Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Vitamin D and Postoperative Delirium After Coronary Artery Bypass Grafting: A Prospective Cohort Study.
Postoperative delirium is the most common neuropsychiatric complication after cardiac surgery. Vitamin D contributes to numerous brain processes, regulation of neurotrophic factors, neuroprotection, neuroplasticity, and brain development, which could play a role in delirium pathophysiology. The authors evaluated the association of admission serum levels of 25-hydroxyvitamin D [25(OH)D] with the occurrence of delirium after coronary artery bypass surgery. ⋯ Preoperative severe vitamin D deficiency was associated with the occurrence of delirium after coronary artery bypass grafting surgery.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Socioeconomic Disparities in Carotid Revascularization Procedures.
Several studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures. ⋯ These results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Observational StudyComparison of Glycemic Variability Indices Blood Glucose Risk Index and Coefficient of Variation in Predicting Adverse Outcomes for Patients Undergoing Cardiac Surgery.
Fluctuations in blood glucose (glycemic variability) increase the risk of adverse outcomes. No universally accepted tool for glycemic variability exists during the perioperative period. The authors compared 2 measures of glycemic variability-(1) coefficient of variation (CV) and (2) the Blood Glucose Risk Index (BGRI)-in predicting adverse outcomes after cardiac surgery. ⋯ Both CV and the BGRI had good predictive ability. The BGRI being a continuous variable could be a preferred measure of glycemic variability in predicting adverse outcomes (cutoff value 2.24) after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Hydroxocobalamin Versus Methylene Blue for Vasoplegic Syndrome in Cardiothoracic Surgery: A Retrospective Cohort.
To compare methylene blue with hydroxocobalamin as a rescue therapy for vasoplegic syndrome. ⋯ Methylene blue and hydroxocobalamin increased mean arterial pressures and systemic vascular resistance without significantly decreasing time-averaged norepinephrine exposure in the hour after administration.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations.
To develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB). ⋯ Consensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.