Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Comparison of Manual and Mechanical Ventilation During Intensive Care Unit Transport Following Cardiac Surgery: Impact on Oxygenation, Ventilation, and Hemodynamic Stability.
Following cardiac surgery, patients often require ventilatory support during transport to the intensive care unit (ICU). Manual ventilation using a bag valve mask (BVM) is commonly employed; however, mechanical ventilation may sometimes be preferred due to concerns regarding oxygenation, ventilation, and hemodynamic stability. The decision between manual and mechanical ventilation is typically based on clinical experience and surgical factors, as there is no established consensus or robust clinical evidence to guide this choice. The aim of this study was to compare oxygenation, ventilation, and hemodynamic parameters between manual ventilation with a BVM and mechanical ventilation using a transport ventilator. ⋯ In patients who have undergone cardiac surgery, hypotension occurred more frequently in the BVM group than in the mechanical ventilation group during transport to the ICU. However, oxygenation and ventilation parameters were comparable between the two groups.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
The Impact of Blood Pressure Below Personalized Lower Cerebral Autoregulation Limit on Outcomes After Cardiac Surgery: A Retrospective Study.
The clinical importance of individualized blood pressure management in optimizing cerebral perfusion during cardiac surgery has been well established. However, consensus on blood pressure goals is lacking. The authors studied the associations between cerebral autoregulation metrics, hemodynamic parameters, and postoperative outcomes, and hypothesized that increased time of mean arterial pressure (MAP) below the lower limit of autoregulation (LLA) is associated with major morbidity and mortality (MMOM) incidence. ⋯ These findings indicate that LLA-related metrics have limited utility for predicting MMOM. Future research should explore their applicability in various contexts and patient cohorts.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Utilization and Outcomes of Epidural Anesthesia Versus Regional Anesthesia for Thoracic Surgery: An ACS-NSQIP Analysis.
To determine the use of epidural anesthesia compared with regional anesthesia as an adjunct to general anesthesia in thoracic surgery over time, and compare length of stay, overall morbidity, serious morbidity, and mortality between epidural and regional anesthesia when utilized as adjuncts to general anesthesia in thoracic surgery. ⋯ The rate of peripheral nerve blocks in thoracic surgery increased over time. Patients receiving peripheral nerve blocks, relative to epidural anesthesia, had better outcomes. Future, adequately powered research is needed to evaluate whether findings remain consistent when accounting for other factors (eg, surgical approach, providers, institutions).
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
ReviewPractice Advisory for Postoperative Pain Management of Thoracic Surgical Patients: A Report from the Society of Cardiovascular Anesthesiologists.
Pain after thoracic surgery is often significant, which can disrupt normal respiratory mechanics and impair the clearance of secretions, thus increasing the risk of postoperative respiratory complications. Poorly controlled acute pain can lead to persistent post-thoracotomy pain and continued opioid use that can affect quality of life. With the increased awareness of opioid-associated adverse effects and recent emphasis on enhanced recovery, opioid-sparing multimodal analgesia has been used widely for acute pain management after thoracic surgery. This practice advisory reviews, evaluates, and summarizes the recent literature related to pharmacological therapies and non-pharmacological therapies used for postoperative pain management after thoracic surgery and offers guidance to providers in making appropriate pain management decisions for their patients.