Seminars in cardiothoracic and vascular anesthesia
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This article summarizes techniques used in reoperative cardiac surgery, outlines a risk-stratified approach to operative planning, and reviews the literature on outcomes after reoperative valvular and coronary surgery.
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There is increasing evidence that the microcirculation and its regulation are severely compromised during many pathological conditions, such as hemorrhage, sepsis, or trauma. The effects of anesthetic agents on macrohemodynamics were investigated intensively in the last several decades. ⋯ Alterations in microvascular reactivity, nitric oxide pathways, and cytokine release are presumably the main mechanisms of anesthetic-induced tissue perfusion changes. This review summarizes current methods of microcirculatory status assessment and current knowledge regarding the microcirculatory effects of intravenous and potent volatile anesthetics and anesthesia-related techniques under both normal and pathophysiological conditions.
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Semin Cardiothorac Vasc Anesth · Dec 2009
The need for specialized preanesthesia clinics for day admission cardiac and major vascular surgery patients.
The majority of patients undergoing surgical procedures today are not admitted to the hospital prior to the morning of surgery. In a medical world that strives not only for patient safety, but also for cost containment, Day Admission Surgery (DAS) plays an important role in our healthcare systems. This is true even for patients undergoing cardiac and major vascular (CMV) procedures. ⋯ Following initiation of our clinic, we performed a patient satisfaction survey. We report these findings along with the demographic data concerning the patients and types of surgeries evaluated in our initial experience. Finally, we discuss the preoperative evaluation including various areas of assessment provided by our PAC.
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Semin Cardiothorac Vasc Anesth · Sep 2009
ReviewAnticoagulation and coagulation management for ECMO.
Advances in extracorporeal membrane oxygenation (ECMO) management have helped to reduce complications compared with its inception but they remain high. The principal causes of mortality and morbidity are bleeding and thrombosis. The nonbiologic surface of an extracorporeal circuit provokes a massive inflammatory response leading to consumption and activation of procoagulant and anticoagulant components. ⋯ Increased use of thrombelastogram will complement other methods currently being used to improved care. Methods to recognize the level of thrombin formation at the bedside could help reduce neurologic complications. ECMO requires a multidisciplinary team approach to achieve the best outcomes.