Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Randomized Controlled TrialModerate, Short-Term, Local Hyperglycemia Attenuates Forearm Endothelium-Dependent Vasodilation After Transient Ischemia-Reperfusion in Human Volunteers.
Acute hyperglycemia causes endothelial dysfunction in diabetic patients, abolishes ischemic pre- and postconditioning, and is an independent predictor of adverse outcome after myocardial infarction in nondiabetic patients. Its effects on endothelial-dependent vasodilation are controversial in healthy subjects. The authors studied the effect of moderate short-term local hyperglycemia on forearm endothelium-dependent vasodilation in healthy volunteers. ⋯ These results indicated that moderate, short-term, local hyperglycemia induced by intra-arterial administration of dextrose attenuated forearm endothelial-dependent vasodilation after ischemia-reperfusion injury in healthy volunteers.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
ReviewPerioperative Use of Coagulation Factor Concentrates in Patients Undergoing Cardiac Surgery.
Coagulopathy and bleeding are common in patients undergoing cardiac surgery, with a perioperative transfusion rate in excess of 50%. The mechanism of coagulopathy associated with cardiac surgery using cardiopulmonary bypass is multifactorial. Historically, coagulation factor-mediated bleeding in such instances has been treated with allogeneic plasma transfusion. ⋯ Formulations of factor concentrates include single and multifactor concentrates and both human and recombinant-derived products. Off-label use of factor concentrates for coagulopathy and bleeding associated with cardiac surgery has been described for decades; however, sound clinical research with regard to this practice is limited. This review highlights the literature discussing the use of factor concentrates in patients undergoing cardiac surgery and provides an overview of reasonable uses or lack thereof for factor concentrates in clinical practice.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Randomized Controlled Trial Comparative StudyUltrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary Vein Cannulation.
The primary objective was to compare the frequency of first-attempt successful axillary vein cannulation by the Seldinger technique using out-of-plane ultrasound guidance versus in-plane imaging. Between the two ultrasound imaging planes, this study also compared the number of attempts that were necessary for the cannulation of the left axillary vein along with the number of needle redirections that had to be done for final cannulation of the vein. Incidence of complications and the number of times the procedure was abandoned also were compared between the two imaging planes. ⋯ Out-of-plane ultrasound imaging during axillary vein cannulation increased the chance of first-attempt successful cannulation. Axillary vein cannulation under out-of-plane ultrasound imaging also appeared to be quicker and was preferable in terms of the fewer number of attempts that were necessary for a successful vein cannulation.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Review Meta Analysis Comparative StudyMitral Regurgitation Grading in the Operating Room: A Systematic Review and Meta-analysis Comparing Preoperative and Intraoperative Assessments During Cardiac Surgery.
To assess differences in mitral regurgitation (MR) grade between the preoperative and the intraoperative evaluations. ⋯ Intraoperative assessment under "GA-only" significantly underestimated MR. A more accurate intraoperative evaluation can be obtained with afterload manipulation, although HM strategy carries high risk of clinically significant overestimation.