Journal of cardiothoracic and vascular anesthesia
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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
Socioeconomic position is not associated with 30-day or 1-year mortality in demographically diverse vascular surgery patients.
Disparities in outcomes after surgical procedures have been attributed to race, sex, use of private insurance, and socioeconomic position (SEP). The purpose of this study was to determine the impact of SEP on mortality after lower-extremity bypass (LEB) surgery in a diverse patient population with extremes of SEP. ⋯ Disparities in SEP are not associated with short- or long-term mortality after LEB surgery. Other comorbid risk factors are more important when determining outcomes and should be the focus of interventions to improve outcomes.
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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.
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J. Cardiothorac. Vasc. Anesth. · Jun 2012
Vascular surgery patients prescribed preoperative β-blockers experienced a decrease in the maximal heart rate observed during induction of general anesthesia.
To investigate the association of preoperative β-blocker usage and maximal heart rates observed during the induction of general anesthesia. ⋯ Preoperative β-blockade of vascular surgery patients undergoing general anesthesia is associated with a lower maximal heart rate during anesthetic induction. There may be potential benefits in administering β-blockers to reduce physiologic stress in this surgical population at risk for perioperative cardiac morbidity. Future research should further explore intraoperative hemodynamic effects in light of existing practice guidelines for optimal medication selection, dosage, and heart rate control.