Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
Randomized Controlled Trial Comparative StudySimulation Versus Problem Based Learning for Cerebrospinal Drainage Catheter Insertion and Management: A Randomized Trial in a Large Academic Anesthesiology Residency Program.
Cerebrospinal fluid drainage catheter-related complications can be reduced by following strict guidelines during their introduction, maintenance, and removal. The authors therefore aimed to determine whether simulation-based learning would improve senior anesthesiology residents' patient care performance during the insertion and management of these catheters compared to interactive problem-based learning (PBL) using the Anaesthetists' Non-Technical Skills global rating scale (ANTS). ⋯ Compared to interactive PBL, simulation-based learning does not result in a statistically significant improvement in anesthesia resident performance during insertion and management of cerebrospinal fluid drainage catheters.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
ReviewRight Ventricular Failure After Left Ventricular Assist Device Placement-The Beginning of the End or Just Another Challenge?
Left ventricular assist device (LVAD) therapy has greatly improved outcomes in patients with end-stage heart failure. However, development of right ventricular failure (RVF) in LVAD recipients is associated with increased long- and short-term morbidity and mortality. The incidence of RVF after LVAD placement is difficult to assess due to the lack of a common definition. ⋯ As long-term RVADs are unavailable, currently approved treatment of prolonged RVF is limited to heart transplantation or the placement of a total artificial heart as bridge-to-transplant. Strategies to improve outcome in this patient population should include better risk stratification for RVF prior to LVAD placement as well as frank discussions about LVAD candidacy in patients ineligible for transplantation. The development of durable right-sided mechanical support would improve the scope of care of LVAD patients developing persistent RVF.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
ReviewAcute Kidney Injury After Cardiac Surgery: A Narrative Review of the Literature.
Acute kidney injury (AKI) is a common and serious complication of cardiac surgery. It is associated with increased morbidity and mortality. On a population level, the financial impact and overall incremental annual index hospitalization costs associated with AKI exceed $1 billion in the United States alone. ⋯ Prevention of AKI is still key to the management of AKI, and strategies include maintenance of renal perfusion and avoidance of nephrotoxins and blood transfusion-related insults. Dialysis in severe AKI is established, but the optimal modality and dose remains an area of ongoing research. This narrative review assesses the pathophysiology of AKI, role of biomarkers, risk assessment, and management in cardiac surgical patients.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
Preoperative QTc Interval is Not Associated With Intraoperative Cardiac Events or Mortality in Liver Transplantation Patients.
The primary objective of this study was to determine whether liver transplantation recipients with preoperative prolonged corrected (QTc) intervals have a higher incidence of intraoperative cardiac events and/or postoperative mortality compared with their peers with normal QTc intervals. ⋯ Prolonged QTc interval is not associated with an increased incidence of intraoperative cardiac events or mortality in liver transplantation recipients. The demonstrated correlation among QTc length and Model for End-stage Liver Disease score, blood component requirements, surgical and anesthetic times, and hospital length of stay likely represents the association between QTc length and severity of liver disease.