Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Randomized Controlled Trial Comparative StudyNeurocognitive function in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass: the effect of two different rewarming strategies.
Hypothermia followed by rewarming during cardiopulmonary bypass can lead to cerebral hyperthermia, which has been implicated as 1 of the causes for postoperative deterioration in neurocognitive function in patients undergoing coronary revascularization. Hence, the authors studied the effects of 2 different rewarming strategies on postoperative neurocognitive function in adult patients undergoing coronary artery bypass graft surgery with the aid of cardiopulmonary bypass. ⋯ Weaning from CPB at 33 degrees C may be a simple and useful strategy to lower the postoperative impairment of neurocognitive function and may be used as a tool to decrease morbidity after coronary revascularization.
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyRecombinant factor VIIa treatment of severe bleeding in cardiac surgery patients: a retrospective analysis of dosing, efficacy, and safety outcomes.
To describe rFVIIa dosing and clinical outcomes in cardiovascular surgery patients with refractory bleeding. ⋯ rFVIIa effectively reduces blood product use in cardiovascular surgery patients having massive blood loss. Although the optimal dose of rFVIIa for use in cardiovascular surgery remains undetermined, these data provide evidence that dosing regimens using <90 microg/kg are effective in this population and may provide guidance for centers establishing standardized protocols for rFVIIa use in cardiovascular surgery patients.
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyMicrocirculatory imaging in cardiac anesthesia: ketanserin reduces blood pressure but not perfused capillary density.
It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and alpha-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting. ⋯ SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation.
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J. Cardiothorac. Vasc. Anesth. · Feb 2009
Comparative StudyExcellent results of cardiac surgery in patients with previous kidney transplantation.
Patients with a kidney allograft are at high risk for the development of cardiovascular diseases that may require surgical intervention. Little is known about the outcome of cardiac surgery in these patients. ⋯ Cardiac surgery can be performed safely in kidney transplant recipients with low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient with early functional recovery. Late survival of kidney recipients with chronic allograft failure undergoing cardiac procedures is limited when compared with that of the general cardiac surgery population. The present data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients.