Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Mediastinal Radiographic Contrast After Nasogastric Tube Placement in a Premature Neonate With a \"Double-Bubble\" Sign.","authors":"Barbara J Meinecke, William R Clarke, Paul S Pagel","doi":"10.1053/j.jvca.2025.02.054","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.054","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardizing Protamine Dosage in Cardiac Surgery","authors":"Ravi Taneja MD, FFARCSI, FRCA, FRCPC","doi":"10.1053/j.jvca.2025.02.039","DOIUrl":"10.1053/j.jvca.2025.02.039","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Page 1610"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Oxygenation Targets and Mortality in Critical Care Patients Following Cardiac Surgery: A Retrospective Cohort Study","authors":"Zhencong Jiang MD, MSc ,&nbsp;Ying Shan PhD ,&nbsp;Yanling Wei MSc ,&nbsp;Tao Luo MD, PhD","doi":"10.1053/j.jvca.2025.02.053","DOIUrl":"10.1053/j.jvca.2025.02.053","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the relationship between arterial oxygen partial pressure (PaO₂) and all-cause mortality of post–cardiac surgery patients.</div></div><div><h3>Design</h3><div>A retrospective cohort study based on the Medical Information Mart in Intensive Care-III (MIMIC-III) database.</div></div><div><h3>Setting</h3><div>The MIMIC-III database is a dataset comprising the clinical data of patients admitted to intensive care units (ICUs) at the Beth Israel Deaconess Medical Center.</div></div><div><h3>Participants</h3><div>Patients who underwent cardiac surgery under extracorporeal circulation.</div></div><div><h3>Interventions</h3><div>The patients were categorized into 4 groups based on PaO₂ level within 24 hours of admission to the ICU after surgery. The primary outcome was in-hospital all-cause mortality. Both linear and nonlinear relationships between PaO₂ and outcome were examined in the study.</div></div><div><h3>Measurements and Main Results</h3><div>During a 1-year follow-up, 296 patients (5.5%) experienced all-cause mortality, including 73 (1.4%) during hospitalization, 83 (1.6%) within 30 days, and 167 (3.1%) within 90 days. The restricted cubic spline regression model revealed a nonlinear relationship between PaO₂ and in-hospital mortality (<em>P</em>_overall = 0.004; <em>P</em>_nonlinearity = 0.012). Subgroup analyses and sensitivity analyses were consistent with the primary analysis.</div></div><div><h3>Conclusions</h3><div>The relationship between PaO₂ level and all-cause in-hospital mortality followed a J-shaped curve among patients following cardiac surgery. When PaO₂ &gt; 196.1mmHg, higher levels of PaO₂ within 24 hours after cardiac surgery were associated with an increased risk of hospital mortality.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1506-1513"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain Computed Tomography Perfusion Facilitates Early Prediction of Neurological Outcomes in Patients Suspected of Ischemic Cerebral Conditions after Cardiac Surgery.","authors":"Hua Liu, Ming-Hao Luo, Jing-Chao Luo, Xiao-Mei Yang, Guo-Guang Ma, Chun-Sheng Wang, Chun-Jiu Zhong, Guo-Wei Tu, Zhe Luo","doi":"10.1053/j.jvca.2025.01.017","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.017","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the value of brain computed tomography perfusion (CTP) imaging in predicting neurological outcomes early in patients with suspected ischemic cerebral events after cardiac surgery.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>A university teaching hospital.</p><p><strong>Participants: </strong>Patients presenting with postoperative neurological symptoms suspected of ischemic stroke following cardiac surgery from June 2020 to January 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Non-contrast computed tomography (NCCT) scans at initial evaluation and follow-up were evaluated using the semiquantitative Alberta Stroke Programme Early CT Score (ASPECTS). On CTP images, the volume of time to maximum (Tmax) >6.0 seconds and volume of relative cerebral blood flow (rCBF) <30% were calculated. The primary outcome was severe disability, defined as a Modified Rankin Scale (mRs) score ≥4 at discharge. In total, 109 patients were included. The presence of volume of Tmax >6.0 seconds (R² = 0.05, p = 0.006) and volume of rCBF <30% (R² = 0.18, p < 0.001) positively correlated with mRs at discharge. The areas under the ROC curves for ASPECTS-1, volume of Tmax >6 seconds, and volume of rCBF <30% were 0.62 (95% CI: 0.52-0.71, p = 0.009), 0.67 (95% CI: 0.57-0.76, p < 0.001), and 0.73 (95% CI: 0.64-0.81, p < 0.001), respectively. The volume of rCBF <30% demonstrated the highest accuracy (0.76, 95% CI: 0.64-0.86, p < 0.001), and a similar accuracy was only achieved by the NCCT scan in the follow-up (0.79, 95% CI: 0.67-0.88, p < 0.001).