Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2012
Randomized Controlled TrialParasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study.
The objective of this study was to assess the effectiveness of 0.5% ropivacaine used for parasternal intercostal blocks for postoperative analgesia in pediatric patients undergoing cardiac surgery. ⋯ Parasternal blocks with ropivacaine appear to be a simple, safe, and useful technique of supplementation of postoperative analgesia in pediatric patients undergoing cardiac surgery with a median sternotomy.
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J. Cardiothorac. Vasc. Anesth. · Jun 2012
ReviewPerioperative management of pheochromocytoma: focus on magnesium, clevidipine, and vasopressin.
The perioperative management of pheochromocytomas requires meticulous anesthetic care. There has been considerable progress in its management, recently 3 agents that may be particularly advantageous to the anesthetic team have been identified. Magnesium sulfate is readily available, cheap, safe, and effective for hemodynamic control before tumor resection. ⋯ Its application in the perioperative management of pheochromocytoma before tumor resection recently has been described and likely will expand in the near future. Vasopressin has demonstrated utility in the management of catecholamine-resistant shock after tumor resection. A familiarity with these 3 agents offers anesthesia providers further effective pharmacologic options for managing the hemodynamic challenges inherent to this population before and after tumor resection.
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J. Cardiothorac. Vasc. Anesth. · Jun 2012
Cardiopulmonary bypass transiently inhibits intraventricular vortex ring formation in patients undergoing coronary artery bypass graft surgery.
Transmitral blood flow during early left ventricular (LV) filling produces an intraventricular rotational body of fluid known as a "vortex ring" that enhances the hydraulic efficiency of early LV filling. The authors tested the hypothesis that exposure to cardiopulmonary bypass (CPB) attenuates intraventricular vortex formation time (VFT) in patients with normal preoperative LV systolic and diastolic function undergoing coronary artery bypass graft (CABG) surgery. ⋯ The results indicated that CPB transiently attenuate VFT in patients with normal preoperative LV systolic and diastolic function undergoing CABG surgery. These data suggest that CPB adversely affects diastolic transmitral flow efficiency by reducing intraventricular vortex ring formation in vivo.
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Even if the first quasi-randomized study in history was published in 1747, there is still a need for evidence-based medicine. In the specific field of cardiac anesthesia, there are few magic bullets (ie, drugs/techniques/strategies that might reduce perioperative mortality), and a recent international consensus conference attempted to list them all. In the absence of evidence-based medicine, medical decisions are made by eminence, experience, or physiopathologic reasoning. ⋯ Patients should be fully aware of the reduced complication rates and the improved outcomes that occur in patients involved in randomized "researcher-driven" clinical trials, the so-called "Hawthorne effect." In conclusion, physicians have to do their best although they sometimes have little information. Their ability must counteract the lack of scientific evidences. Caring for critical patients involves making decisions based on realistic tradeoffs of clinical benefit and side effects, but too often these choices are made on the basis of extrapolations and educated guesses.
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J. Cardiothorac. Vasc. Anesth. · Jun 2012
Intraoperative changes in regional wall motion: can postoperative coronary artery bypass graft failure be predicted?
To evaluate the accuracy of new intraoperative regional wall motions abnormalities (RWMAs) detected by transesophageal echocardiography (TEE) to predict early postoperative coronary artery graft failure. ⋯ In this retrospective study, RWMAs detected with TEE were of limited value to predict early postoperative CABG failure.