6,876 results match your criteria Perioperative Cardiac Management


Isolated atrial amyloid: a potential contributor to morbidity and mortality following cardiac surgery.

Interact Cardiovasc Thorac Surg 2019 Mar 15. Epub 2019 Mar 15.

Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.

Objectives: Diffuse cardiac amyloidosis is a significant diagnosis with a poor prognosis. Isolated atrial amyloidosis (IAA) is the most common form of cardiac amyloidosis caused by accumulation of alpha-atrial natriuretic peptide. IAA has been associated with dysrhythmia, but otherwise remains a poorly characterized condition. Read More

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http://dx.doi.org/10.1093/icvts/ivz051DOI Listing

Post-surgical chronic pain and quality of life in children operated for congenital heart disease.

Acta Anaesthesiol Scand 2019 Mar 14. Epub 2019 Mar 14.

Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Advances in medical technology have resulted in an increased life expectancy in pediatric patients with congenital heart diseases. Assessment of health-related quality of life is crucial to improving their healthcare status. We aimed to assess post-surgical pain prevalence and its impact on health-related quality of life in pediatric patients who underwent cardiac surgery during childhood. Read More

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http://dx.doi.org/10.1111/aas.13346DOI Listing
March 2019
1 Read

Enhanced Recovery Pathways for Cardiac Surgery.

Curr Pain Headache Rep 2019 Mar 14;23(4):28. Epub 2019 Mar 14.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Purpose Of Review: Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care. Read More

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http://link.springer.com/10.1007/s11916-019-0764-2
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http://dx.doi.org/10.1007/s11916-019-0764-2DOI Listing
March 2019
2 Reads

Association between Normothermia at the End of Surgery and Postoperative Complications following Orthopaedic Surgery.

Clin Infect Dis 2019 Mar 13. Epub 2019 Mar 13.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.

Background: Maintaining perioperative normothermia is recommended by recent guidelines for prevention of surgical site infection (SSI). However, the majority of supporting data originates outside the field of orthopaedic surgery.

Methods: The effect of normothermia was explored using prospectively collected data of consecutive patients who underwent single-site surgery in seven tertiary referral hospitals between November 2013 and July 2016. Read More

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http://dx.doi.org/10.1093/cid/ciz213DOI Listing
March 2019
1 Read

Regional anesthesia for sternotomy and bypass-Beyond the epidural.

Authors:
Naveen Raj

Paediatr Anaesth 2019 Mar 12. Epub 2019 Mar 12.

Jackson Rees, Department of Anesthesia. Alder Hey Children's NHS Foundation Trust, Liverpool, UK.

Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution and duration of pain in these children has not been studied as extensively as in adults. Currently there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response whilst minimising their unwanted side effects. Read More

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http://dx.doi.org/10.1111/pan.13626DOI Listing
March 2019
2 Reads

Perioperative haemodynamic therapy for major gastrointestinal surgery: the effect of a Bayesian approach to interpreting the findings of a randomised controlled trial.

BMJ Open 2019 Mar 7;9(3):e024256. Epub 2019 Mar 7.

Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.

Objective: The traditional approach of null hypothesis testing dominates the design and analysis of randomised controlled trials. This study aimed to demonstrate how a simple Bayesian analysis could have been used to analyse the Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome (OPTIMISE) trial to obtain more clinically interpretable results.

Design, Setting, Participants And Interventions: The OPTIMISE trial was a pragmatic, multicentre, observer-blinded, randomised controlled trial of 734 high-risk patients undergoing major gastrointestinal surgery in 17 acute care hospitals in the UK. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-024256DOI Listing
March 2019
2 Reads

The effect of combining coronary bypass with carotid endarterectomy in patients with unrevascularized severe coronary disease.

J Vasc Surg 2019 Mar 5. Epub 2019 Mar 5.

