Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
Observational StudyLabetalol Infusion Attenuates Paradoxical Hypertension and Decreases Plasma Renin Activity After Repair of Coarctation of the Aorta in Children.
Paradoxical hypertension after repair of coarctation of the aorta in children is associated with the release of catecholamines and activation of the renin-angiotensin system. The objective of the present study was to describe the effects of labetalol infusion on blood pressure, plasma catecholamine levels, and plasma renin activity in a series of children undergoing repair of coarctation of the aorta. ⋯ Labetalol inhibited activation of the renin-angiotensin system and helped control paradoxical hypertension after coarctation repair in children.
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
Observational StudyMultiple Electrode Aggregometry After Cardiopulmonary Bypass to Assess Platelet (Dys)-Function and Transfusion Threshold: A Concordance Study.
Cardiac surgery patients have a high risk of postoperative bleeding. Historically, the platelet count has been one of the main parameters used to establish the need for platelet transfusions, and the recent introduction of point-of-care tests for platelet function has allowed clinicians to rationalize platelet transfusion needs by assessing the platelet (dys-)function of the patient. For the present study, the authors evaluated how the introduction of one of these systems-the adenosine diphosphate (ADP) test, performed using a Multiplate electrode analyzer (Roche Diagnostics, Basel, Switzerland)-into their clinical practice had modified their platelet transfusion practice. The relationship between the platelet count and the functional evaluation of platelet aggregation (via the ADP test) also was examined. ⋯ The application of new Multiplate analyzer technologies, like the ADP test, have the potential to reduce platelet transfusion rates in cardiac surgery patients compared with the use of platelet counts alone; this point-of-care test may constitute an important strategy to help spare the use of allogeneic blood products. Additional studies are needed to confirm this trend and establish the best cutoff values to apply.
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
Advanced Age and Sex Influence Baseline Regional Cerebral Oxygen Saturation as Measured by Near-Infrared Spectroscopy: Subanalysis of a Prospective Study.
The aging brain shows decreased venous oxygenation predominantly in the frontal cortex, which seems sex- dependent. The authors hypothesized that age and sex would influence baseline regional cerebral oxygen saturation (rScO2) measured by the INVOS 5100. ⋯ Baseline rScO2, as measured by the INVOS 5100, decreases with advanced age and is lower in women. New definitions of cerebral oxygen desaturation need to be analyzed in future trials that will evaluate neurologic outcome in the aging population or in women.
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
ReviewNeuromonitoring Modalities in Pediatric Cardiac Anesthesia: A Review of the Literature.
Recent decades have witnessed incredible developments in the care of children with congenital heart disease (CHD), such that survival into adulthood is the expected outcome. Improved survival has shifted the focus from improvements in mortality to improvements in morbidity, with long-term neurologic sequelae among the most important. Children with CHD who undergo corrective procedures in infancy and early childhood have a high rate of neurodevelopmental disability later in childhood. ⋯ Even though each modality has merits, no single modality is able to reliably guide changes to management that improve neurologic outcomes. The best strategy is likely a multimodal neurologic monitoring strategy, although the combination of monitoring may depend on local resources and patient risk factors. This review provides a brief overview of the current knowledge regarding neurodevelopmental outcomes in children with CHD and summarizes the evidence for the use of the following 4 neuromonitoring modalities: transcranial Doppler, cerebral near-infrared spectroscopy, standard electroencephalography, and processed electroencephalography.