Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Type of Anesthesia and Postoperative Delirium After Vascular Surgery.
The purpose of this study was to investigate the association between general (GA), regional (RA), and local (LA) anesthetic techniques with respect to the development of delirium after vascular surgery. The authors hypothesized that patients undergoing GA for vascular surgery would have a higher incidence of postoperative delirium. The role of LA with respect to postoperative delirium in vascular surgery patients previously has not been reported. ⋯ Delirium rates after vascular surgery were similar with local, regional, or general anesthesia techniques. The presence of risk factors for the development of postoperative delirium should not influence the type of anesthesia provided.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Effects of Early Inhaled Epoprostenol Therapy on Pulmonary Artery Pressure and Blood Loss During LVAD Placement.
Several strategies have been used to reduce the incidence of right ventricular failure after left ventricular assist device (LVAD) placement, including pulmonary vasodilation. The inhaled prostacyclin, epoprostenol, selectively dilates the pulmonary vasculature of ventilated areas of the lung, but also has been shown to inhibit platelet aggregation.(1) The authors evaluated the impact of early initiation of epoprostenol administration during LVAD placement on pulmonary artery pressures, use of vasoactive drugs, and blood loss. ⋯ Inhaled prostacyclin reduces sPAP and mPAP in the postoperative period after LVAD placement regardless of the timing of initiation. Early initiation seems to reduce sPAP as well as mPAP more effectively during the weaning process from CPB. However, early initiation is associated with an increased blood loss in the immediate postoperative period. The concept of preventively "bathing" the lung in prostacyclin should be evaluated critically in a prospective fashion to adequately examine this question.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Observational StudyCardiac Output Calculation and Three-Dimensional Echocardiography.
To compare the determination of stroke volume (SV) and cardiac output (CO) using 2-dimensional (2D) versus 3-dimensional (3D) transesophageal echocardiography (TEE). ⋯ LVOT area is underestimated with the single- axis 2D method when compared with 3D planimetered area. This results in a CO that is approximately 10% lower with the 2D method.