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address:

Objective: Management of significant carotid stenosis in those with symptomatic coronary disease remains controversial. Staged and combined carotid endarterectomy (CEA) with coronary artery bypass grafting has been described. Yet, an understanding of the additive risks of these approaches is poor. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.12.026DOI Listing
March 2019
1 Read

Comparison of Patient Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Using Pre-Sedation Radial Versus Post-Sedation Femoral Arterial Sites for Blood Pressure Monitoring.

J Cardiothorac Vasc Anesth 2019 Feb 8. Epub 2019 Feb 8.

Department of Anesthesiology, Pain Management and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Henry Ford Hospital, Detroit, MI.

Objective: To compare outcomes among patients with and without preprocedural radial arterial catheters who underwent transfemoral transcatheter aortic valve replacement (TF-TAVR) under deep intravenous (IV) sedation and to assess predictive variables for preprocedural placement.

Design: Single-center, retrospective, cohort analysis.

Setting: Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, which is a tertiary care, university-affiliated hospital. Read More

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http://dx.doi.org/10.1053/j.jvca.2019.01.060DOI Listing
February 2019
2 Reads

Sternal Wound Infections, Risk Factors and Management - How Far Are We? A Literature Review.

Heart Lung Circ 2019 Feb 2. Epub 2019 Feb 2.

Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK. Electronic address:

Sternal wound infection (SWI) is one of the potential complications post cardiac surgery, and despite refined surgical techniques such as smaller incisions, antibiotic therapy, and optimised glycaemic control, the incidence rate is between <1% in elective cases with low risk factors and as high as 25% in patients with extensive risk factors. The presence of SWI will increase the perioperative morbidity and mortality rates and prolong the patient's hospital stay, therefore the prevention and diagnosis with appropriate management of such adverse outcomes at an early stage is important to prevent further progression as it can be fatal when the mediastinal structures are affected. Currently, the diagnosis typically consists of three main stages: clinical, biochemical including microbiology studies and imaging studies. Read More

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http://dx.doi.org/10.1016/j.hlc.2019.01.008DOI Listing
February 2019
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Anaphylactic risk due to systemic mastocytosis: Perioperative management in cardiac surgery.

Rev Esp Anestesiol Reanim 2019 Mar 5. Epub 2019 Mar 5.

Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, España.

Mastocytosis is a disease characterised by an abnormal proliferation of mast cells. The degranulation of mast cells can be triggered by chemical, physical, and psychological factors, and in severe cases may be accompanied by cardiovascular alterations and shock. Tryptase concentrations greater than 20ug/L may be associated with an increased risk of mastocyte degranulation. Read More

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http://dx.doi.org/10.1016/j.redar.2019.01.008DOI Listing
March 2019
2 Reads

Tricuspid valve intervention at the time of mitral valve surgery: a meta-analysis.

Interact Cardiovasc Thorac Surg 2019 Mar 8. Epub 2019 Mar 8.

Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.

Objectives: The surgical management of tricuspid regurgitation (TR) at the time of mitral valve surgery remains controversial. Our objectives were to determine the safety and efficacy of tricuspid valve (TV) repair during mitral valve surgery in a meta-analysis.

Methods: MEDLINE and EMBASE were searched from 1946 to 2017 for all studies comparing TV repair to no intervention at the time of mitral valve surgery on early and late mortality and late TR. Read More

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http://dx.doi.org/10.1093/icvts/ivz036DOI Listing
March 2019
2 Reads

Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry.

Intensive Care Med 2019 Mar 8. Epub 2019 Mar 8.

Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY, USA.

Purpose: Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers.

Methods: Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. Read More

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http://dx.doi.org/10.1007/s00134-019-05580-7DOI Listing
March 2019
1 Read

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management.

J Clin Monit Comput 2019 Apr 7;33(2):211-222. Epub 2019 Mar 7.

Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field. Read More

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http://dx.doi.org/10.1007/s10877-019-00297-wDOI Listing
April 2019
3 Reads

Impact of renin-angiotensin system inhibitors continuation versus discontinuation on outcome after major surgery: protocol of a multicenter randomized, controlled trial (STOP-or-NOT trial).

