Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Randomized Controlled Trial Comparative StudyComparison of Epsilon Aminocaproic Acid and Tranexamic Acid in Thoracic Aortic Surgery: Clinical Efficacy and Safety.
To evaluate the efficacy and safety of tranexamic acid (TXA) versus epsilon aminocaproic acid (EACA) in patients undergoing thoracic aortic surgery. ⋯ Both EACA and TXA were equally effective in reducing the perioperative blood loss and transfusion requirement in patients undergoing thoracic aortic surgery. While significant renal injury was observed with EACA, there was a tendency for higher incidence of seizure with TXA. Prospective placebo-controlled trials recruiting larger sample size using sensitive biomarkers are required before any recommendations.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Randomized Controlled Trial Multicenter StudyTezosentan and Right Ventricular Failure in Patients with Pulmonary Hypertension Undergoing Cardiac Surgery: The TACTICS Trial.
To evaluate the efficacy of tezosentan in reducing the incidence of right ventricular (RV) failure and associated mortality in patients with pre-existing pulmonary hypertension. The primary endpoint was the proportion of patients with RV failure during weaning from cardiopulmonary bypass (CPB), assessed 30 minutes after the end of CPB. ⋯ A reduction in RV failure with tezosentan was not observed in this study.(Current Controlled Trials, identifier NCT00458276).
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Propofol-Based Versus Dexmedetomidine-Based Sedation in Cardiac Surgery Patients.
To evaluate the effects of propofol-based and dexmedetomidine-based sedation regimens on achieving early extubation, length of stay (LOS), intensive care length of stay (ICU-LOS), total hospital costs, and mortality rates in cardiac surgery patients. ⋯ Dexmedetomidine-based sedation resulted in achievement of early extubation more frequently than propofol-based sedation. Mean postoperative time to extubation and average hospital LOS were shorter with dexmedetomidine-based sedation and met a statistical level of significance. There was no difference in ICU-LOS or in-hospital mortality between the two groups. Total hospital charges were similar, although slightly higher in the propofol group.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Impact of Guideline Implementation on Transfusion Practices in a Surgical Intensive Care Unit.
Anemia is a common clinical problem in cardiac surgery patients in the postoperative period and may result in transfusion in up to 90% of this population. There is tremendous variation in transfusion rates by hospital and individual physician. It is unknown if implementation of a clinical practice guideline lowers unnecessary transfusion in hospital practices that already have a restrictive transfusion culture . ⋯ This study suggests that clinical guideline implementation utilizing guideline development, education, and compliance audit/feedback may reduce unnecessary transfusion in cardiac surgery patients. A fully powered prospective trial would be necessary to validate these findings.