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Source: Journal of Cardiothoracic and Vascular Anesthesia

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Total 207 results found since Jan 2013.

High Thoracic Epidural Analgesia and Cardiac Performance
We read with interest the recent paper of CJ Jakobsen et al regarding high thoracic epidural analgesia (HTEA) in cardiac surgery. They studied 60 low-risk patients between 65 and 80 years of age scheduled for elective coronary artery bypass graft surgery with or without HTEA. They thought HTEA improved perioperative cardiac performance both before and after cardiopulmonary bypass, shown by a higher stroke volume index and cardiac index without increases in heart rate or mean arterial pressure. But we do not think so.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 14, 2013 Category: Anesthesiology Authors: Yong Xin Liang, He Dong, Yun Bo Sun Tags: Letters to the Editor Source Type: research

Pooled Estimates of Immediate and Late Outcome of Mitral Valve Surgery in Octogenarians: A Meta-analysis and Meta-regression
Objective: The authors evaluated the outcome of patients≥80 years undergoing mitral valve (MV) surgery.Design: Systematic review of the literature and meta-analysis.Setting: None.Participants: None.Interventions: None.Main Results: Twenty-four studies reporting on 5,572 patients ≥80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% CI 2.6-5.2), and dialysis was 2.7% (95% CI 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other t...
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 1, 2013 Category: Anesthesiology Authors: Fausto Biancari, Paola Schifano, Michele Pighi, Francesco Vasques, Tatu Juvonen, Giulia Vinco Tags: Original Articles Source Type: research

Pro: Cerebral Oximetry Should be a Routine Monitor During Cardiac Surgery
BRAIN INJURY is a common complication during cardiac surgery and is defined by both postoperative neurocognitive decline (PONCD) and frank stroke, with rates as high as 50% and 3%, respectively. Stroke after cardiac surgery is associated with a 10-fold increase in mortality, and the majority of patients who suffer a stroke require extensive rehabilitation after surgery. Postoperative stroke carries significant costs as well. In the landmark investigation by Roach et al, it was estimated, using 1996 dollars, that perioperative stroke after cardiac surgery leads to an increase in total costs of $2-$4 billion annually throughout the world.
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 1, 2013 Category: Anesthesiology Authors: William J. Vernick, Jacob T. Gutsche Tags: Pro and Con Source Type: research

General Versus Regional Anesthesia for Carotid Endarterectomy
THE FIRST CAROTID ENDARTERECTOMY (CEA) was performed at St Mary Hospital, London, England, in 1954. This is a surgical procedure performed to reduce the incidences of embolic and thrombotic stroke. The incidence of perioperative stroke during CEA is approximately 2.3%. The incidence of perioperative myocardial infarction (MI), which is defined by Q-wave criteria on an electrocardiogram, in patients undergoing CEA is
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 2, 2013 Category: Anesthesiology Authors: Dragana Unic-Stojanovic, Srdjan Babic, Vojislava Neskovic Tags: Review Articles Source Type: research

Changes in End-Tidal Carbon Dioxide and Volumetric Carbon Dioxide as Predictors of Volume Responsiveness in Hemodynamically Unstable Patients
Conclusions: Dynamic changes in PETCO2 and VCO2 may be used as adjunctive indicators of fluid responsiveness in patients without underlying lung disease.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 21, 2012 Category: Anesthesiology Authors: Alisha Young, Paul E. Marik, Steven Sibole, David Grooms, Alex Levitov Tags: Original Articles Source Type: research

Challenges After the First Decade of Transcatheter Aortic Valve Replacement: Focus on Vascular Complications, Stroke, and Paravalvular Leak
Transcatheter aortic valve replacement (TAVR) is entering its second decade. Three major clinical challenges have emerged from the first decade of experience: vascular complications, stroke, and paravalvular leak (PVL). Major vascular complications remain common and independently predict major bleeding, transfusion, renal failure, and mortality. Although women are more prone to vascular complications, overall they have better survival than men. Further predictors of major vascular complications include heavily diseased femoral arteries and operator experience. Strategies to minimize vascular complications include a multimo...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 12, 2012 Category: Anesthesiology Authors: Christopher Reidy, Aris Sophocles, Harish Ramakrishna, Kamrouz Ghadimi, Prakash A. Patel, John G.T. Augoustides Tags: Expert Review Source Type: research

