Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
A French Nationwide Survey on Anesthesiologist-Perceived Barriers to the Use of Epidural and Paravertebral Block in Thoracic Surgery.
To explore the barriers to the use of epidural block (EDB) or paravertebral block (PVB) for thoracotomy or thoracoscopy. ⋯ This survey suggested that the use of epidural or paravertebral block to provide analgesia for thoracic surgery might be increased by multimodal actions focused on improved communication with surgical and managerial teams. Paravertebral block, as an emerging technique, still is insufficiently recognized in France.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Assessing Endothelial Responsiveness After Cardiopulmonary Bypass: Insights on Different Perfusion Modalities.
Cardiopulmonary bypass (CPB) exerts several deleterious effects on inflammatory pathways. Most of these can be related to an endothelial insult leading to endothelial dysfunction. To date, the degree of endothelial damage only has been evaluated on a cellular and molecular level, but no studies exist looking at the functional effects of CPB on the endothelium. ⋯ In conclusion, in this study population of adult patients undergoing elective coronary revascularization, continuous-flow CPB markedly impaired endothelial function, although this was not the case with pulsatile-flow CPB. This study posed the rationale for further investigations on the potential value of FMD to predict cardiovascular events in these patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Observational StudyTiming and Strategy for Weaning From Venoarterial ECMO are Complex Issues.
Weaning from venoarterial extracorporeal membrane oxygenation (VA ECMO) usually is performed without clear guidelines; yet, patients still die after removal of extracorporeal circulation because of inadequate heart or end-organ recovery. The aim of the study was to address the weaning procedure, analyzing the hemodynamic and echocardiographic picture of patients weaned and to identify predictors of poor outcome among this population. ⋯ Successful weaning from ECMO is a multifaceted process, which encompasses consistent recovery of myocardial and end-organ function; LVEF, though improved, is still low at weaning. Hospital survival is correlated significantly to the duration of ECMO support and to bleeding complications.
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J. Cardiothorac. Vasc. Anesth. · Aug 2015
Observational StudyNear-Infrared Spectroscopy Hemoglobin Index Measurement During Fluid Challenge: A Prospective Study in Cardiac Surgery Patients.
Little is known about changes in near-infrared spectroscopy-derived tissue hemoglobin index (HbI). The authors tested the hypothesis that absolute values and changes in brain hemoglobin index (HbIb) and skeletal muscle hemoglobin index (HbIm) could differ from the reference arterial hemoglobin (Hb) during fluid challenge. ⋯ HbIb and HbIm cannot be used to provide continuous noninvasive estimation of Hb, and trends in HbIb and HbIm cannot be considered as noninvasive surrogates for the trend in Hb after cardiac surgery.