Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Randomized Controlled TrialLevosimendan Improves Renal Outcome in Cardiac Surgery: A Randomized Trial.
The effect of levosimendan on renal function in patients with low ejection fraction undergoing mitral valve surgery was investigated. ⋯ Perioperative treatment with levosimendan in addition to standard inotropic therapy in patients with a low ejection fraction undergoing mitral valve surgery improved immediate postoperative renal function and reduced need for RRT.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Randomized Controlled Trial Multicenter Study Comparative StudyUse of Partial Venovenous Cardiopulmonary Bypass in Percutaneous Hepatic Perfusion for Patients with Diffuse, Isolated Liver Metastases: A Case Series.
Diffuse isolated liver metastases are the dominant mode of tumor progression in a number of cancers and present a major treatment challenge for oncologists. An experimental treatment, percutaneous hepatic perfusion (PHP), utilizes partial venovenous cardiopulmonary bypass to allow administration of high-dose chemotherapy directly and solely to the liver with filtration of chemotherapeutic agents from the blood prior to its return to the systemic circulation, thereby minimizing toxic systemic effects. The following case series describes the management of 5 patients with metastatic melanoma undergoing serial PHPs. ⋯ In patients with diffuse isolated liver metastases, PHP is a safe and well-tolerated procedure that can be performed more than once and is associated with marked anti-tumor activity in some patients.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
ReviewTherapeutic Hypothermia After In-hospital Cardiac Arrest: A Critique.
More than 210,000 in-hospital cardiac arrests occur annually in the United States. Use of moderate therapeutic hypothermia (TH) in comatose survivors after return of spontaneous circulation following out-of-hospital cardiac arrest (OOH-CA) caused by ventricular fibrillation or pulseless ventricular tachycardia is recommended strongly by many professional organizations and societies. The use of TH after cardiac arrest associated with nonshockable rhythms and after in-hospital cardiac arrest (IH-CA) is recommended to be considered by these same organizations and is being applied widely. ⋯ Most importantly, it inhibits the ability of researchers to conduct needed RCTs. The author believes that the proper method of providing TH in these cases needs to be better defined. Based on this analysis the author concludes that TH should not be used indiscriminantly following most cases of IH-CA, and instead clinicians should concentrate their efforts in conducting high-quality large RCTs or large-scale, well-designed prospective observation studies to determine its benefits and identify appropriate candidates.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Arterial Hyperoxia During Cardiopulmonary Bypass and Postoperative Cognitive Dysfunction.
To determine the effect of arterial normobaric hyperoxia during cardiopulmonary bypass (CPB) on postoperative neurocognitive function. The authors hypothesized that arterial hyperoxia during CPB is associated with neurocognitive decline at 6 weeks after cardiac surgery. ⋯ Arterial hyperoxia during CPB was not associated with neurocognitive decline after 6 weeks in cardiac surgical patients.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
ReviewNovel, Multimodal Approach for Basic Transesophageal Echocardiographic Teaching.
Web and simulation technology may help in creating a transesophageal echocardiography (TEE) curriculum. The authors discuss the educational principles applied to developing and implementing a multimodal TEE curriculum. ⋯ It is possible to develop and implement an integrated, multimodal TEE curriculum supported by educational theory. The authors will explore the transferability of this approach to intraoperative TEE on live patients.