Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
ReviewAdvances in anticoagulation: focus on dabigatran, an oral direct thrombin inhibitor.
Dabigatran is an oral direct thrombin inhibitor with a rapid onset. Patients on dabigatran do not require coagulation monitoring. Recent prospective randomized trials have shown the efficacy of dabigatran for the prevention of venous thromboembolism after knee or hip arthroplasty and for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. ⋯ There currently is no reversal agent for dabigatran although hemodialysis can facilitate its rapid removal in life-threatening circumstances. The management of severe bleeding associated with dabigatran also may include the administration of a procoagulant, such as recombinant activated factor VII. Based on recent guidelines, regional anesthesia should be used cautiously in patients taking this novel oral thrombin inhibitor.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Randomized Controlled TrialManagement of tight intraoperative glycemic control during off-pump coronary artery bypass surgery in diabetic and nondiabetic patients.
To optimize intra- and postoperative insulin management in cardiac surgical patients. ⋯ In diabetics and nondiabetics undergoing off-pump coronary artery bypass surgery, tight perioperative glycemic control is feasible and efficient, with minimal risks for hypo- and hyperglycemia. In nondiabetics, starting insulin therapy from induction onwards results in more measurements within target, without affecting the mean BG. In diabetics, decreasing the sampling interval from 60 to 30 minutes results in more measurements within target and in a mean blood glucose within target at ICU arrival.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Randomized Controlled TrialAn alternative central venous route for cardiac surgery: supraclavicular subclavian vein catheterization.
To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery. ⋯ The supraclavicular approach for subclavian vein catheterization is an acceptable alternative for central venous access during cardiac surgery in terms of procedural success rate, ease of placement, rate of complications, and usability after sternal retractor expansion.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Randomized Controlled TrialTarget-controlled dosing of remifentanil during cardiac surgery reduces postoperative hyperalgesia.
One of the strategies to attenuate opioid-induced hyperalgesia (OIH) may be to decrease intraoperative doses of opioids by using target-controlled infusion (TCI). ⋯ The intraoperative decrease of opioid consumption when comparing the CI versus TCI mode of administration of remifentanil led to less OIH after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Randomized Controlled TrialHigh-dose insulin administration improves left ventricular function after coronary artery bypass graft surgery.
To test the hypothesis that the intravenous administration of high doses of insulin while maintaining normoglycemia (GIN therapy) improves myocardial function after coronary artery bypass graft (CABG) surgery. ⋯ Intraoperative GIN therapy improves global and systolic left ventricular function after CABG surgery.