Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · May 2021
Observational StudyAssociation Between Intraoperative Hypotension and Postoperative Adverse Outcomes in Patients Undergoing Vascular Surgery - A Retrospective Observational Study.
Intraoperative hypotension (IOH) is associated with adverse outcomes. It could be challenging to define IOH in vascular surgical patients with increased baseline blood pressure (BP). The authors studied the relationship between (1) absolute and relative BP thresholds of IOH, (2) preoperative pulse pressure (PP) and isolated systolic hypertension, and (3) endovascular versus open surgical approach with adverse outcomes in vascular surgical patients. ⋯ Longer periods of IOH (MAP <65 mmHg for >60 minutes) during endovascular surgery were associated with adverse outcomes. Relative fall in BP from baseline, preoperative isolated systolic, and PP hypertension were not associated with postoperative complications.
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The aim of the survey was to understand the contemporary thoracic anesthesia practice in India. ⋯ Despite the challenges offered by limited resources, the practice of thoracic anesthesia in India is at par with the standards followed across the world.
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J. Cardiothorac. Vasc. Anesth. · May 2021
ReviewA Narrative Review for Cardiac Anesthesiologists of the 2019 Expert Consensus on Operator and Institutional Recommendations for Transcatheter Mitral Valve Intervention.
US Food and Drug Administration approval of the edge-to-edge clip repair device (MitraClip; Abbott Laboratories, Abbott Park, IL) in 2013 led to wide adoption of the device for treatment of severe primary mitral regurgitation in patients unsuitable for surgery. Demonstration of favorable outcomes in the setting of secondary mitral regurgitation by the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial in 2019 provided an additional impetus to the transcatheter mitral interventional program. ⋯ This document has direct implications for the cardiac anesthesiologist involved in the care of these patients because a broader understanding of pertinent issues is essential to function as an effective clinical member within the multidisciplinary team. As such, this narrative review serves to highlight the salient features of the "2019 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Mitral Valve Intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons," focuses on issues pertinent to the cardiac anesthesiologist, and provides an outline for the clinical context and evolution of transcatheter mitral valve interventions.
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J. Cardiothorac. Vasc. Anesth. · May 2021
ReviewFunctional Hemodynamic Monitoring With a Wireless Ultrasound Patch.
In this Emerging Technology Review, a novel, wireless, wearable Doppler ultrasound patch is described as a tool for resuscitation. The device is designed, foremost, as a functional hemodynamic monitor-a simple, fast, and consistent method for measuring hemodynamic change with preload variation. More generally, functional hemodynamic monitoring is a paradigm that helps predict stroke volume response to additional intravenous volume. ⋯ Reaffirming clinical studies, the ultrasound patch tracks immediate SV change with excellent accuracy in healthy volunteers when cardiac preload is altered by various maneuvers. The wearable ultrasound also follows jugular venous Doppler, which qualitatively trends right atrial pressure. With further clinical research and the application of artificial intelligence, the monitoring modalities with this new technology are manifold.
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J. Cardiothorac. Vasc. Anesth. · May 2021
Observational StudyEnd-of-Procedure Volume Responsiveness Defined by the Passive Leg Raise Test Is Not Associated With Acute Kidney Injury After Cardiopulmonary Bypass.
Renal hypoperfusion is a common mechanism of cardiac surgery-related acute kidney injury (CS-AKI). However, the optimal amount of volume resuscitation to correct systemic hypoperfusion and prevent the postoperative development of CS-AKI has been a subject of debate. The goal of this study was to assess the association of volume responsiveness determined by stroke volume variation using the passive leg raise test (PLRT) at chest closure, with the development of CS-AKI according to the Kidney Disease Improving Global Outcomes criteria. ⋯ End-of-procedure volume responsiveness is not associated with a high risk for postoperative CS-AKI.