Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Detection and monitoring of complications associated with femoral or axillary arterial cannulation for surgical repair of aortic dissection.
Femoral arterial perfusion can be associated with complications, and axillary arterial perfusion is not free from risk. The purpose of this study was to describe the incidence and complications of femoral versus axillary artery cannulation for surgical repair of aortic dissection and to devise a strategy for early detection and monitoring of complications using transesophageal echocardiography, near-infrared spectroscopy, and orbital Doppler. ⋯ Flexible management guided by real-time information is essential. Upon initiating femoral arterial perfusion, malperfusion should first be checked for in the descending aorta and then in the coronary and visceral arteries, especially in cases of type III dissection with retrograde extension. Attention should be paid to cerebral and coronary malperfusion when initiating axillary arterial perfusion.
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Comparative StudyDirect versus guidewire-assisted pediatric radial artery cannulation technique.
Radial artery cannulation is a more difficult procedure in pediatric patients. Direct technique commonly fails in these patients, and several techniques have been developed for successful arterial cannulation. The purpose of this study was to compare direct radial artery cannulation with guidewire-assisted cannulation in children undergoing cardiac or aortic surgery. The hypothesis was that the guidewire-assisted technique would lead to fewer attempts and provide better long-term blood pressure monitoring and blood sampling. ⋯ The authors recommend the use of a guidewire-assisted radial artery cannulation technique rather than a direct technique. The guidewire-assisted technique provided easy, safe, and quick cannulation and allowed for long-term satisfactory blood pressure monitoring and blood sampling because of the longer length of the Teflon catheter advanced into the artery over the guidewire, and a low rate of dissection of the radial artery.
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care.
The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). ⋯ The above parameters establish a baseline incidence for major perioperative complications in adults undergoing elective DHCA with RCP for elective proximal aortic arch repair. In approaching the open aortic arch for short periods of circulatory arrest, deep hypothermia with adjunctive RCP is safe and effective.
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Serum lactate level has prognostic significance after pediatric cardiac surgery.
The determination of postoperative course after cardiac surgery has always been a challenging issue. It is more sophisticated in the pediatric age group. The aim of this investigation was to identify whether increased concentrations of lactate in arterial blood has a predictive value for postoperative morbidity and mortality after heart surgery. ⋯ Blood lactate concentration of 4.8 mmol/L or higher during the early postoperative hours identifies a group of patients with increased risk of postoperative morbidity and mortality.