</p><p><strong>Conclusions: </strong>In patients with suspected ischemic cerebral events after cardiac surgery, brain CTP, particularly the assessment of the volume of rCBF <30%, demonstrates accuracy in predicting severe neurological disability compared to the initial NCCT scan. CTP may serve as an early and reliable prognostic tool to guide clinical decision-making in these patients.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic Muscle Plane Block Versus Erector Spinae Plane Block in Pediatric Patients Undergoing Corrective Cardiac Surgeries: A Randomized Controlled Study","authors":"Mai Abdel Fattah Ahmed Madkour MD,&nbsp;Engy Ibrahim Barsoum Abueldahab MD,&nbsp;Amel Hanafy Abo Elela MD,&nbsp;Mohamed Farouk Youssef MD,&nbsp;Ahmed Ali Gado MD","doi":"10.1053/j.jvca.2025.03.001","DOIUrl":"10.1053/j.jvca.2025.03.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Transversus thoracic plane block (TTPB) and erector spinae plane block (ESPB) are gaining popularity in cardiac surgeries to avoid excessive narcotic use and achieve fast-track extubation This study was performed to compare the analgesic efficacy of TTPB to that of ESPB in pediatric patients undergoing cardiac surgeries. The study was conducted in a university pediatric hospital (ClinicalTrials.gov NCT05559684).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Single-center prospective randomized controlled study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Tertiary referring pediatric university hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Sixty pediatric patients undergoing corrective cardiac surgeries during the period from November 2022 to August 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Randomization was done using a sealed envelope technique that contained 20 labels of (control), 20 labels of (ESPB), and another 20 labels of (TTPB). Patients in the control group (n = 20) were given fentanyl infusion at a dosage of 0.5 µg/kg/h throughout the whole operation, in addition to 1 µg/kg during skin incision, sternotomy, and aortic cannulation. Patients in the ESPB group (n = 20) were given fentanyl infusion at a dose of 0.5 µg/kg/h all through the whole operation plus ultrasound-guided ESPB done bilaterally by injecting 0.4 mL/kg (1:1 solution of Bupivacaine25 % and lidocaine 1%) on each side. Patients in the TTPB group were given fentanyl infusion at a dose of 0.5 µg/kg/h throughout the operation plus ultrasound-guided TTPB done bilaterally by injecting 0.4 mL/kg on each side (1:1 solution of bupivacaine 0.25 % and lidocaine 1%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Main Results&lt;/h3&gt;&lt;div&gt;Primary outcome was the total intraoperative fentanyl consumption; secondary outcomes included hemodynamics and time to first analgesic request (which is the elapsed time between giving the block and the patient's FLACC score ≥4), postoperative fentanyl consumption, extubation time, and adverse events. Intraoperative fentanyl consumption was significantly decreased in the TTPB group (3.4 ± 2.9) compared with the control group (6.7 ± 4.2), mean difference = 3.35, 95% CI (0.84, 5.86), p = 0.006. It was comparable between the ESPB group and the control group. Also, the TTPB and ESPB groups were comparable regarding the primary outcome, mean difference 1.2, 95% CI (–1.31, 3.71), p = 0.486. Total fentanyl consumption in the intensive care unit was significantly decreased in the TTPB group (1.1 ± 1.54) than in the control group (4.6 ± 4.25), mean difference 3.55, 95% CI (1.5, 5.6) with p = 0.001. Other pairwise comparisons were comparable between the groups. The time to first rescue analgesia was significantly longer in TTPB group (5.15 ± 4.21) compared to the control group (1.95 ± 3.5), mean difference –3.2, 95% CI (–5.68, –0.72), p = 0.04. Patients in ESPB needed first rescue analgesia slightly earlier (4.9 ± 4.4) than patients in TTPB group, m","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1495-1505"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Next Wave: Are