Trials 2019 Mar 5;20(1):160. Epub 2019 Mar 5.

AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.

Background: Chronic treatment of hypertension or heart failure very often includes an angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) as renin-angiotensin system inhibitors (RASi) treatments. To stop or not to stop these medications before major surgery remains an unresolved issue. The lack of evidence leads to conflicting guidelines with respect to RASi management before major surgery. Read More

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http://dx.doi.org/10.1186/s13063-019-3247-1DOI Listing
March 2019
4 Reads

Role of imaging in diagnosis and management of left ventricular assist device complications.

Int J Cardiovasc Imaging 2019 Mar 4. Epub 2019 Mar 4.

Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.

Heart failure is a clinical condition that is associated with significant morbidity and mortality. With the advent of left ventricular assist device (LVAD), an increasing number of patients have received an artificial heart both as a bridge-to-therapy and as a destination therapy. Clinical trials have shown clear survival benefits of LVAD implantation. Read More

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http://dx.doi.org/10.1007/s10554-019-01562-4DOI Listing
March 2019
2 Reads

A Restrictive Hemoglobin Transfusion Threshold of Less Than 7 g/dL Decreases Blood Utilization Without Compromising Outcomes in Patients With Hip Fractures.

J Am Acad Orthop Surg 2019 Feb 28. Epub 2019 Feb 28.

From the Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD (Dr. Amin, Dr. Best, Dr. Shafiq, Dr. Hasenboehler, Dr. Sterling, and Dr. Khanuja), and the Department of Anesthesiology and Critical Care Medicine, The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, MD (Mr. DeMario and Dr. Frank).

Introduction: In patients with hip fracture, a transfusion threshold of hemoglobin (Hb) <8 g/dL is associated with similar or better outcomes than more liberal thresholds. Whether a more restrictive threshold of <7 g/dL Hb produces equivalent outcomes in such patients is unknown. The aim of the study was to examine whether a restrictive threshold of <7 g/dL Hb is safe in this population. Read More

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http://dx.doi.org/10.5435/JAAOS-D-18-00374DOI Listing
February 2019
3 Reads

Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study.

BMJ Open 2019 Mar 1;9(2):e022995. Epub 2019 Mar 1.

Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada.

Introduction: Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-022995DOI Listing
March 2019
1 Read
2.063 Impact Factor

Preoperative cardiopulmonary evaluation in specific neonatal surgery.

Semin Pediatr Surg 2019 Feb 18;28(1):3-10. Epub 2019 Jan 18.

Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, 1001 Decarie Blvd, Room B04.2318, Montreal, QC, Canada. Electronic address:

Preoperative assessment of surgical neonates often relates to issues of prematurity, low birth weight, or associated malformations. This review explores the preoperative cardiopulmonary evaluation in specific newborn surgical populations, the role of echocardiography in congenital diaphragmatic hernia perioperative management, the impact of bronchopulmonary dysplasia in the ex-preterm surgical neonate and a brief discussion on the risk of general anesthesia and specific anesthetic considerations for any surgical neonate. Newborns with congenital anomalies requiring early general surgical intervention should have an assessment for congenital heart disease. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10558586193000
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http://dx.doi.org/10.1053/j.sempedsurg.2019.01.002DOI Listing
February 2019
3 Reads

Noncardiac surgery in the congenital heart patient.

Semin Pediatr Surg 2019 Feb 18;28(1):11-17. Epub 2019 Jan 18.

Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.

More children with congenital heart disease are surviving and require noncardiac surgery. A high-yield summary of congenital heart anatomy and pathophysiology is presented to contextualize these patients for surgeons. Preoperative planning including risk stratification, anesthetic management and timing of elective surgery are discussed. Read More

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http://dx.doi.org/10.1053/j.sempedsurg.2019.01.003DOI Listing
February 2019
7 Reads

Management of Saphenous Vein Graft Disease in Patients with Prior Coronary Artery Bypass Surgery.

