Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2006
Randomized Controlled TrialOpioids and cardioprotection: the impact of morphine and fentanyl on recovery of ventricular function after cardiopulmonary bypass.
Experimental studies have shown that opioids protect the myocardium from ischemic injury and that opioid cardioprotection is enhanced by the coadministration of volatile anesthetics. Previous data suggest that morphine produces a more potent cardioprotective effect than fentanyl. The present study investigated the effect of the choice of intraoperative opioid (morphine or fentanyl) on recovery of myocardial function after coronary artery bypass graft (CABG) surgery. ⋯ In patients undergoing CPB, global ventricular function is enhanced by the administration of morphine prior to the ischemic insult of cardioplegic arrest.
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J. Cardiothorac. Vasc. Anesth. · Aug 2006
Randomized Controlled Trial Comparative StudySevoflurane-remifentanil versus propofol-remifentanil anesthesia at a similar bispectral level for off-pump coronary artery surgery: no evidence of reduced myocardial ischemia.
Sevoflurane could decrease myocardial ischemic injury in patients undergoing off-pump coronary artery bypass surgery. This study was designed to compare postoperative troponin I (cTnI) concentrations after sevoflurane-remifentanil versus propofol-remifentanil anesthesia. ⋯ This study does not support cardioprotective effects of sevoflurane. The particularly short total cumulative duration of ischemia and the relatively low administered end-tidal sevoflurane concentrations may explain this result.
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J. Cardiothorac. Vasc. Anesth. · Aug 2006
Comparative StudyTransfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests.
The Thromboelastogram (TEG; Haemoscope Corporation, Niles, IL) and the ROTEM thromboelastometry analyzer (Pentapharm GmbH, Munich, Germany) are coagulation monitors that measure the viscoelastic changes accompanying whole-blood coagulation generation and lysis. It is not clear whether TEG and ROTEM transfusion algorithms suggest similar blood component intervention. This study aims to report the extent to which administration of platelets, fresh frozen plasma, and cryoprecipitate would be indicated using protocol-dictated interventions by the Rotem, TEG, and conventional coagulation screens during orthotopic liver transplantation (OLT). ⋯ Transfusion practice is likely to differ according to the method of coagulation monitoring used. A prospective case-matched study using the viscoelastic tests used in this study would be beneficial in determining the optimal therapy. Rotem fib-TEM monitoring may improve hemostasis management.
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J. Cardiothorac. Vasc. Anesth. · Aug 2006
The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery.
The objective of this study was to determine the relationship of the kaolin-activated Thrombelastograph (TEG) with postoperative bleeding and laboratory tests of coagulation in the setting of cardiac surgery with the routine use of -aminocaproic acid. ⋯ In conclusion, the kaolin-activated TEG is associated with early coagulopathic bleeding. It may reflect the severity of a global coagulopathy affecting both platelets and coagulation factors and be a guide to incremental prohemostatic therapy in this setting.