Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
ReviewThe Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak.
Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
ReviewCardiac interventions in pregnancy and peripartum - a narrative review of the literature.
In the UK, mortality rate during pregnancy/in the peripartal period is 14.1 per 100,000 maternities with heart disease being the leading cause of non-obstetric maternal mortality (10% to 15% of all maternal deaths). Owing to the advances in the treatment of congenital heart disease (CHD), an increasing percentage of women has reached childbearing age, making CHD nowadays the most frequent cardiovascular disease during pregnancy in the Western world. ⋯ While all these interventions seem to be relatively safe for the mother, fetal mortality remains considerably high. A thorough understanding of maternal physiology during pregnancy and of the perfusion of the feto-maternal unit is mandatory for the successful management of pregnant patients in need of cardiac (surgical) interventions.
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J. Cardiothorac. Vasc. Anesth. · Dec 2020
ReviewBiased Agonism: The Future (and Present) of Inotropic Support.
Biased agonism, which is the concept that different ligands activate different downstream signalling partners in different ratios to cause different functional effects, is yet to gain appropriate appreciation in the field of inotropic pharmacology. Biased agonism has already proven to be a clinically translatable technology in analgesic pharmacology, but this development is yet to be translated into inotropes. A better appreciation of bias in clinically used inotropes and a focus on bias when developing novel inotropes has the potential to lead to more targeted, personalized, and cleaner inotropes.
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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.