Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Multicenter Study Observational StudyElevated Levels of Angiopoietin-2 as a Biomarker for Respiratory Failure After Cardiac Surgery.
Angiopoietin-1 and angiopoietin-2 are important factors in regulating endothelial vascular permeability. This study evaluated perioperative changes in serum levels of angiopoietin-1 and -2 in patients undergoing cardiac surgery. ⋯ Angiopoietin-2 serum levels were elevated after cardiac surgery. Elevated angiopoietin-2 had a good predictive performance for respiratory failure after cardiac surgery, perhaps reflecting the severity of lung dysfunction related to postoperative increases in vascular permeability.
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Observational StudyA Novel Assessment of Peripheral Tissue Microcirculatory Vasoreactivity Using Vascular Occlusion Testing During Cardiopulmonary Bypass.
Cardiac surgery and cardiopulmonary bypass are associated with release of inflammatory mediators and microcirculatory alterations that result in organ dysfunction. Near-infrared spectroscopic measurement of tissue oxygen saturation (StO2) and the vascular occlusion test (VOT) were utilized in a study of elective cardiac surgical patients as a novel, noninvasive method of assessing microcirculatory vasoreactivity during nonpulsatile cardiopulmonary bypass (CPB). The objective of this pilot study was to determine whether differences in microcirculatory function and vasoreactivity could be measured in cardiac surgery using StO2 and VOT. ⋯ This pilot study demonstrates a significant difference in reperfusion slopes during cardiopulmonary bypass when compared to prebypass and postbypass, suggesting impaired peripheral microvascular reactivity. Reperfusion slopes also exhibited a successive decline with duration of CPB, implying worsening microcirculatory dysfunction that returned to baseline values in all patients within 1 hour of separation from CPB. This noninvasive technique has potential to optimize circulatory parameters during cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial.
To prevent urinary retention, urinary catheters commonly are removed only after thoracic epidural discontinuation after thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection after early catheter removal. ⋯ Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multifaceted approach to reducing the incidence of catheter-associated urinary tract infections.
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Clinical Trial Observational StudyProtamine requirements in cardiac surgery: effect of changes in the heparin reference standard.
UFH (unfractionated heparin) and protamine are integral to cardiac surgery, and inappropriate dosing can predispose to coagulopathy and hemorrhage. The FDA (Food and Drug Administration) recently has instituted changes to UFH formulation and it is not known if this has influenced its susceptibility to neutralization by protamine. Hence, the authors sought to compare 2 commercial preparations of UFH (old and new) with regard to their neutralization by protamine in patients undergoing cardiopulmonary bypass (CPB). ⋯ The 'old' and 'new' formulations of UFH evaluated in this study were similar in their susceptibility to protamine neutralization. Circulating UFH is detected as early as 5 minutes after protamine administration and anti-IIa is more resistant to protamine neutralization as compared to anti-Xa activity. Further studies are required to quantify the precise dose of protamine following CPB.