Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewRegional Analgesia in Pediatric Cardiothoracic Surgery: A Bayesian Network Meta-Analysis.
Various regional analgesia techniques are used to reduce postoperative pain in pediatric patients undergoing cardiothoracic surgeries. This study aimed to determine the relative efficacy of regional analgesic interventions. PubMed, EMBASE, Web of Science, and Cochrane databases were searched to identify all randomized controlled studies evaluating the effects of regional block after cardiothoracic surgery. ⋯ The incidence of postoperative nausea and vomiting was the lowest in the epidural anesthesia group, followed by the transversus thoracis muscle plane block group. Regional anesthesia revealed significant opioid-sparing effects following pediatric cardiothoracic surgery. However, indirect comparisons are limited because of the heterogeneity of previous studies, and direct comparisons are needed to establish the relative efficacies of different blocks.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewAwake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts.
Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. ⋯ Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Cerebral Oximetry Index-Guided Blood Pressure Management During Cardiopulmonary Bypass Reduces Postoperative Delirium in Patients with Acute Type A Aortic Dissection.
To investigate whether cerebral oximetry index (COx)-guided blood pressure management during cardiopulmonary bypass (CPB) could reduce postoperative delirium (POD) in patients undergoing acute type A aortic dissection (ATAAD) repair. ⋯ COx-guided blood pressure management during CPB was associated with reduced incidence and severity of POD following ATAAD surgery. This approach also showed potential benefits in reducing postoperative complications and improving early recovery outcomes. Further multicenter studies are needed to confirm these findings.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Quality Improvement Methodologies: An Application in Cardiac Anesthesiology.
Quality improvement (QI) in medicine serves as the cornerstone of best practices. It enhances medical care by maximizing safety and efficiency while minimizing errors and waste. For a QI initiative to succeed it requires careful strategizing and effective change management plans, including the application of established QI methodologies to ensure sustainable success. ⋯ This document provides a concise summary of methodologies that can be effectively led and executed by process improvement teams. We examine these methods within the context of cardiac anesthesiology, highlighting one institution's experience in reducing surgical site infections following coronary artery bypass graft surgery. However, these principles are applicable to various healthcare situations and beyond.