Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
Multicenter Study Clinical TrialCerebral oximetry during cardiac surgery: the association between cerebral oxygen saturation and perioperative patient variables.
This "real-world" study was designed to assess the patterns of regional cerebral oxygen saturation (rSO(2)) change during adult cardiac surgery. A secondary objective was to determine any relation between perioperative rSO(2) (baseline and during surgery) and patient characteristics or intraoperative variables. ⋯ In cardiac surgical patients, lower baseline rSO(2) value, on-pump surgery, and height were significant predictors of nadir rSO(2), whereas only baseline rSO(2) was a predictor of postoperative length of stay. These findings support previous research on the predictive value of baseline rSO(2) on length of stay and emphasize the need for further research regarding the clinical relevance of baseline rSO(2) and intraoperative changes.
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
Randomized Controlled TrialHigh thoracic epidural analgesia in cardiac surgery. Part 2--high thoracic epidural analgesia does not reduce time in or improve quality of recovery in the intensive care unit.
To evaluate the postoperative effect of high thoracic epidural analgesia on the time in the intensive care unit (ICU) and the quality of cardiac recovery in patients undergoing cardiac surgery. ⋯ HTEA does not reduce the time in the ICU or improve the quality of recovery in the ICU.
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
Randomized Controlled TrialThe effect of depth of anesthesia on the severity of mitral regurgitation as measured by transesophageal echocardiography.
The unloading effect of anesthesia on the left ventricle results in a downgrade of mitral regurgitation (MR) severity, which increases as anesthesia deepens. This study examined how the depth of anesthesia could affect the loading condition of the left ventricle and the severity of MR. ⋯ It may be helpful to measure the severity of MR at a shallower anesthesia depth guided by BIS monitoring to avoid a downgrade of MR under general anesthesia.
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
ReviewThe "medial-oblique" approach to ultrasound-guided central venous cannulation--maximize the view, minimize the risk.
Carotid puncture and insertion of a large-bore catheter into the carotid artery is a feared complication associated with internal jugular vein (IJV) cannulation. The use of ultrasound with real-time imaging of the neck vessels during needle insertion has the potential to decrease the incidence of serious complications associated with central venous access. ⋯ The suggested "medial-oblique" approach allows for optimal imaging of the IJV and the carotid artery side by side and following the needle throughout the insertion from skin to vessel penetration in a medial-cephalad to lateral-caudad direction. This technique combines the advantages of the short-axis and long-axis approaches and minimizes the risk of carotid puncture from a medial-to-lateral needle direction.