Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2007
Comparative StudyLow-volume interscalene brachial plexus block for post-thoracotomy shoulder pain.
This study was designed to evaluate the effectiveness of low-volume interscalene brachial plexus block for post-thoracotomy ipsilateral shoulder pain and to compare it with nonsteroidal anti-inflammatory drug treatment. ⋯ The authors concluded that low-volume interscalene brachial plexus block is a superior treatment for post-thoracotomy shoulder pain compared with diclofenac injection, although it requires a slightly longer stay in the PACU.
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J. Cardiothorac. Vasc. Anesth. · Aug 2007
Comparative StudyWake-up test after carotid endarterectomy for combined carotid-coronary artery surgery: a case series.
In combined carotid-coronary artery surgery, it is important to determine patients' neurologic status after carotid endarterectomy (CEA). An initial stroke could be exacerbated by cardiopulmonary bypass required for coronary artery bypass graft (CABG) surgery. Various monitoring methods (eg, electroencephalogram) have been used to reduce neurologic deficits during CEA under general anesthesia. However, none of the methods of determining neurologic status of patients are ideal during the time between the end of CEA and the beginning of CABG surgery. In this study, patient's neurologic status was assessed after CEA with a wake-up test to identify stroke before CABG surgery. ⋯ Although this is a case series, the authors believe that performing a neurologic examination using a wake-up test may make a contribution and increases the safety of combined surgical procedures in patients with coronary and carotid artery disease.
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J. Cardiothorac. Vasc. Anesth. · Aug 2007
Randomized Controlled Trial Comparative StudyCerebral near-infrared spectroscopy in adult patients after cardiac surgery is not useful for monitoring absolute values but may reflect trends in venous oxygenation under clinical conditions.
Cerebral near-infrared spectroscopy (NIRS) was evaluated for use in monitoring global oxygenation in adult patients after cardiac surgery. ⋯ Cerebral NIRS in adult patients might not be the tool to replace mixed venous oxygen monitoring. Further work has to be done to assess its potential to reflect intraindividual trends.
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J. Cardiothorac. Vasc. Anesth. · Aug 2007
Randomized Controlled Trial Comparative StudyComparison of the modulatory effects of four different fast-track anesthetic techniques on the inflammatory response to cardiac surgery with cardiopulmonary bypass.
To test the hypothesis that the choice of anesthesia technique for coronary artery surgery influences the degree and magnitude of the subsequent inflammatory response and its consequences. ⋯ Supplementation of a fast-track anesthetic technique with epidural analgesia preserves hemodynamic stability and is associated with faster extubation times (p = 0.003) and less postoperative pain (p = 0.045). Thoracic epidural analgesia was associated with significantly higher levels of IL-6 throughout the study period as compared with the total intravenous anesthesia groups. The exact clinical relevance of this finding remains unclear.