Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Review Meta AnalysisLocal Adverse Events Associated with Peripheral Vasoactive Infusion in Children: A Systematic Review with Meta-analysis.
Prior meta-analysis suggested a low incidence of local adverse events after infusion of vasoactive agents via a peripheral venous catheter in children. However, the number of included patients was relatively low, and the vasoactive agents used were mostly dopamine. We performed an updated systematic review with meta-analysis using databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials to explore the safety of infusing vasoactive agents, including epinephrine and norepinephrine, through peripheral venous catheters or intraosseous access in critically ill children. ⋯ The pooled incidence rates of local adverse events associated with infusion of vasoactive agents through peripheral venous catheters or intraosseous access, peripheral venous catheters only, and intraosseous access only were 2.1% (95% confidence interval [CI]: 0.8%-3.9%), 2.3% (95% CI: 1.0%-4.0%), and 1.1% (95% CI: 0.0%-9.8%), respectively. Based on the findings of this meta-analysis, the incidence rate of local adverse events associated with peripheral vasoactive infusion appears to be low. Peripheral infusion of vasoactive agents, including epinephrine and norepinephrine, can be considered when necessary.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Impact of Covert Brain Infarction Following Coronary Angiography on Coronary Artery Bypass Surgery Outcomes.
To determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG). ⋯ Among patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCEs within 30 days or long-term mortality after CABG.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Nighttime/Weekend Venoarterial Extracorporeal Membrane Oxygenation Cannulation Is Not Associated With Increased 1-Year Mortality for Non-Extracorporeal Cardiopulmonary Resuscitation Indications.
The process of placing a patient on venoarterial extracorporeal membrane oxygenation (VA-ECMO) is complex and requires the activation and coordination of numerous personnel from a variety of disciplines to achieve procedural success, initiate flow, and subsequently monitor the patient's condition. The literature suggests that nighttime cannulation for extracorporeal cardiopulmonary resuscitation (ECPR) is associated with adverse outcomes compared to daytime cannulation. Given the strain on personnel that this process can create, it is plausible that patients who are initiated on VA-ECMO for non-ECPR indications during the nighttime and on weekends, which are generally periods with reduced staffing compared to weekday daytime hours, also may experience worse outcomes, including decreased survival. This study aimed to determine whether nighttime/weekend VA-ECMO cannulation is associated with worse outcomes, including decreased survival. ⋯ We conclude that nighttime and weekend VA-ECMO cannulations can be performed safely at a large academic medical center.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Incidence and Factors Associated With Burnout Among Cardiac Anesthesiologists in India.
Many previous surveys have demonstrated a high incidence of burnout among anesthesiologists. The current survey was designed to estimate the incidence and understand the factors associated with burnout among cardiac anesthesiologists in India. ⋯ The burden of burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia. There is a need for various stakeholders to be sensitized and institute necessary measures to reduce the burden and impact of burnout.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Predictors of Postoperative Morphine Milligram Equivalents in Cardiac Surgery.
Given both the short- and long-term deleterious effects of opioids, there has been an increased focused on reducing the use of postoperative opioid analgesia. As patients undergoing cardiac surgery often require high levels opioids postoperatively, understanding risk factors for increased postoperative opioid use may be helpful for the development of patient-specific opioid-sparing pain regimens for this patient population. ⋯ CABG, liver disease, patient-controlled analgesia, younger age, and higher BMI are associated with increased narcotic use after cardiac surgery. Implementation of more aggressive perioperative multimodal opioid-sparing regimens should be considered for these patient groups.