Curr Treat Options Cardiovasc Med 2019 Feb 28;21(2):12. Epub 2019 Feb 28.

Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.

Purpose Of Review: In this review, we summarize the pathogenesis of saphenous venous graft (SVG) failure in patients following coronary artery bypass graft (CABG) surgery. We also provide an update on various aspects of prevention and management of SVG failure.

Recent Findings: Application of perioperative measures and medical therapies to promote SVG patency is crucial to optimize clinical outcomes in patients following CABG. Read More

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http://dx.doi.org/10.1007/s11936-019-0714-7DOI Listing
February 2019
1 Read

Potentially Modifiable Predictors for Renal Replacement Therapy in Patients with Cardiac Surgery Associated-Acute Kidney Injury: a Propensity Score-Matched Case-Control Study.

Braz J Cardiovasc Surg 2019 Jan-Feb;34(1):33-40

Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

Objective: To discover potentially modifiable perioperative predictors for renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI).

Methods: A cohort of 1773 consecutive cardiac surgery patients with postoperative acute kidney injury (AKI) from January 2013 to December 2015 were included retrospectively. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Read More

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http://dx.doi.org/10.21470/1678-9741-2018-0206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385827PMC
March 2019
1 Read

Association Between Infection and Thrombosis After Coronary Artery Bypass Grafting: A Cohort Study.

J Cardiothorac Vasc Anesth 2018 Sep 8. Epub 2018 Sep 8.

Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Objective: Surgery-related infection remains a major complication for patients undergoing cardiac surgery, and its association with thrombosis is unclear. This study aimed to examine the association of postoperative infection with thrombosis and major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing coronary artery bypass grafting (CABG).

Design: Retrospective cohort study. Read More

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http://dx.doi.org/10.1053/j.jvca.2018.09.008DOI Listing
September 2018
2 Reads

Sternal wound complications in patients undergoing orthotopic heart transplantation.

J Card Surg 2019 Feb 25. Epub 2019 Feb 25.

The University of Pennsylvania Health System, Philadelphia, Pennsylvania.

Purpose: The incidence and management of sternal wound complications in patients undergoing orthotopic heart transplantation (OHT) is not well studied. We report outcomes in heart transplant patients who developed sternal infections requiring reoperations.

Methods: From 2004 to 2013, 437 patients underwent OHT at a single institution. Read More

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http://dx.doi.org/10.1111/jocs.14003DOI Listing
February 2019
1 Read

Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest: an analysis of the TTH48 trial.

Crit Care 2019 Feb 22;23(1):61. Epub 2019 Feb 22.

Department of Intensive Care, Cliniques Universitaires de Bruxelles Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.

Background: The aim of this study was to explore the performance and outcomes for intravascular (IC) versus surface cooling devices (SFC) for targeted temperature management (TTM) after out-of-hospital cardiac arrest.

Methods: A retrospective analysis of data from the Time-differentiated Therapeutic Hypothermia (TTH48) trial (NCT01689077), which compared whether TTM at 33 °C for 48 h results in better neurologic outcomes compared with standard 24-h duration. Devices were assessed for the speed of cooling and rewarming rates. Read More

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http://dx.doi.org/10.1186/s13054-019-2335-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385423PMC
February 2019
1 Read

Why does a point of care guided transfusion algorithm not improve blood loss and transfusion practice in patients undergoing high-risk cardiac surgery? A prospective randomized controlled pilot study.

BMC Anesthesiol 2019 Feb 18;19(1):24. Epub 2019 Feb 18.

Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.

Background: Adult cardiac surgery is often complicated by elevated blood losses that account for elevated transfusion requirements. Perioperative bleeding and transfusion of blood products are major risk factors for morbidity and mortality. Timely diagnostic and goal-directed therapies aim at the reduction of bleeding and need for allogeneic transfusions. Read More

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http://dx.doi.org/10.1186/s12871-019-0689-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379957PMC
February 2019
1 Read

[Off-pump Coronary Artery Bypass Grafting in Jehovah's Witness Patient on Hemodialysis;Report of a Case].

