Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2016
Observational StudyAssessment of Risk Factors for a Sustainable "On-Table Extubation" Program in Pediatric Congenital Cardiac Surgery: 5-Year Experience.
To delineate risk factors for failure of extubation in the operating room among pediatric cardiac surgery patients. ⋯ Extubation in the operating room was successful in a majority of patients undergoing cardiac surgery. Multivariate analysis identified weight<5 kg, age<1 year, cardiopulmonary bypass time>120 minutes, and presence of significant noncardiac structural anomalies as significant factors affecting extubation in the operating room, with an adjusted odds ratio (95% confidence interval) of 10 (2.7-37), 7.2 (2-22), 5.5 (1.7-17.7), and 3.3 (1.2-9.3), respectively. Pulmonary hypertension, redo sternotomy, higher Risk Adjusted Congenital Heart Surgery category, and aortic clamp time>60 minutes did not achieve significance in the multivariate analysis as risk factors for extubation in the operating room.
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J. Cardiothorac. Vasc. Anesth. · Dec 2016
Outcomes of Patients with Prolonged Intensive Care Unit Length of Stay After Cardiac Surgery.
To determine in-hospital and post-discharge long-term survival in patients with prolonged intensive care unit (ICU) stays after cardiac surgery. ⋯ In-hospital mortality rates post-cardiac surgery correlate with length of ICU stay but appear to plateau after 4 weeks. However, a>4 week ICU length of stay confers a worse long-term outcome post-hospital discharge, especially in patients with postoperative stroke.
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J. Cardiothorac. Vasc. Anesth. · Dec 2016
Noninvasive Positive-Pressure Ventilation in Treatment of Hypoxemia After Extubation Following Type-A Aortic Dissection.
To assess the efficacy of noninvasive positive-pressure ventilation (NPPV) in improving hypoxemia after extubation for Stanford type-A aortic dissection and to compare NPPV using a mask or a helmet. ⋯ NPPV with a helmet may quickly improve oxygen partial pressure, decrease carbon dioxide partial pressure, decrease the reintubation rate, and effectively shorten the hospital stay after extubation for Stanford type-A aortic dissection.
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J. Cardiothorac. Vasc. Anesth. · Dec 2016
Observational StudyAnesthetic Management of Transapical Off-Pump Mitral Valve Repair With NeoChord Implantation.
Various minimally invasive surgical approaches have been used in mitral valve (MV) surgery. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive, alternative procedure for the treatment of degenerative mitral regurgitation. There are several special considerations for the anesthesiologist during the TOP-MINI procedure. The main purpose of this study was to present the anesthetic management of the TOP-MINI procedure. ⋯ The TOP-MINI procedure requires complex anesthetic management. Transesophageal echocardiographic guidance is essential for this procedure. One-lung ventilation, fluid administration, avoidance of hypothermia, and pain management are the bases for anesthetic management.