Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2011
ReviewProgress in perioperative echocardiography: focus on safety, clinical outcomes, 3-dimensional imaging, and education.
Gastric decompression with an orogastric tube after anesthetic induction does not appear to enhance image quality for routine cases. The insertion of a transesophageal echocardiographic (TEE) probe can cause significant upper-airway trauma, which can be minimized with rigid laryngoscopy. Limited TEE imaging without transgastric views appears to be safe and clinically adequate in patients with advanced liver disease and esophageal varices. ⋯ Furthermore, 3D imaging of the mitral apparatus has highlighted the importance of the annular saddle shape and the anatomic variability in ischemic mitral regurgitation. Education in perioperative echocardiography is experiencing high demand that can be satisfied partially with simulators and Internet-based educational activities. These modalities will aid in the dissemination of echocardiography through perioperative practice.
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J. Cardiothorac. Vasc. Anesth. · Jun 2011
Comparative StudyEffects of extravascular lung water on the measurement of transpulmonary thermodilution cardiac output in acute respiratory distress syndrome patients.
Transpulmonary thermodilution cardiac output is used in calculating aortic impedance for calibrating the pulse-contour analysis and is applied to calculate extravascular lung water (EVLW). Whether pulmonary edema affects the accuracy of transpulmonary thermodilution is controversial. This study aimed to investigate the effects of extravascular lung water index (EVLWI) on the transpulmonary thermodilution measurement in acute respiratory distress syndrome (ARDS). ⋯ In ARDS patients, the agreement between transpulmonary thermodilution and pulmonary artery thermodilution for cardiac output measurement is marginally acceptable. The severity of pulmonary edema expressed as EVLWI weakly and negatively correlates with the difference between BCItp and CCIpa derived from the two techniques.
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J. Cardiothorac. Vasc. Anesth. · Jun 2011
Comparative StudyComparison of MAX-ACT and K-ACT values when using bivalirudin anticoagulation during minimally invasive hybrid off-pump coronary artery bypass graft surgery.
To compare the kaolin-activated coagulation time (K-ACT) to the MAX-ACT for monitoring anticoagulation with bivalirudin in patients undergoing hybrid off-pump coronary artery revascularization procedures. ⋯ To maximize patient safety, centers using bivalirudin for anticoagulation during cardiac surgical procedures need to be aware of the different performance characteristics of ACT assay subtypes.