Kyobu Geka 2019 Feb;72(2):136-139

Department of Cardiovascular Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan.

Cardiac surgery in Jehovah's witnesses is challenging due to their refusal of blood transfusion. Furthermore, dialysis patients often suffer from anemia and are also prone to bleeding. We performed offpump coronary artery bypass grafting (CABG) [OPCAB] on a Jehovah's witness male patient on hemodialysis. Read More

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February 2019
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The Use of Subcostal Echocardiographic Views to Guide the Insertion of a Right Ventricular Temporary Transvenous Pacemaker-Description of the Technique.

J Cardiothorac Vasc Anesth 2019 Jan 16. Epub 2019 Jan 16.

University of Ottawa Department of Anesthesiology, Ottawa, Ontario, Canada; Department of Anesthesiology and Perioperative Medicine, Western University, London, Ontario, Canada. Electronic address:

The need for temporary cardiac pacing may occur in emergency and elective situations and may require transvenous right ventricular lead placement. The treatment of bradyarrhythmias presents the most common perioperative emergency indication. Intraoperatively, temporary rapid right ventricular pacing is accepted as a safe, titratable, and highly reliable method to achieve deliberate hypotension, and it has become a routine practice in the anesthetic management of cardiovascular interventions. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10530770193006
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http://dx.doi.org/10.1053/j.jvca.2019.01.033DOI Listing
January 2019
6 Reads

[Focused Transthoracic Echocardiography in the Perioperative Setting].

Anasthesiol Intensivmed Notfallmed Schmerzther 2019 Feb 15;54(2):90-106. Epub 2019 Feb 15.

With focused transthoracic echocardiography (TTE) we rapidly and non-invasively receive up-to-date information on a patient's hemodynamic status. These can subsequently influence our therapy and thus our risk management. Postoperatively, TTE has proved its worth as an examination method in the recovery room and in the intensive care unit to promptly diagnose life-threatening causes of circulatory depression. Read More

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http://dx.doi.org/10.1055/a-0586-6146DOI Listing
February 2019
4 Reads

The Year in Electrophysiology: Selected Highlights From 2018.

J Cardiothorac Vasc Anesth 2019 Jan 22. Epub 2019 Jan 22.

Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH.

This article is the first in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, the associate editor-in-chief, Dr. Read More

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http://dx.doi.org/10.1053/j.jvca.2019.01.049DOI Listing
January 2019
1 Read

Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms.

J Am Coll Cardiol 2019 Feb;73(6):643-651

Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California. Electronic address:

Background: For the management of descending thoracic aortic aneurysms, recent evidence has suggested that outcomes of open surgical repair may surpass thoracic endovascular aortic repair (TEVAR) in as early as 2 years.

Objectives: The purpose of this study was to evaluate the comparative effectiveness of TEVAR and open surgical repair in the treatment of intact descending thoracic aortic aneurysms.

Methods: Using the Medicare database, a retrospective study using regression discontinuity design and propensity score matching was performed on patients with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014. Read More

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http://dx.doi.org/10.1016/j.jacc.2018.10.086DOI Listing
February 2019
1 Read

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension.

Authors:
Sherif Kandil

Curr Opin Organ Transplant 2019 Apr;24(2):121-130

Department of Anesthesiology, Keck Medical School of USC, Los Angeles, California, USA.

Purpose Of Review: Liver transplantation in patients with portopulmonary hypertension (POPH) is associated with increased perioperative risk. Important recent advances in the management of liver transplantation recipients with POPH are discussed.

Recent Findings: The presence of POPH at the time of liver transplantation should not be a contraindication for liver transplantation, as POPH is common and may be related to volume overload and/or high cardiac output (CO). Read More

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http://dx.doi.org/10.1097/MOT.0000000000000613DOI Listing
April 2019
1 Read

Correlation of blood biomarkers and biomarker panels with traumatic findings on computed tomography after traumatic brain injury.

