Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2007
Randomized Controlled TrialFenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study.
The purpose of this study was to evaluate the renoprotective effects of fenoldopam in patients at high risk of postoperative acute kidney injury undergoing elective cardiac surgery requiring cardiopulmonary bypass. ⋯ A 24-hour infusion of 0.1 mug/kg/min of fenoldopam prevented acute kidney injury in a high-risk population undergoing cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Dec 2007
The acute physiology and chronic health evaluation III outcome prediction in patients admitted to the intensive care unit after pneumonectomy.
The Acute Physiology and Chronic Health Evaluation (APACHE) III prognostic system has not been previously validated in patients admitted to the intensive care unit (ICU) after pneumonectomy. The purpose of this study was to determine if the APACHE III predicts hospital mortality after pneumonectomy. ⋯ In patients admitted to the ICU after pneumonectomy, the APACHE III discriminates moderately well between survivors and nonsurvivors. The calibration of the model appears to be good, although the low number of deaths limits the power of the calibration analysis. The use of APACHE III data in outcomes research involving patients who have undergone pneumonectomy is acceptable.
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J. Cardiothorac. Vasc. Anesth. · Dec 2007
Comparative StudyHigh thoracic epidural anesthesia in coronary artery bypass surgery: a propensity-matched study.
To assess if 2 different anesthesia strategies, high-thoracic epidural anesthesia (HTEA) plus inhalation anesthesia and total intravenous anesthesia (TIVA) with sufentanil/propofol had different influence on outcomes of coronary artery bypass graft (CABG) surgery patients. ⋯ HTEA and TIVA provided similar early outcomes after CABG surgery, and there were no major differences between these 2 strategies in the average risk CABG patient populations. Although HTEA did not cause neurologic problems and yielded a significant reduction in time to extubation, a consistent benefit over standard techniques could not be shown.
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J. Cardiothorac. Vasc. Anesth. · Dec 2007
Comparative StudyAn intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography.
There are a number of techniques available to assess the aorta for atheromatous disease in the intraoperative period. This study compared the relationship among the findings of digital palpation (DP), transesophageal echocardiography (TEE), and epiaortic ultrasound (EAU) in the detection of atheroma in the ascending aorta. ⋯ Assuming EAU as the "gold standard" to detect atheroma, this study has shown that when assessing the ascending aorta neither DP nor TEE appear sensitive. This study supports the proposal that detection of atheroma should be performed by EAU.
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J. Cardiothorac. Vasc. Anesth. · Dec 2007
The effect of routine intraoperative transesophageal echocardiography on surgical management.
To assess the effects of routine intraoperative transesophageal echocardiography (TEE) on surgical management of patients undergoing all types of cardiac surgery. ⋯ The routine use of TEE during cardiac surgery revealed new cardiac pathology in 1 of every 3 patients and led to altered surgical management in 1 of every 4 patients. TEE information also influenced decisions regarding use/nonuse of CPB in 3% of patients. Thus, the authors suggest that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery.