmid, Katrin Umgelter, Theresa Hager, Clemens Langgartner, Eberhard F Kochs, Karl-Ludwig Laugwitz, Bettina Jungwirth, Isabell Bernlochner
This study evaluates whether immature platelets (IPF) determined in the post anesthesia care unit (PACU) can predict major adverse cardiovascular events (MACE) or other thromboembolic events after intermediate and high-risk surgery. IPF are increased in patients with acute coronary syndrome and recently gained interest as novel biomarker for risk stratification. In this prospective observational trial 732 patients undergoing intermediate or high-risk non-cardiac surgery were enrolled (NCT02097602). IPF was measured preoperatively and postoperatively in the PACU...
August 10, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28777814/prevalence-of-preoperative-anemia-abnormal-mean-corpuscular-volume-and-red-cell-distribution-width-among-surgical-patients-in-singapore-and-their-influence-on-one-year-mortality
#10
Yilin Eileen Sim, Hide Elfrida Wee, Ai Leen Ang, Niresh Ranjakunalan, Biauw Chi Ong, Hairil Rizal Abdullah
INTRODUCTION: Preoperative anemia and high red cell distribution width (RDW) are associated with higher perioperative mortality. Conditions with high RDW levels can be categorized by mean corpuscular volume (MCV). The relationship between RDW, anemia and MCV may explain causality between high RDW levels and outcomes. We aim to establish the prevalence of preoperative anemia and distribution of RDW and MCV among pre-surgical patients in Singapore. In addition, we aim to investigate the association between preoperative anemia, RDW and MCV levels with one-year mortality after surgery...
2017: PloS One
https://www.readbyqxmd.com/read/28746233/preoperative-thromboelastometry-for-the-prediction-of-increased-chest-tube-output-in-cardiac-surgery-a-retrospective-study
#11
Waldemar Gozdzik, Barbara Adamik, Grzegorz Wysoczanski, Anna Gozdzik, Maciej Rachwalik, Tomasz Skalec, Andrzej Kübler
Bleeding following cardiac surgery is a serious event with potentially life-threatening consequences. Preoperative recognition of coagulation abnormalities and detection of cardiopulmonary bypass (CPB) related coagulopathy could aid in the start of preventive treatment strategies that minimize perioperative blood loss. Most algorithms that analyze thromboelastometry coagulation tests in elective cardiac surgery do not include test results performed before surgery. We evaluated preoperative rotational thromboelastometry test results for their ability to predict blood loss during and after cardiac surgery...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28741894/randomized-controlled-trial-on-the-influence-of-intra-operative-remifentanil-versus-fentanyl-on-acute-and-chronic-pain-after-cardiac-surgery
#12
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 receive intra-operatively 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/28739038/anesthetic-and-perioperative-management-of-patients-with-brugada-syndrome
#13
REVIEW
Gregory Dendramis, Claudia Paleologo, Giuseppe Sgarito, Umberto Giordano, Roberto Verlato, Adrian Baranchuk, Pedro Brugada
Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit...
June 28, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28738862/impact-of-ischemic-preconditioning-on-surgical-treatment-of-brain-tumors-a-single-center-randomized-double-blind-controlled-trial
#14
Arthur H A Sales, Melanie Barz, Stefanie Bette, Benedikt Wiestler, Yu-Mi Ryang, Bernhard Meyer, Martin Bretschneider, Florian Ringel, Jens Gempt
BACKGROUND: Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Particularly in the field of cardiac and vascular surgery, the application of a brief ischemic stimulus not only in the target organ but also in remote tissues can prevent subsequent ischemic damage. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences...
July 25, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28727703/intrathecal-morphine-improves-hemodynamic-parameters-and-analgesia-in-patients-undergoing-aortic-valve-replacement-surgery-a-prospective-double-blind-randomized-trial
#15
Hamed Elgendy, Hatem A R Helmy
BACKGROUND: Intrathecal morphine (ITM) has been used in hopes of providing good postoperative analgesia in cardiac surgery. Little is known about its use in isolated aortic valve replacement surgery. OBJECTIVES: To evaluate the effects of 7 µ/kg ITM administration in aortic valve replacement in regards to hemodynamics, pain score, and postoperative complications when compared to general anesthesia alone. STUDY DESIGN: A randomized, double-blind trial...
July 2017: Pain Physician
https://www.readbyqxmd.com/read/28723765/perioperative-management-of-intracardiac-leiomyomatosis-an-observational-cohort-study
#16
Jiaying Xu, Min Wei, Qi Miao, Bin Zhu, Chunhua Yu, Yuguang Huang
Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear.We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016.The mean patient age was 44.5 (range 25-55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28716819/effect-of-type-2-diabetes-surgical-incision-and-volatile-anesthesia-on-hemodynamics-in-the-rat
#17
Carol T Bussey, Regis R Lamberts
Diabetic patients have increased cardiac complications during surgery, possibly due to impaired autonomic regulation. Anesthesia lowers blood pressure and heart rate (HR), whereas surgical intervention has opposing effects. The interaction of anesthesia and surgical intervention on hemodynamics in diabetes is unknown, despite being a potential perioperative risk factor. We aimed to determine the effect of diabetes on the integrative interaction between hemodynamics, anesthesia, and surgical incision. Zucker type 2 diabetic rats (DM) and their nondiabetic littermates (ND) were implanted with an intravenous port for drug delivery, and a radiotelemeter to measure mean arterial blood pressure (MAP) and derive HR (total n = 50)...
July 2017: Physiological Reports
https://www.readbyqxmd.com/read/28704248/low-end-tidal-carbon-dioxide-at-the-onset-of-emergent-trauma-surgery-is-associated-with-nonsurvival-a-case-series
#18
Roman Dudaryk, Danielle K Bodzin, Juliet J Ray, Craig S Jabaley, Richard R McNeer, Richard H Epstein
BACKGROUND: End-tidal carbon dioxide (EtCO2) is a valuable marker of the return of adequate circulation following cardiac arrest due to medical causes. Previously, the prognostic value of capnography in trauma has been studied among limited populations in prehospital and emergency department settings. We aimed to investigate the relationship between early intraoperative EtCO2 and nonsurvival of patients undergoing emergency surgery at a level 1 academic trauma center as a case series...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28701611/the-utility-of-targeted-perioperative-transthoracic-echocardiography-in-managing-an-adult-patient-with-anomalous-origin-of-the-left-coronary-artery-pulmonary-artery-for-noncardiac-surgery
#19
Anudeep Jafra, Suman Arora, Aveek Jayant
Congenital coronary artery anomalies as a whole are uncommon. Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is probably the most common congenital coronary defect. An overwhelming majority of the patients with untreated ALCAPA do not survive to adulthood. As yet, there is no consensus on the management of adults with ALCAPA. We describe a patient with breast malignancy and incidentally detected ALCAPA; primacy was given to treatment of the oncologic condition as a first step...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28701593/neutrophil-gelatinase-associated-lipocalin-as-a-biomarker-for-predicting-acute-kidney-injury-during-off-pump-coronary-artery-bypass-grafting
#20
Muralidhar Kanchi, R Manjunath, Jos Massen, Lloyd Vincent, Kumar Belani
BACKGROUND: Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality, and economic burden. In this study, we assessed the usefulness of estimating serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in predicting AKI in patients with stable chronic kidney disease (CKD) and undergoing off-pump coronary artery bypass grafting (OP-CABG). PATIENTS AND METHODS: We prospectively studied sixty nondialysis-dependent CKD patients with estimated glomerular filtration rate <60 ml/min/1...
July 2017: Annals of Cardiac Anaesthesia
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