J Neurotrauma 2019 Feb 14. Epub 2019 Feb 14.

Göteborg University, Neuroscience and Physiology , Sahlgrenska University Hospital , Mölndal, Sweden , SE-43180 ;

The aim of the study was to examine the ability of eight protein biomarkers and their combinations in discriminating CT-negative and CT-positive patients with TBI, utilizing highly sensitive immunoassays in a well-characterized cohort. Blood samples were obtained from 160 patients with acute TBI within 24h from admission. Levels of β-amyloid isoforms 1-40 (Aβ40) and 1-42 (Aβ42), glial fibrillary acidic protein (GFAP), heart fatty-acid binding protein (H-FABP), interleukin 10 (IL-10), neurofilament light (NF-L), S100 calcium-binding protein B (S100B) and tau were measured. Read More

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http://dx.doi.org/10.1089/neu.2018.6254DOI Listing
February 2019
2 Reads

Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience.

J Thorac Cardiovasc Surg 2018 Dec 21. Epub 2018 Dec 21.

Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.

Objective: The study objective was to evaluate the perioperative and long-term outcomes of aortic root repair and aortic root replacement and provide evidence for root management in acute type A aortic dissection.

Methods: From 1996 to 2017, 491 patients underwent aortic root repair (n = 307) or aortic root replacement (n = 184) (62% bioprosthesis) for acute type A aortic dissection. Indications for aortic root replacement were intimal tear at the aortic root, root measuring 4. Read More

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http://dx.doi.org/10.1016/j.jtcvs.2018.09.129DOI Listing
December 2018
2 Reads

Design and implementation of a large and complex trial in emergency medical services.

Trials 2019 Feb 8;20(1):108. Epub 2019 Feb 8.

University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

Background: The research study titled "Cluster randomised trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out-of-hospital cardiac arrest (AIRWAYS-2)" is a large-scale study being run in the English emergency medical (ambulance) services (EMS). It compares two airway management strategies (tracheal intubation and the i-gel) in out-of-hospital cardiac arrest. We describe the methods used to minimise bias and the challenges associated with the set-up, enrolment, and follow-up that were addressed. Read More

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http://dx.doi.org/10.1186/s13063-019-3203-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368693PMC
February 2019
2 Reads

New 5-Factor Modified Frailty Index Predicts Morbidity and Mortality in Geriatric Hip Fractures.

J Orthop Trauma 2019 Jan 30. Epub 2019 Jan 30.

Medical University of South Carolina Department of Orthopaedics 96 Jonathan Lucas Dr CSB 708 Charleston, SC 29425.

Introduction: While the 11-factor modified frailty index (mFI-11) has been shown to predict adverse outcomes in elderly patients undergoing surgery for hip fractures, the newer 5-factor index has not been evaluated in this population. The goal of this study is to evaluate the mFI-5 as a predictor of morbidity and mortality in elderly patients undergoing surgical management for hip fractures.

Methods: The NSQIP database was queried for patients aged 60 years and older who underwent surgical management for hip fractures between 2005-2016. Read More

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http://dx.doi.org/10.1097/BOT.0000000000001455DOI Listing
January 2019
1 Read

Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III.

ERJ Open Res 2019 Feb 1;5(1). Epub 2019 Feb 1.

Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK.

Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. Read More

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http://dx.doi.org/10.1183/23120541.00073-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355980PMC
February 2019
5 Reads

Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines.

Pain Physician 2019 Jan;22(1S):S1-S74

Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Background: Interventional pain management involves diagnosis and treatment of chronic pain. This specialty utilizes minimally invasive procedures to target therapeutics to the central nervous system and the spinal column. A subset of patients encountered in interventional pain are medicated using anticoagulant or antithrombotic drugs to mitigate thrombosis risk. Read More

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January 2019
7 Reads
3.542 Impact Factor

Innovative 2-Step Management Strategy Utilizing EXIT Procedure for a Fetus With Hypoplastic Left Heart Syndrome and Intact Atrial Septum.

