Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
ReviewCurrent Evidence and Future Directions of Tranexamic Acid Use, Efficacy, and Dosing for Major Surgical Procedures.
Tranexamic acid reduces blood loss and transfusion requirements with no significant thrombotic adverse effects. Postoperative seizures have been seen in cardiac surgical patients in association with patient (advanced age, underlying neurologic disease, chronic kidney disease); surgical (open cardiac procedures, long bypass times); and drug (high tranexamic acid dose) risk factors. ⋯ Optimal dosing for cardiac surgical patients has been recommended. Additional research is required to determine dosing regimens in major noncardiac surgery and plasma concentration levels associated with inducing seizures.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Multicenter StudyTransesophageal Echocardiography, Acute Kidney Injury, and Length of Hospitalization Among Adults Undergoing Coronary Artery Bypass Graft Surgery.
To test the association between transesophageal echocardiography (TEE) and incidence of acute kidney injury and length of hospitalization among United States adults undergoing isolated coronary artery bypass graft (CABG) surgery. ⋯ TEE monitoring in CABG surgery was not associated with a lower incidence of acute kidney injury or decreased length of hospitalization. These findings highlight the importance of additional work to study the clinical effectiveness of TEE in CABG surgery.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
ReviewThrombocytosis: Perioperative Considerations for Patients Undergoing Cardiac Surgery.
Thrombocytosis is an uncommon yet important laboratory abnormality with significant considerations for patients undergoing cardiac surgery. The etiology of thrombocytosis can be categorized by those related to reactive processes; acquired platelet disorders (ie, myeloproliferative neoplasms, hematologic malignancies); or inherited platelet disorders (ie, hereditary thrombocythemia). A foundational understanding of the normal physiologic function of platelets and the abnormalities associated with each of these disorders is critical when considering implications and optimization to prevent perioperative complications. This review systematically outlines the platelet disorders that cause thrombocytosis with an emphasis on how the disorder affects normal physiologic processes, summarizes the literature related to the disorder, and the describes the implications and recommendations for patients undergoing cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Case ReportsPulmonary Artery Stenosis in a Patient with Prior Histoplasmosis and the Discovery of Complications.
Pulmonary hypertension (PH) results from varied etiologies, leading to progressive symptoms and limiting physical activity and quality of life, with associated morbidity and mortality. External compression of the pulmonary artery (PA) is a rare cause of PH and may give the clinician cause to investigate compression of nearby structures. In this E-Challenge, the authors present a case of PA stenosis in a patient with prior histoplasmosis scheduled for left PA stenting. ⋯ TEE revealed external compression of the pulmonary veins. This case highlights the value of pathophysiologic understanding, preoperative planning, and the effect of echocardiography on clinical management and patient safety. In this case, TEE prevented possible morbidity and mortality.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
The Program Evaluation Committee in the Adult Cardiothoracic Anesthesiology Fellowship - Harnessing Opportunities for Program Improvement.
The Program Evaluation Committee has an essential role in the quality improvement process of the adult cardiothoracic anesthesiology fellowship. The annual program evaluation presents all stakeholders with an opportunity to evolve with the changing needs and opportunities of the fellowship milieu. The active engagement of the program in this process is a high-quality approach to successful planning, preparation and conduct of the self-study and site visit that are important extensions of the annual program evaluation and the program evaluation committee.