Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
ReviewPediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.
Pediatric cardiac surgical patients are at particular risk for post-cardiopulmonary bypass hemorrhage. Moreover, both the incidence and volume of blood transfusions have been associated with increased morbidity in pediatric cardiac patients. Transfusion of red blood cells, platelets, and coagulation factors is necessary to combat the hemodilution associated with cardiopulmonary bypass and to treat postoperative bleeding. ⋯ Development of a transfusion algorithm for the pediatric cardiac population requires individualization at both the institutional level, considering local resources, equipment, and case mix, and the patient level, considering age, cardiac diagnosis, and planned procedure, at minimum. A growing body of literature suggests that application of appropriate intraoperative testing (platelet count, fibrinogen concentration, thromboelastometry) along with recognition of risk factors for bleeding, adequate bypass anticoagulation, and judicious use of factor concentrates allows for thoughtful transfusion and potentially improved outcomes in pediatric cardiac patients. This review examines the evolution of transfusion algorithms in pediatric cardiac surgery and examines the considerations involved in building an algorithm for this challenging, heterogenous population.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
ReviewThe Right Ventricle During Selective Lung Ventilation for Thoracic Surgery.
The right ventricle (RV) has been an area of evolving interest after decades of being ignored and considered less important than the left ventricle. Right ventricular dysfunction/failure is an independent predictor of mortality and morbidity in cardiac surgery; however, very little is known about the incidence or impact of RV dysfunction/failure in thoracic surgery. The pathophysiology of RV dysfunction/failure has been studied in the context of acute respiratory distress syndrome (ARDS), cardiac surgery, pulmonary hypertension, and left ventricular failure, but limited data exist in literature addressing the issue of RV dysfunction/failure in the context of thoracic surgery and one-lung ventilation (OLV). ⋯ The most important of these mechanisms seems to be the role of intraoperative mechanical ventilation, which potentially could cause both ventilator-induced lung injury leading to ARDS and RV injury. Identification of at-risk patients in the perioperative period using focused imaging, particularly echocardiography, is paramount. The authors also discuss the various RV-protective strategies required to prevent RV dysfunction and management of established RV failure.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
Randomized Controlled TrialDynamic Needle Tip Positioning for Ultrasound-Guided Arterial Catheterization in Infants and Small Children With Deep Arteries: A Randomized Controlled Trial.
Arterial catheterization for infants and small children is technically challenging. This study evaluated whether the dynamic needle tip positioning (DNTP) technique improved the success rate of ultrasound-guided radial artery catheterization in patients with a radial artery depth ≥4 mm compared with the conventional ultrasound-guided technique. ⋯ Dynamic needle tip positioning improved first-attempt and overall success rates of ultrasound-guided radial artery catheterization in pediatric patients with a radial artery depth ≥4 mm.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
Multicenter StudyAssociation Between Motor-Evoked Potentials and Spinal Cord Damage Diagnosed With Magnetic Resonance Imaging After Thoracoabdominal and Descending Aortic Aneurysm Repair.
The authors investigated the association between intraoperative motor-evoked potential (MEP) changes and the severity of spinal cord infarction diagnosed with magnetic resonance imaging (MRI) to clarify the discrepancy between them, which was observed in patients with postoperative motor deficits after thoracic and thoracoabdominal aortic surgery. ⋯ Motor-evoked potential <25% was associated significantly with motor deficits at discharge, but not with the severity of spinal cord infarction.