Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
ReviewSpinal Cord Injury Following Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review.
Spinal cord infarction (SCI) or ischemia is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA ECMO). The natural course and outcomes are poorly studied. ⋯ Spinal infarction/ischemia on VA ECMO typically presents with paraplegia of lower extremities with low potential for even partial recovery. Because no treatment is currently available, the efforts should be focused on prevention. Several strategies have been proposed, but they need further testing under controlled settings.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Multicenter StudyThe Use of Methadone and Ketamine for Intraoperative Pain Management in Cardiac Surgery: A Retrospective Cohort Study.
To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients. ⋯ Adding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyPredicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study.
This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery. ⋯ Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post-cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyIntroduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration.
In the dynamic perioperative setting, changing fluid states complicate determination of ventricular function. This study evaluated the feasibility of clinical ventricular pressure-volume loop (PVL) construction using routine monitoring (echocardiography and invasive pressure monitoring). An application was developed and tested with biventricular simulated data and right ventricular (RV) clinical data. ⋯ This study introduces a vendor-independent application to generate PVLs from routinely available clinical data. The results highlight the potential application of the pressure-volume framework in cardiovascular research and patient care. A lack of external validation must be taken into account. Further research is warranted to validate the application. The app can be accessed at https://michael-vandenheuvel.shinyapps.io/eMv_Looper/.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Perioperative Stroke Following Implantation of Left Ventricular Assist Device: A Retrospective Cohort Study.
Stroke is common following left ventricular assist device (LVAD) implantation, although comprehensive data on perioperative strokes in this uncommon population is lacking. The current study aim was to characterize the presentation, features, and outcomes of perioperative cerebrovascular ischemia post-LVAD implantation at the authors' institution. ⋯ LVAD patients carry a high risk of perioperative stroke. They experience delayed recognition and diagnosis, limited intervention, and poor outcomes. Frequent neurological assessment and a low threshold for neuroimaging are prudent.