HbA1c: A Prognostic Biomarker in the Surgical and Critically Ill Patient Population
HYPERGLYCEMIA CAN OCCUR as part of the catabolic response to stress. Acute hyperglycemia is associated with a poor outcome and increased mortality under a variety of clinical conditions, most notably myocardial infarction, stroke, and major surgical tissue trauma. Data from hospital admissions indicate that nondiabetic patients with newly diagnosed hyperglycemia have an increased risk of death. However, the evidence supporting a link between diabetes mellitus (DM) and increased mortality in critically ill and surgical patients is not as strong. This may be caused partly by the underdiagnosis of DM and, thereby, falsely lab...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 3, 2012 Category: Anesthesiology Authors: Justin Letourneau, Helen Bui, Thomas Schricker, Roupen Hatzakorzian Tags: Review Articles Source Type: research

Lack of Evidence for a Remote Effect of Renal Ischemia/Reperfusion Acute Kidney Injury on Outcome from Temporary Focal Cerebral Ischemia in the Rat
Objective: Acute kidney injury (AKI) and ischemic stroke may occur in the same cardiac surgical patient. It is not known if an interaction exists between these organ injuries. Isolated renal ischemia/reperfusion is associated with dysfunction in remote, otherwise normal organs, including the brain. In a rat model of simultaneous bilateral renal artery occlusion (BRAO) and middle cerebral artery occlusion (MCAO), the authors tested the hypothesis that AKI would worsen experimental stroke outcome. Design: Sixty thermoregulated anesthetized rats were randomized to (1) 40-minute BRAO, (2) 80-minute MCAO, or (3) simultaneous...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 30, 2012 Category: Anesthesiology Authors: Robert B. Yates, Huaxin Sheng, Hiroaki Sakai, Daniel T. Kleven, Noelle A. DeSimone, Mark Stafford-Smith, David S. Warner Tags: Original Articles Source Type: research

Anesthetic and Technical Considerations in Redo Coronary Artery Bypass Surgery Using Sternal-Sparing Approaches
REOPERATIVE CORONARY ARTERY bypass grafting (CABG) has decreased significantly in the previous 20 years, likely because of the increased availability of percutaneous coronary intervention (PCI). Reoperative surgery using the classic trans-sternal approach is more technically challenging than primary surgery and is associated with an increased risk of major complications and death. There is an increased risk of injury to patent bypass grafts, the great vessels, and right ventricle during sternal re-entry. Manipulation of the aorta or diseased bypass grafts can precipitate embolization and cause stroke or myocardial infarcti...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 9, 2012 Category: Anesthesiology Authors: Mitsuko Takahashi, Amanda J. Rhee, Farzan Filsoufi, George Silvay, Ramachandra C. Reddy Tags: Case Reports Source Type: research

A Woman With a History of Stroke and a Mass in the Aorta
A 65-YEAR-OLD WOMAN presented with an acute onset of slurred speech and left facial droop. She had a past medical history of Raynaud's disease, well-controlled hypertension, and moderate tricuspid regurgitation, which was being followed by serial transthoracic echocardiographic examinations. A duplex ultrasound of the carotid and vertebral arteries was negative, whereas a magnetic resonance imaging scan of her brain revealed a subacute embolic cerebral infarction. A transesophageal echocardiographic (TEE) examination also was performed during the workup, revealing the presence of moderate-to-severe tricuspid regurgitation ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 26, 2012 Category: Anesthesiology Authors: Robina Matyal, Angela Wang, Bilal Mahmood, Kamal Khabbaz, Feroze Mahmood Tags: Diagnostic Dilemmas Source Type: research