Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
ReviewFast-track cardiac surgery: economic implications in postoperative care.
Economics is the main driving force in changing health care delivery in the 90s. The motto is to "do more with less." Cost containment and efficient resource utilization swing the pendulum back to the debate of early tracheal extubation in cardiac surgical patients. Recently, it has been confirmed that fast-track cardiac anesthesia is both safe and cost-effective. ⋯ The perioperative cost analysis in fast-track cardiac surgery, including the cost of complications and resource utilization, is outlined. Lastly, it is important to realize that early extubation does not necessarily mean earlier intensive care unit or hospital discharge. To achieve a maximum cost benefit from early extubation, team organization of a fast-track cardiac surgery program for the perioperative management of these patients is detailed.
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
Preoperative intensive care unit admission and hemodynamic monitoring in patients scheduled for major elective noncardiac surgery: a retrospective review of 95 patients.
To review experience with preoperative intensive care unit (ICU) admission and hemodynamic monitoring to determine which patients benefited and how. ⋯ Patients who had normal initial preoperative hemodynamic parameters or abnormal initial parameters that were normalized preoperatively experienced significantly fewer perioperative cardiovascular complications than those with abnormal initial values that were not normalized preoperatively. These results suggest that there may be benefit to the practice of preoperative ICU admission, hemodynamic monitoring with a PAC, and "optimization" of cardiac function in selected patients undergoing major elective noncardiac surgery. Further studies are needed to better delineate the most appropriate patient populations and effective therapeutic protocol.
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
Estimation of the pulmonary capillary wedge pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow: influence of the respiratory cycle during mechanical ventilation.
Pulsed Doppler measurement of pulmonary venous flow (PVF) in the left superior pulmonary vein has been suggested as a noninvasive method to evaluate pulmonary capillary wedge pressure (PCWP). In previous studies, PVF was measured at end-expiration, and it is unknown to what extent PVF is affected by the respiratory cycle. It is hypothesized that phasic variations of PVF during mechanical ventilation may be used to estimate PCWP. ⋯ It has been documented that PVF velocity is influenced by the respiratory cycle during mechanical ventilation in patients undergoing cardiac surgery, and the magnitude of this variation is influenced by PCWP. However, it is not actually possible to predict PCWP accurately using these findings. Further studies are needed in which preload is varied acutely to confirm the usefulness of the results.
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
Comparative StudyGoal-directed transesophageal echocardiography performed by intensivists to assess left ventricular function: comparison with pulmonary artery catheterization.
Transesophageal echocardiography (TEE) is a valuable procedure for assessing left ventricular (LV) function, but it has not been widely applied in critical care because of the limited number of intensivists who are trained in echocardiography. This prospective study was designed to evaluate the feasibility of training intensivists to perform a goal-directed, limited-scope TEE to assess LV function in critically ill patients using a pediatric monoplane TEE probe. A secondary goal was to compare the usefulness of the TEE data with that of data obtained by a simultaneous pulmonary artery catheter (PAC). ⋯ Training intensivists in limited-scope, goal-directed TEE, using a pediatric monoplane probe to evaluate LV function, can be done rapidly and safely, and yield data pertinent to management of critically ill patients even in the early stages of skill acquisition.
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J. Cardiothorac. Vasc. Anesth. · Feb 1998
Vectorcardiographic changes as predictors of cardiac complications during major vascular surgery.
To elucidate the relation of changes in computerized vectorcardiographic trend parameters indicating perioperative myocardial ischemia with perioperative cardiac complications. ⋯ Vectorcardiographic signs of myocardial ischemia were significantly increased intraoperatively, but most pronounced postoperatively in the patients subsequently suffering cardiac events. The changes could be related to the individual cardiac morbidity with acceptable precision. Thus, continuous vectorcardiographic monitoring may be beneficial for patients at risk of developing perioperative ischemia.