Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comment Letter Case ReportsCoopdech bronchial blocker is useful in abnormalities of the tracheobronchial tree.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Meta Analysis Comparative StudyEpidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials.
The authors conducted a review of randomized studies to determine whether there were any advantages for clinically relevant outcomes by adding epidural analgesia in patients undergoing cardiac surgery under general anesthesia. ⋯ This analysis suggested that epidural analgesia on top of general anesthesia reduced the incidence of perioperative acute renal failure, the time on mechanical ventilation, and the composite endpoint of mortality and myocardial infarction in patients undergoing cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Randomized Controlled Trial Comparative StudyModifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass.
Postoperative delirium after cardiac surgery is associated with increased morbidity and mortality as well as prolonged stay in both the intensive care unit and the hospital. The authors sought to identify modifiable risk factors associated with the development of postoperative delirium in elderly patients after elective cardiac surgery in order to be able to design follow-up studies aimed at the prevention of delirium by optimizing perioperative management. ⋯ In this post hoc analysis, larger doses of fentanyl administered intraoperatively and longer duration of mechanical ventilation were associated with postoperative delirium in the elderly after cardiac surgery. Prospective randomized trials should be performed to test the hypotheses that a reduced dose of fentanyl administered intraoperatively, the use of a different opioid, or weaning protocols aimed at early extubation prevent delirium in these patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comparative StudyAsleep-awake-asleep technique during carotid endarterectomy: a case series.
Carotid endarterectomy (CEA) has become one of the most common vascular procedures in the world. It can be performed both under general anesthesia (GA) and regional anesthesia (RA). The aim of this study was to present results of a technique for CEA in which the patients anesthetized with target-controlled infusions of propofol and remifentanil were awake during the endarterectomy phase. Neurologic function was evaluated as if under RA. Patient satisfaction and the incidence of major complications also were investigated. ⋯ Although this is a case series, the authors believe that this technique combines the advantages of RA (good evaluation of the patients' neurologic status) and GA (patients relaxed and comfortable). Moreover, the analysis of the results of the questionnaire suggests that the patients can tolerate the operation awake under propofol and remifentanil, and major complications also were low. It can be concluded that this technique appears to be safe and well accepted by patients and could be a good alternative in patients in whom RA cannot be performed.