Journal of cardiothoracic and vascular anesthesia
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Recent advances in surgical techniques and perfusion technology allow cardiac operations to be performed routinely with low mortality rates. However, patients undergoing cardiac operations with cardiopulmonary bypass (CPB) are still associated with bleeding disorders, thrombotic complications, massive fluid shifts, and the activation of blood components that are collectively known as the whole body inflammatory response. In this review, the effect of cardiopulmonary bypass on various humoral and cellular components of blood is examined. ⋯ These include surface modification of extracorporeal circuit, control of flow dynamics in the circuit, pharmacological intervention, and the use of extracorporeal devices to remove inflammatory mediators. Recent findings on the effects of heparin-coated circuits on inflammatory response and clinical outcome are reviewed. It appears that the causes of inflammatory response to cardiopulmonary bypass are multifactorial and that an integrated strategy is needed to control and eliminate the negative effects of CPB.
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The "chain of survival" is important in the resuscitation of a patient who has had a cardiac arrest. The provision of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) is essential in this "chain of survival." Both BLS and ACLS have undergone several revisions since their initial inception. This article reviews (1) the current established and investigational issues of cardiopulmonary resuscitation, (2) the incidence and outcomes of anesthesia-related cardiac arrest, (3) the use of cardiopulmonary bypass in resuscitation, and (4) cerebral protection during and after resuscitation.
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J. Cardiothorac. Vasc. Anesth. · May 1997
ReviewThe role of the pulmonary circulation in the regulation of coagulation and fibrinolysis in relation to major surgery.
Cardiac surgery and hip replacement surgery (HRS) are associated with serious cardiorespiratory and vascular complications. Activation of blood coagulation and fibrinolysis in the lung vasculature seem to play a key role in the pathophysiology of this process. This article reviews the results of several experimental and clinical studies within this field. ⋯ However, this clearing process, to obtain adequate blood flow and gas exchange, was shut down several hours after surgery by an antifibrinolytic activity (PAI-1). Thus, these studies indicated that bone surgery induces a substantial intraoperative hemostatic activation in the lung capillaries, which is the primary target organ for venous blood-borne bone-marrow debris. Soft-tissue surgery and vascular surgery seem to induce less systemic activation of coagulation and fibrinolysis.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Pro: intraoperative transesophageal echocardiography is a cost-effective strategy for cardiac surgical procedures.
TEE is an expensive but useful intraoperative diagnostic strategy for cardiac surgical procedures. It can alter surgical management with tremendous potential benefits to the patient. It also has the potential to avoid unnecessary surgery and reduce the risk of complications such as reoperation, thromboembolism, and stroke. ⋯ Based on the information presented in this report, it can be concluded that TEE is a cost-effective strategy for valvular and congenital heart repairs. Current data are very convincing that TEE has the potential to be cost-effective in reducing the risk of stroke in selected populations of cardiac surgical patients. As experience with the use of TEE in its various applications increases and the technology itself continues to improve, it will undoubtedly become a more valuable and cost-effective strategy for cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of lumbar and thoracic epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair.
To determine whether there is an advantage of thoracic over lumbar epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair. ⋯ There is no advantage of thoracic over lumbar epidural analgesia using morphine in patients undergoing abdominal aortic aneurysm repair.