Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Dec 2014
Comparative Study Observational StudyCephalic Versus Digital Plethysmographic Variability Index Measurement: A Comparative Pilot Study in Cardiac Surgery Patients.
Noninvasive measurement of digital plethysmographic variability index (PVI(digital)) has been proposed to predict fluid responsiveness, with conflicting results. The authors tested the hypothesis that cephalic sites of PVI measurement (namely PVI(ear) and PVI(forehead)) could be more discriminant than PVI(digital) to predict fluid responsiveness after cardiac surgery. ⋯ PVI(forehead) was more discriminant than PVI(digital) and could be a valuable alternative to arterial PPV in predicting fluid responsiveness.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2014
ReviewThe PhysiologicPerspective in FluidManagement in VascularAnesthesiology.
Vascular surgery patients frequently suffer from atherosclerosis and peripheral arterial occlusive disease generating endothelial dysfunction. Furthermore, ischemia and reperfusion during surgery damage endothelial cells and, especially, the endothelial glycocalix. The damage of the glycocalix promotes an increase in permeability. ⋯ From a theoretical physiologic point of view, iso-osmolar albumin is the best choice regarding volume effect, antioxidative properties, and protection against destruction of the glycocalix. Nonetheless, albumin experimentally has not lived up to its promise in the clinical setting. Thus, further well-conducted large randomized clinical trials are necessary to ascertain the optimal fluid therapy in vascular surgery patients.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2014
Acute Kidney Injury Is Independently Associated With Higher Mortality After Cardiac Surgery.
To investigate the incidence of acute kidney injury after cardiac surgery and its association with mortality in a patient population receiving ibuprofen and gentamicin perioperatively. ⋯ More than 28% of the patients undergoing elective or subacute cardiac surgery developed AKI in this contemporary cohort. Furthermore, acute kidney injury was an independent predictor of increased mortality irrespective of the perioperative risk factors.