Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2014
Reappearance of Circulating Heparin in Whole Blood Heparin Concentration-Based Management Does Not Correlate With Postoperative Bleeding After Cardiac Surgery.
The Hepcon Heparin Management System (HMS) facilitates administration of higher heparin and lower protamine doses, which may affect bleeding potential due to heparin rebound. The present study evaluated heparin rebound in patients for whom the Hepcon HMS was used to determine whether point-of-care tests detect residual heparin and residual heparin is associated with postoperative blood loss. ⋯ Circulating heparin detected by the chromogenic assay was too low to be clinically significant based on postoperative bleeding, although all 31 patients had residual heparin or heparin rebound at 2 hours after protamine administration with use of the Hepcon HMS.
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J. Cardiothorac. Vasc. Anesth. · Aug 2014
Anticoagulation for Critically Ill Cardiac Surgery Patients: Is Primary Bivalirudin the Next Step?
Anticoagulation with unfractionated heparin (UFH) in critically ill cardiac surgery patients has several limitations, including the risk of heparin-induced thrombocytopenia. The use of a direct thrombin inhibitor, such as bivalirudin, might either treat this complication or completely eliminate it. The aim of the present study was to analyze the use of bivalirudin in this setting, as either a secondary drug switching from heparin or as the primary anticoagulant, and to evaluate clinical outcomes. ⋯ Novel anticoagulant strategies might play a crucial role in critically ill cardiac surgery patients. In a propensity-matched population, results of the present study showed that primary bivalirudin anticoagulation may reduce bleeding complications and mortality.
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J. Cardiothorac. Vasc. Anesth. · Aug 2014
Risk Factors of Postoperative Acute Kidney Injury in Patients Undergoing Esophageal Cancer Surgery.
The purpose of this study was to identify perioperative risk factors for postoperative acute kidney injury (AKI) in patients undergoing esophageal cancer surgery. ⋯ Postoperative AKI is common in patients undergoing esophageal surgery for cancer. Closer evaluation and monitoring in patients with risk factors for AKI may be warranted.
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J. Cardiothorac. Vasc. Anesth. · Aug 2014
Perioperative Management of Carotid Endarterectomy: A Survey of Clinicians' Backgrounds and Practices.
To examine current trends in anesthetic practice for management of carotid endarterectomy (CEA) and how practice may differ by groups of practitioners. ⋯ Although there are areas of perioperative management in which there seems to be agreement for the CEA, there are also areas of divergent practice that could represent potential for improvement in overall outcomes. There are many potential reasons to explain divergence in practice by location or subspecialty training, but it remains unclear what the "best practice" may be. Future studies examining outcomes after carotid endarterectomy should include perioperative anesthetic management strategies to help delineate "best practice."