Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Low-Range Heparin and Protamine Detection: A Single-Center Prospective Diagnostic Study.
The detection of low-range heparin activity is important to correctly assess heparin reversal and rebound, especially after cardiopulmonary bypass. Current parameters are either not available at point-of-care (anti-Xa activity [aXa] and activated partial thromboplastin time [aPTT]), insensitive (kaolin-activated clotting time [kACT]), or expensive (ROTEM viscoelastic test). We aimed to assess the performance of a recently proposed parameter from the Sonoclot viscoelastic test: the slope-45. We aimed to assess the effects of a range of low-dose heparin and protamine and their interaction on multiple proposed parameters. ⋯ We were able to confirm that the Sonoclot slope-45 has a high sensitivity for low-dose heparin, which is retained in the setting of interacting protamine. It was insensitive to protamine in itself.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewVasoplegia in Heart, Lung, or Liver Transplantation: A Narrative Review.
Vasoplegia is a pathophysiologic state of hypotension in the setting of normal or high cardiac output and low systemic vascular resistance despite euvolemia and high-dose vasoconstrictors. Vasoplegia in heart, lung, or liver transplantation is of particular interest because it is common (approximately 29%, 28%, and 11%, respectively), is associated with adverse outcomes, and because the agents used to treat vasoplegia can affect immunosuppressive and other drug metabolism. This narrative review discusses the pathophysiology, risk factors, and treatment of vasoplegia in patients undergoing heart, lung, and liver transplantation. ⋯ Occasionally, agents, including methylene blue, hydroxocobalamin, and angiotensin II, are administered. Though retrospective literature suggests a hemodynamic response to these agents in the transplant population, minimal evidence is available to guide management. In what follows, we discuss the treatment of vasoplegia in the heart, lung, and liver transplant populations based on patient characteristics and potential risk factors associated with non-catecholamine agents.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Thrombotic Complications Associated With Right Atrial Lines in Neonates and Infants Undergoing Cardiac Surgery. Is Calcium Chloride a Culprit?
To determine if a change from calcium chloride to calcium gluconate infusion resulted in a decreased incidence of atrial thrombi and thrombotic events in neonates undergoing cardiac surgery. ⋯ In this single-center study, a significant decrease in the odds of an atrial catheter-related thrombus when a calcium gluconate infusion is used instead of calcium chloride was shown.