Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2012
Electrical cardioversion for atrial fibrillation improves microvascular flow independent of blood pressure changes.
This study tested the hypothesis that there is a discrepancy between global hemodynamic parameters and microvascular flow in patients before and after successful elective electrical cardioversion (ECV) for atrial fibrillation (AF). ⋯ Successful ECV in patients with AF improves indices of sublingual microvascular perfusion. This change has no clear relation to the change in blood pressure and cannot be predicted from it. It may be prudent not to rely solely on global hemodynamic parameters to assess end-organ perfusion in this setting.
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J. Cardiothorac. Vasc. Anesth. · Oct 2012
Randomized Controlled TrialSpectral entropy monitoring reduces anesthetic dosage for patients undergoing off-pump coronary artery bypass graft surgery.
The measurement of the depth of anesthesia is of clinical interest for patients undergoing off-pump coronary artery bypass graft (OPCAB) surgery in order to avoid intraoperative awareness and cardiac depression. Entropy recently was introduced as a monitor of anesthetic depth. This study was conducted to investigate the feasibility of entropy monitoring during the conduct of OPCAB surgery and to find out whether it reduced the anesthetic dosage for patients undergoing OPCAB surgery. ⋯ Entropy monitoring reduced propofol and sufentanil dosage for patients undergoing OPCAB surgery.
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J. Cardiothorac. Vasc. Anesth. · Oct 2012
ReviewThe inflammatory response to cardiac surgery with cardiopulmonary bypass: should steroid prophylaxis be routine?
Cardiac surgery with cardiopulmonary bypass (CPB) triggers a vigorous systemic inflammatory response characterized by early and late phases involving both the humoral and cellular pathways. Steroids dampen the immune response to CPB in a multimodal fashion. Perioperative steroid prophylaxis offers the possibility to manipulate the inflammatory response to CPB for outcome benefit. ⋯ In conclusion, steroids offer significant potential to improve meaningful clinical outcomes after cardiac surgery with CPB. The results of 2 landmark multicenter randomized trials in adult CPB likely will determine whether steroids should become routine therapy in this setting. It is likely that similar multicenter trials in pediatric CPB will be launched in the near future.