Journal of cardiothoracic and vascular anesthesia
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Historically, several studies showed an association between malnutrition in critically ill patients and poor outcomes. As a result, the standard practice had been to provide patients with full nutrition as soon as possible to eliminate malnutrition, improve outcomes, and reduce mortality. However, several studies recently suggested that providing more calories and protein is not better in critical illness and may be harmful in certain disease states. This literature review and editorial describe the harms of maximal feeding early in critical illness.
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J. Cardiothorac. Vasc. Anesth. · Oct 2023
Effectiveness of Dexmedetomidine as Myocardial Protector in Children With Classic Tetralogy of Fallot Having Corrective Surgery: A Randomized Controlled Trial.
Efficacy of dexmedetomidine (DEX) as a cardioprotective agent in Indonesian children undergoing classic tetralogy of Fallot (TOF) repair with cardiopulmonary bypass (CPB). ⋯ Dexmedetomidine during CPB is an effective cardioprotective agent in TOF children having surgery. Postoperative mortality was comparable across groups.
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J. Cardiothorac. Vasc. Anesth. · Oct 2023
ReviewInfectious Risk of Arterial Lines: A Narrative Review.
Arterial catheter-related bloodstream infections have been identified as a significant healthcare burden. However, the incidence of arterial catheter-related infections is commonly underestimated in clinical practice, and adherence to CDC-recommended practices is inconsistent. Several categories of interventions have been studied to prevent arterial catheter-related bloodstream infections, which include barrier precautions, cutaneous antisepsis, insertion site selection, dressings, chlorhexidine-impregnated sponges, and the duration of catheter placement with or without catheter replacement. The majority of these studies are limited by small sample sizes and single-center designs, and further randomized trials are needed to update current clinical practice guidelines to reduce the risk of arterial catheter-related infections.
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J. Cardiothorac. Vasc. Anesth. · Oct 2023
Randomized Controlled TrialComparison of Procedural Sedation With Propofol and Dexmedetomidine During Transcatheter Aortic Valve Replacement Using the Transfemoral Approach.
Although procedural sedation is an established method of anesthesia for transcatheter aortic valve replacement (TAVR), reliable evidence to guide the choice of a suitable sedative agent remains scarce. Accordingly, this trial aimed to compare the effect of procedural sedation with dexmedetomidine versus propofol on postoperative neurocognitive and related clinical outcomes in patients undergoing TAVR. ⋯ Compared with propofol, procedural sedation with dexmedetomidine in TAVR was associated with a significantly lower incidence of delayed neurocognitive recovery.
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J. Cardiothorac. Vasc. Anesth. · Oct 2023
ReviewHighlights and Perioperative Implications from the 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease.
As the understanding of aortic diseases and their complications grow, increasing importance of uniformity in diagnosis and management is crucial for optimal care of this patient population. The 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease discusses these considerations in detail. ⋯ A few notable points include, shared decision-making with patients, creation of multidisciplinary aortic teams, lower diameter thresholds for surgery in certain situations, and increased testing for patients with heritable aortic diseases. In addition to briefly reviewing basics of aortic diseases, the authors discuss changes to guidelines that are especially relevant to perioperative care.