Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2012
Randomized Controlled Trial Comparative StudyAn increase in endogenous erythropoietin concentrations has no cardioprotective effects in patients undergoing coronary artery bypass graft surgery.
Preliminary data showed an increase in endogenous erythropoietin (EPO) concentrations after acute normovolemic hemodilution (ANH) in patients undergoing coronary artery bypass graft (CABG) surgery. Numerous studies have shown the organ protective properties of EPO. The aim of this study was to investigate the cardioprotective effects of these increased EPO concentrations that resulted from ANH during cardiac surgery. ⋯ In patients undergoing CABG surgery on CPB, an increase in endogenous EPO concentrations in the physiologic range has no cardioprotective effects.
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J. Cardiothorac. Vasc. Anesth. · Apr 2012
Comparative StudyReal-time compared to off-line evaluation of segmental wall motion abnormalities with transesophageal echocardiography using dobutamine stress testing.
To compare real-time (on-line) monitoring of myocardial ischemia with transesophageal echocardiography (TEE) with off-line reviewing during a dobutamine stress test in patients undergoing coronary artery bypass grafting (CABG). ⋯ Only a fair agreement exists between on-line and off-line analysis of myocardial ischemia during dobutamine stress testing in patients undergoing CABG. However, TEE misses up to one third of ischemic episodes and the present observations suggest using continuous electrocardiographic methods to complement TEE monitoring.
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J. Cardiothorac. Vasc. Anesth. · Apr 2012
ReviewAdvances in acute kidney injury associated with cardiac surgery: the unfolding revolution in early detection.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is important because it remains common and serious. A major limitation in the management of CSA-AKI has been ongoing delayed diagnosis by standard clinical approaches, including serum creatinine and calculated glomerular filtration rate. Recent advances in the understanding of CSA-AKI have highlighted the utility of novel biomarkers that diagnose CSA-AKI within the first 24 hours. ⋯ Future clinical trials likely will focus on whether these biomarkers predict adverse outcomes independent of serum creatinine fluctuations and whether therapies guided by biomarker profiles improve renal salvage and overall clinical outcomes. Given their clinical utility, these novel biomarkers have been evaluated beyond cardiac surgery for AKI in multiple clinical environments, including the emergency department, the operating room, the cardiac catheterization laboratory, and the intensive care unit. Their integration into clinical practice seems likely in the near future.
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J. Cardiothorac. Vasc. Anesth. · Apr 2012
Comparative StudyTechnical aspects of anesthesia and cardiopulmonary bypass in patients undergoing totally thoracoscopic cardiac surgery.
The use of fast-track general anesthesia in patients undergoing nonrobotically assisted and totally thoracoscopic cardiac surgeries has not been previously reported previously. ⋯ Cardiopulmonary bypass for totally thoracoscopic cardiac surgery can be established through the femoral artery and femoral vein. With fast-track anesthesia, early extubation in the operating room can be achieved in more than one third of patients.
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J. Cardiothorac. Vasc. Anesth. · Apr 2012
Comparative StudyEchocardiographic evaluation of systolic and diastolic function: a preoperative study of correlation with serum NT-proBNP.
The authors hypothesized that preoperative N-terminal probrain natriuretic peptide (NT-proBNP) correlates well with longitudinal strain measurements and with Doppler measurements of diastolic function. ⋯ A correlation was found between plasma levels of NT-proBNP and speckle tracking ultrasound strain measurements by an easily employed method applicable in the anesthesia and preoperative settings. In addition, the well-established marker of diastolic function, E/E', correlated well with NT-proBNP, whereas the E/A ratio failed to show any association.