Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2011
Review Meta AnalysisRecombinant activated factor VII increases stroke in cardiac surgery: a meta-analysis.
Recombinant activated factor VII (rFVIIa) is used in various surgical procedures to reduce the incidence of major blood loss and the need for re-exploration. Few clinical trials have investigated rFVIIa in cardiac surgery. The authors performed a meta-analysis focusing on the rate of stroke and surgical re-exploration. ⋯ The administration of rFVIIa in cardiac surgery patients could result in a significant increase of stroke with a trend toward a reduction of the need for surgical re-exploration. The authors do not recommend routine use in cardiac surgery patients. rFVIIa may be considered with caution in patients with refractory life-threatening bleeding.
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J. Cardiothorac. Vasc. Anesth. · Oct 2011
Randomized Controlled TrialThe effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery.
The purpose of this study was to evaluate the analgesic effects of perioperative gabapentin on postoperative acute and chronic pain after coronary artery bypass graft (CABG) surgery with median sternotomy and internal mammary artery harvesting. ⋯ Gabapentin significantly reduced the intensity of pain and tramadol consumption in the early postoperative period after CABG surgery. Pain scores at 1 and 3 months after surgery were low in both groups, with no significant difference between the groups.
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J. Cardiothorac. Vasc. Anesth. · Oct 2011
Randomized Controlled TrialThoracic epidural analgesia with levobupivacaine for 6 postoperative days attenuates sympathetic activation after thoracic surgery.
To investigate the impact of 2 postoperative analgesic regimens on heart rate variability in patients who underwent thoracotomy. ⋯ Postoperatively decreased cardiac sympathetic outflow continues with epidural analgesia, whereas it is abolished by the change to intravenous patient-controlled morphine.
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J. Cardiothorac. Vasc. Anesth. · Oct 2011
ReviewIntegrating outcome benefit into anesthetic design: the promise of steroids and statins.
Steroids and statins may facilitate the integration of anesthetic design with clinical outcome. Although steroids clearly benefit adult cardiac surgical patents, the evidence is weaker in pediatric cardiac surgery. Current large randomized trials of steroids likely will determine the future role of steroids in adult cardiac surgery. ⋯ Statins are essential in vascular surgery because they reduce mortality, myocardial ischemia, and acute renal injury. As a result, they have been recommended highly for outcome enhancement in recent perioperative guidelines. Although they may improve survival in sepsis, further investigation is indicated to define their therapeutic role.