Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2017
Observational StudyMyocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy Induced by Thoracic Epidural Anesthesia.
To evaluate the effect of acute cardiac sympathectomy by thoracic epidural anesthesia on myocardial blood flow and microvascular function. ⋯ An increased myocardial blood volume was observed with thoracic epidural anesthesia compared to baseline (from 0.08±0.02 to 0.10±0.03 mL/mL; p = 0.02). No difference existed in resting myocardial blood flow between baseline conditions and epidural anesthesia (0.85±0.24 v 1.03±0.27 mL/min/g, respectively). Hyperemia during thoracic epidural anesthesia increased myocardial blood flow to 4.31±1.07 mL/min/g (p = 0.0008 v baseline) and blood volume to 0.17±0.04 mL/mL (p = 0.005 baseline). After sympathetic stimulation, no difference in myocardial blood flow parameters was observed CONCLUSIONS: Acute cardiac sympathectomy by thoracic epidural anesthesia increased the blood volume in the myocardial capillary system. Also, thoracic epidural anesthesia increased hyperemic myocardial blood flow, indicating augmented endothelial-independent vasodilator capacity of the myocardium.
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J. Cardiothorac. Vasc. Anesth. · Feb 2017
Hyperlactemia Predicts Surgical Mortality in Patients Presenting with Acute Stanford Type-A Aortic Dissection.
Inspired by the limited facility of the Penn classification, the authors aimed to determine a rapid and optimal preoperative assessment tool to predict surgical mortality after acute Stanford type-A aortic dissection (AAAD) repair. ⋯ Lactic acidosis, ostensibly as a surrogate for systemic malperfusion, represents a novel, accurate, and easily obtainable preoperative predictor of short-term mortality after attempted AAAD repair. These data may improve identification of patients who would not benefit from surgery.
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J. Cardiothorac. Vasc. Anesth. · Feb 2017
Association Between Arterial Carbon Dioxide Tension and Outcome in Patients Admitted to the Intensive Care Unit After Coronary Artery Bypass Surgery.
The aim of this study was to determine the association between PaCO2 and patient outcome in patients admitted to the intensive care unit (ICU) after coronary artery bypass grafting (CABG). ⋯ Exposure to both hypocapnia and hypercapnia within 24 hours after CABG was associated independently with increased risk of 30-day mortality and delayed extubation. Exposure to either hypocapnia or hypercapnia alone was not associated with patient outcome.