Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Observational StudyPreoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy.
To test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population. ⋯ Patients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Inaccuracy of the FloTrac/Vigileo™ System in Patients With Low Cardiac Index.
The goal of this study was to compare cardiac output derived from the FloTrac/Vigileo™ system (CO(FT)) with cardiac output measured by 3-dimensional transesophageal echocardiography (CO3D) in patients with severe heart failure undergoing cardiac resynchronization therapy. The impact of preoperative systemic vascular resistance index on the accuracy of the FloTrac/Vigileo™ system also was investigated. ⋯ The FloTrac/Vigileo™ system is not accurate in patients with low cardiac output, especially those with a cardiac index<2.2 L/min/m(2). A high systemic vascular resistance index in patients with low cardiac index may contribute to this inaccuracy.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Dose-Dependent Effects of Intraoperative Low Volume Red Blood Cell Transfusions on Postoperative Outcomes in Cardiac Surgery Patients.
To determine the incremental risk associated with each intraoperative red blood cell transfusion in cardiac surgery patients. ⋯ There is a step-wise increase in length of postoperative intubation with each red blood cell transfusion in patients undergoing cardiac surgery. Each additional unit of intraoperative RBC transfusion also may increase postoperative infectious complications. Thus, even single-unit reductions in red blood cell transfusions may have significant impact on outcomes.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Comparative StudyDiagnostic Value of Chest Ultrasound after Cardiac Surgery: A Comparison with Chest X-ray and Auscultation.
Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. ⋯ Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Comparative StudyInteroperator and Intraoperator Variability of Whole Blood Coagulation Assays: A Comparison of Thromboelastography and Rotational Thromboelastometry.
Near-patient viscoelastic tests have proved useful in decreasing blood and blood product use in cardiac surgery. Two different analyzers are available, TEG and ROTEM. Many different individuals operate these devices, which raises concern that this factor may significantly affect results. The present study sought to objectively assess variability in results between operators. ⋯ This series of results suggested ROTEM analyses are more reproducible than TEG and, consequently, that ROTEM may be better suited for use in a multiuser environment.