Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
ReviewEfficacy, Safety, and Strategies for Recombinant-Activated Factor VII in Cardiac Surgical Bleeding: A Narrative Review.
As perioperative bleeding continues to be a major source of morbidity and mortality in cardiac surgery, the search continues for an ideal hemostatic agent for use in this patient population. Transfusion of blood products has been associated both with increased costs and risks, such as infection, prolonged mechanical ventilation, increased length of stay, and decreased survival. Recombinant-activated factor VII (rFVIIa) first was approved for the US market in 1999 and since that time has been used in a variety of clinical settings. This review summarizes the existing literature pertaining to perioperative rFVIIa, in addition to society recommendations and current guidelines regarding its use in cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
Review2021 Acute Respiratory Distress Syndrome Update, With Coronavirus Disease 2019 Focus.
Acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease responsible for significant morbidity and mortality among critically ill patients, including those infected with severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019. Despite recent advances in pathophysiology, diagnostics, and therapeutics, ARDS is dangerously underdiagnosed, and supportive lung protective ventilation and prone positioning remain the mainstay interventions. Rescue therapies, including neuromuscular blockade and venovenous extracorporeal membrane oxygenation, remain a key component of clinical practice, although benefits are unclear. Even though coronavirus disease 2019 ARDS has some distinguishing features from traditional ARDS, including delayed onset, hyperinflammatory response, and pulmonary microthrombi, it clinically is similar to traditional ARDS and should be treated with established supportive therapies.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
Review Case ReportsLate Diagnosis of a Large Extrapleural Hematoma in a Patient With Stanford Type B Aortic Dissection: A Case Report and Review of Literature.
Acute aortic dissection is a rare but catastrophic condition. When the dissection extends through the adventitia, blood can extravasate into the extrapleural or intrapleural spaces, causing an extrapleural hematoma or hemothorax. The early recognition of extrapleural hematoma and distinguishing it from hemothorax is critical because the management of those two entities is different. ⋯ Without clear radiographic diagnostic features of extrapleural hematoma, unsuccessful drainage of hematoma after insertion of a chest tube may suggest an extrapleural hematoma or a clotted hemothorax. If patients continue to have circulatory or respiratory compromises, prompt surgical exploration should be considered. It is important for clinicians to be aware of extrapleural hematoma in complicated acute aortic dissection, especially when chest tube drainage of an apparent hemothorax is unsuccessful.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
Randomized Controlled Trial Multicenter StudyThe Impact on 30-Day Mortality From a Brief Focused Ultrasound-Guided Management Protocol Immediately Before Emergency Noncardiac Surgery in Critically Ill Patients: A Multicenter Randomized Controlled Trial.
To determine whether brief ultrasound-guided treatment of hemodynamic shock and respiratory failure immediately before emergency noncardiac surgery reduced 30-day mortality. ⋯ In critically ill patients with hemodynamic shock or respiratory failure, a focused ultrasound-guided management did not reduce 30-day mortality but led to frequent changes in diagnosis and patient management.
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J. Cardiothorac. Vasc. Anesth. · Apr 2022
ReviewPerioperative Implications of the 2020 American Heart Association Scientific Statement on Drug-Induced Arrhythmias-A Focused Review.
The recently released American Heart Association (AHA) scientific statement on drug-induced arrhythmias discussed medications commonly associated with bradycardia, supraventricular tachycardias, and ventricular arrhythmias. The foundational data for this statement were collected from general outpatient and inpatient populations. Patients undergoing surgical and minimally invasive treatments are a unique subgroup, because they may experience hemodynamic changes associated with anesthesia and their procedure, receive multiple drug combinations not given in either inpatient or outpatient settings, or experience postprocedural inflammatory syndromes. ⋯ In many instances, the risk of arrhythmia reported by the AHA scientific statement in the general population appeared to be higher than found in perioperative arenas. Furthermore, the authors discuss the arrhythmia risk of additional medications commonly ordered or administered by anesthesiologists that are not included in the AHA scientific statement. As patient and procedural complexity increases and novel anesthetic combinations propagate, further research and observational studies will be required to delineate further perioperative risks for drug-induced arrhythmia.