Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2018
Randomized Controlled TrialEffect of Remote Ischemic Preconditioning on Intestinal Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A Randomized Controlled Pilot Trial.
Cardiopulmonary bypass (CPB) surgery commonly threatens the heart and remote organs with ischemia-reperfusion injury. Transient episodes of ischemia to nonvital tissue, known as remote ischemic preconditioning (RIPC), is thought to help local and remote vital organs to withstand subsequent ischemic insults. ⋯ These findings suggest that RIPC does not affect intestinal injury in patients undergoing CPB surgery. In patients undergoing cardiac surgery, intestinal injury appears to be moderate and transient without any clinical relevant complication.
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J. Cardiothorac. Vasc. Anesth. · Jun 2018
ReviewUltra-Short-Acting β-Blockers (Esmolol and Landiolol) in the Perioperative Period and in Critically Ill Patients.
β-Blockers are useful drugs in several clinical cardiologic scenarios. Their use in the perioperative period and in critically ill patients is increasing, but their effect on clinically relevant outcomes remains controversial. ⋯ The authors describe the possible clinical uses of ultra-short-acting β-blockers (esmolol and landiolol) in the perioperative period and in critically ill patients because these drugs have the beneficial effects of β-blockers, but do not have the detrimental effects of long-acting agents. This narrative review focuses on ultra-short-acting β-blockers in the following clinical settings: prevention and treatment of arrhythmias and myocardial ischemia in noncardiac and cardiac surgery, usage as cardioplegia adjuvants or to test the reversibility of systolic anterior motion of the mitral valve in cardiac surgery, medical treatment of aortic dissection before surgery, improvement of microcirculation and oxygenation in critically ill patients experiencing sepsis or undergoing extracorporeal membrane oxygenation, anesthesia induction, and coronary computed tomography angiography.
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J. Cardiothorac. Vasc. Anesth. · Jun 2018
ReviewUse of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia.
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. ⋯ At present, the use of dexmedetomidine for sedation outside the ICU remains an off-label indication. The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
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J. Cardiothorac. Vasc. Anesth. · Jun 2018
ReviewAdvances in Left Ventricular Assist Devices and Mechanical Circulatory Support.
Recent technologic advances have resulted in the availability of percutaneous and minimally invasive surgical devices for temporary mechanical circulatory support. These may be deployed rapidly without the requirement for sternotomy or cardiopulmonary bypass. In addition, third generation implantable left ventricular assist devices have been compared with second generation devices in 2 recent randomized controlled trials. The aim of this article is to provide a current review of the recent literature relating to left ventricular assist devices and mechanical circulatory support.