Mayo Clin Proc 2019 Feb;94(2):356-361

Division of Obstetrics and Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN. Electronic address:

Hypoplastic left heart syndrome (HLHS) with intact atrial septum (HLHS-IAS) carries a high risk of mortality and affects about 6% of all patients with HLHS. Fetal interventions, postnatal transcatheter interventions, and postnatal surgical resection have all been used, but the mortality risk continues to be high in this subgroup of patients. We describe a novel, sequential approach to manage HLHS-IAS and progressive fetal hydrops. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00256196183058
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http://dx.doi.org/10.1016/j.mayocp.2018.08.004DOI Listing
February 2019
7 Reads

Patient management algorithm combining processed electroencephalographic monitoring with cerebral and somatic near-infrared spectroscopy: a case series.

Can J Anaesth 2019 Feb 1. Epub 2019 Feb 1.

Department of Anesthesia and Division of Critical Care, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.

Purpose: Cerebral oximetry is a monitoring tool used in the perioperative care of cardiac surgery patients to ensure adequate cerebral perfusion and oxygenation. When combined with somatic oximetry, the differential diagnosis of cerebral desaturation can be better identified and managed more specifically, as somatic oximetry serves as a global or localized perfusion monitor (depending on its regional position). The use of processed electroencephalography (pEEG) in cardiac surgery could further guide the management of desaturation episodes, as reductions in pEEG activity without a change in the anesthetic agent level indicate potential cerebral ischemia. Read More

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http://dx.doi.org/10.1007/s12630-019-01305-yDOI Listing
February 2019
9 Reads

Bone Cement Implantation Syndrome: Key Concepts for Perioperative Nurses.

AORN J 2019 Feb;109(2):202-216

Bone cement implantation syndrome (BCIS) is a potentially fatal complication of orthopedic surgeries that use cement. The symptoms of BCIS occur primarily during femoral fracture repairs, but this complication has been reported in a wide variety of cemented procedures. Clinical presentation of this syndrome begins as a cascade with hypoxia and hypotension; if it is not reversed, it ends with right-sided heart failure and cardiac arrest. Read More

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http://dx.doi.org/10.1002/aorn.12584DOI Listing
February 2019
2 Reads

Impact of Approach and Hospital Volume on Cardiovascular Complications After Pulmonary Lobectomy.

J Surg Res 2019 Mar 30;235:202-209. Epub 2018 Oct 30.

Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Electronic address:

Background: Cardiovascular complications contribute significantly to the morbidity and resource utilization after pulmonary resections. Maturation of less-invasive technologies, such as video and robot-assisted thoracoscopic surgery, aims at improving postoperative outcomes by reducing the trauma of surgery. The present work aimed to evaluate changes in cardiovascular complications after open and minimally invasive lobectomies in the United States. Read More

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http://dx.doi.org/10.1016/j.jss.2018.09.062DOI Listing
March 2019
1 Read

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery.

Br J Anaesth 2019 Feb 11;122(2):255-262. Epub 2018 Dec 11.

Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. Electronic address:

Background: The STOP-BANG questionnaire screens for obstructive sleep apnoea (OSA) in surgical patients. In prior research, the association of STOP-BANG scores with comorbidities and outcomes was inconsistent. The objective of this study was to evaluate the validity of the STOP-BANG score. Read More

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http://dx.doi.org/10.1016/j.bja.2018.10.059DOI Listing
February 2019
2 Reads

Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery.

Br J Anaesth 2019 Feb 15;122(2):170-179. Epub 2018 Dec 15.

Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.

Background: The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE).

Methods: Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. Read More

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http://dx.doi.org/10.1016/j.bja.2018.09.029DOI Listing
February 2019
1 Read

A Narrative Review for Anesthesiologists of the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.

