Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2020
Randomized Controlled TrialEfficacy of Bilateral Erector Spinae Plane Block in Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.
Regional analgesia continues to evolve with the introduction of ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB) is a novel technique gaining recent acceptability as a perioperative modality of analgesia in various thoracic and abdominal surgeries. However, literature on the use of ESPB in pediatric cardiac surgery is limited. ⋯ Ultrasound-guided bilateral ESPB presents a simple, innovative, reliable, and effective postoperative analgesic modality for pediatric cardiac surgeries contemplated through a midline sternotomy.
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J. Cardiothorac. Vasc. Anesth. · Apr 2020
ReviewPerioperative Anemia Management as Part of PBM in Cardiac Surgery - A Narrative Updated Review.
Anemia is common in patients with cardiac disease. Iron deficiency is the cause of anemia in about 80% of all cases. Preoperative anemia is associated with an increased morbidity and mortality in patients undergoing cardiac surgery. ⋯ PBM comprises 3 pillars: (1) detection and treatment of preoperative anemia, (2) reduction of perioperative blood loss, and (3) optimization of allogeneic blood therapy. The World Health Organization has urged all Member States to implement PBM. This narrative review focuses on pre-, intra-, and postoperative strategies to detect, prevent, and treat anemia as part of PBM in cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2020
ReviewAnalysis of Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement.
Over the last decade, transcatheter aortic valve replacement (TAVR) has emerged as the recommended approach for patients with high and intermediate risk for surgical aortic valve replacement. Even though initial trials demonstrated a higher incidence of conduction abnormalities (CAs), such as left bundle branch block, atrial fibrillation, and permanent pacemaker implantation with TAVR, the incidence of CAs has not decreased. With an increasing number of patients expected to undergo TAVR in the coming decades, even those at low risk for surgical aortic valve replacement, it is important to review the incidence, course, risk factors, mortality, and rehospitalization associated with CAs and permanent pacemaker implantation after TAVR. The newer-generation valves have demonstrated an improved safety profile, but have failed to demonstrate a clinically significant reduction in the incidence of CAs.
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J. Cardiothorac. Vasc. Anesth. · Apr 2020
Meta AnalysisCost-Effectiveness Analysis of Landiolol, an Ultrashort-Acting Beta-Blocker, for Prevention of Postoperative Atrial Fibrillation for the Germany Health Care System.
Landiolol is an ultrashort-acting beta-blocker with high beta-1 receptor affinity and less blood pressure-lowering properties than other beta-blockers available for intravenous use in Germany. The present analysis aimed to determine whether perioperative treatment with landiolol in cardiac surgical patients is cost-effective under the conditions of the German Diagnosis-Related Groups health cost reimbursement system. ⋯ This analysis suggests that preventing POAF with landiolol is highly cost-effective. Additional studies are needed to assess whether a comparable reduction in POAF and associated cost savings may be achieved using conventional intravenous beta-blockers or amiodarone.
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J. Cardiothorac. Vasc. Anesth. · Apr 2020
In Vitro Recovery of Sufentanil, Midazolam, Propofol, and Methylprednisolone in Pediatric Cardiopulmonary Bypass Systems.
To evaluate in vitro drug recovery in cardiopulmonary bypass (CPB) systems used for pediatric cardiac surgery. ⋯ The present in vitro experiment with neonatal, infant, and pediatric CPB systems shows a variable recovery of routinely used drugs with significant differences between drugs, but not between system categories (with the exception of propofol). The decreased recovery of mainly sufentanil and propofol could lead to suboptimal dosing of patients during cardiac surgery with CPB.