J Cardiothorac Vasc Anesth 2019 Jan 4. Epub 2019 Jan 4.

Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR.

This is a review of the 2017 AHA/ACC/HRS Guidelines with guidance for intraoperative physicians. Ventricular arrhythmias occurring during the perioperative period have the potential for significant morbidity and mortality. Hence, an in-depth knowledge of VA mechanisms, prevention, and management is crucial for all clinicians caring for these at-risk patients in the perioperative period. Read More

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http://dx.doi.org/10.1053/j.jvca.2019.01.004DOI Listing
January 2019
3 Reads

A Systematic Review of the Impact of Surgical Special Care Units on Patient Outcomes and Health Care Resource Utilization.

Anesth Analg 2019 Mar;128(3):533-542

From the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.

Perioperative intermediate care units (termed surgical special care units) have been widely implemented across health systems because they are believed to improve surveillance and management of high-risk surgical patients. Our objective was to conduct a systematic review to investigate the effects of a 3-level model of perioperative care delivery (ie, ward, surgical special care unit, or intensive care unit) compared to a 2-level model of care (ie, ward, intensive care unit) on postoperative outcomes. Our protocol was registered with PROSPERO, the international prospective register of systematic reviews (CRD42015025155). Read More

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http://dx.doi.org/10.1213/ANE.0000000000003942DOI Listing
March 2019
2 Reads

Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery-A Patient-Matched, Controlled Before-and-After Study.

J Cardiothorac Vasc Anesth 2018 Nov 19. Epub 2018 Nov 19.

Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Cedex, France; Montpellier NeuroSciences Institute, Montpellier University, Montpellier, France. Electronic address:

Objectives: Open cardiac surgery may cause severe postoperative pain. The authors hypothesized that patients receiving a bundle of care using continuous erector spinae plane blocks (ESPB) would have decreased perioperative opioid consumption and improved early outcome parameters compared with standard perioperative management.

Design: A consecutive, patient-matched, controlled before-and-after study. Read More

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http://dx.doi.org/10.1053/j.jvca.2018.11.021DOI Listing
November 2018
4 Reads

The effect of obstructive sleep apnea on readmissions and atrial fibrillation after cardiac surgery.

J Clin Anesth 2019 Jan 18;56:17-23. Epub 2019 Jan 18.

Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY 10065, USA. Electronic address:

Study Objective: To understand the effect of obstructive sleep apnea on readmission rates and post-operative atrial fibrillation in the cardiac surgical population.

Design: Retrospective cohort study.

Setting: Administrative database consisting of 2007-2014 data from California, Florida, New York, Kentucky, and Maryland from the State Inpatient Databases, Healthcare Cost and Utilization Project. Read More

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http://dx.doi.org/10.1016/j.jclinane.2019.01.011DOI Listing
January 2019
4 Reads

Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children.

Ann Intensive Care 2019 Jan 18;9(1). Epub 2019 Jan 18.

Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Huispost CA 80, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.

Background: High-frequency oscillatory ventilation (HFOV) is a common but unproven management strategy in paediatric critical care. Oscillator settings have been traditionally guided by patient age and/or weight rather than by lung mechanics, thereby potentially negating any beneficial effects. We have adopted an open-lung HFOV strategy based on a corner frequency approach using an initial incremental-decremental mean airway pressure titration manoeuvre, a high frequency (8-15 Hz), and high power to initially target a proximal pressure amplitude (∆P) of 70-90 cm HO, irrespective of age or weight. Read More

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https://annalsofintensivecare.springeropen.com/articles/10.1
Publisher Site
http://dx.doi.org/10.1186/s13613-019-0492-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338613PMC
January 2019
8 Reads

Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery.

Braz J Cardiovasc Surg 2018 Nov-Dec;33(6):618-625

Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil.

Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. Read More

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http://dx.doi.org/10.21470/1678-9741-2018-0147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326452PMC
March 2019
1 Read