We Prepared for Patients on Anticoagulation With Factor XI Inhibitors in Cardiac Surgery?","authors":"Gabor Erdoes MD, PhD ,&nbsp;Andreas Koster MD ,&nbsp;Marie E. Steiner MD, MS","doi":"10.1053/j.jvca.2025.02.043","DOIUrl":"10.1053/j.jvca.2025.02.043","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1361-1364"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Dexmedetomidine on Cerebrovascular Carbon Dioxide Reactivity During Pediatric Cardiac Surgery With Cardiopulmonary Bypass","authors":"Liping Sun MD ,&nbsp;Kan Zhang MD, PhD ,&nbsp;Hong Wang ,&nbsp;Wei Ji MD ,&nbsp;Yue Huang MD ,&nbsp;Jie Bai MD ,&nbsp;Jijian Zheng MD, PhD","doi":"10.1053/j.jvca.2025.03.002","DOIUrl":"10.1053/j.jvca.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effects of dexmedetomidine (DEX) on cerebrovascular autoregulation in children with congenital heart disease (CHD) using transcranial color-coded duplex sonography (TCCD).</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>This single-center study was conducted at a tertiary care center in Shanghai, China.</div></div><div><h3>Patients</h3><div>Fifty-nine children aged 0 to 6 years with CHD who underwent cardiac surgery with cardiopulmonary bypass were enrolled.</div></div><div><h3>Intervention</h3><div>Children were randomly assigned to receive either DEX (DEX group) or normal saline (control group) for 10 minutes following anesthetic induction. Cerebrovascular carbon dioxide reactivity (CVR-CO₂) was assessed by adjustment of lung ventilation.</div></div><div><h3>Measurements and Main Results</h3><div>Patients underwent TCCD before and after surgery. CVR-CO₂, resistance index (RI), pulsatility index (PI), mean blood flow velocity (V_mean) of the right middle cerebral artery, and regional cerebral oxygen saturation (ScrO₂) of the right frontal lobe were measured and analyzed at three distinct time points, resulting in six measurements. Hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded at each time point. The parameters CVR-CO₂ (p = 0.402), PI (p = 0.203), RI (p = 0.290), V_mean (p = 0.290), ScrO₂ (p = 0.426), HR (p = 0.522), and MAP (p = 0.236) were comparable between the two groups. In the control group, PI, RI, and HR significantly differed before and after surgery. In the DEX group, RI, V_mean, ScrO_2, and HR significantly differed before and after surgery.</div></div><div><h3>Conclusions</h3><div>A low loading dose of DEX did not compromise CVR-CO₂ in children with CHD undergoing cardiac surgery with cardiopulmonary bypass.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1482-1488"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of Intraoperative Neuromonitoring for Detection of Cerebral Ischemia","authors":"Bhav Jain BS ,&nbsp;Parthasarathy D. Thirumala MD, MS","doi":"10.1053/j.jvca.2024.12.032","DOIUrl":"10.1053/j.jvca.2024.12.032","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 852-854"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echogenicity Following Device Closure of a Ventricular Septal Defect: A Diagnostic Dilemma","authors":"Madan Mohan Maddali MD ,&nbsp;Khalid Al Alawi MRCPCH, FRCPI ,&nbsp;Abdullah Mohammed Al Farqani MRCPCH ,&nbsp;Salim Nasser Al Maskari FRCPCH","doi":"10.1053/j.jvca.2024.10.002","DOIUrl":"10.1053/j.jvca.2024.10.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 855-857"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided Serratus Anterior Plane Block Versus Paravertebral Block for Postoperative Analgesia in Children Undergoing Video-assisted Thoracoscopic Surgery: A Randomized, Comparative Study","authors":"Elsayed Elemam ,&nbsp;Ibrahim Abdelbaser ,&nbsp;Mahmoud Abdelfattah ,&nbsp;Ahmed Amin Eisa ,&nbsp;Ahmed Gamal Moursi ,&nbsp;Mohamed Y. Yousef Abd Allah ,&nbsp;Ahmed Alaidy ,&nbsp;Reem Abdelraouf Elsharkawy ,&nbsp;Ahmed Farid ,&nbsp;Eiad Ramzy ,&nbsp;Samah Elkenany ,&nbsp;Tarek Habeeb ,&nbsp;Ramy Sabry ,&nbsp;Mohamed Tharwat ,&nbsp;May Elsherbiny Badr","doi":"10.1053/j.jvca.2024.09.134","DOIUrl":"10.1053/j.jvca.2024.09.134","url":null,"abstract":"<div><h3>Objectives</h3><div>This study compared the postoperative analgesic efficacy of serratus anterior plane block (SAPB) and thoracic paravertebral block (PVB) in children undergoing video-assisted thoracoscopic surgery.</div></div><div><h3>Setting</h3><div>Operating room and intensive care unit of a tertiary care hospital.</div></div><div><h3>Design</h3><div>A single-center, randomized, comparative, open-labeled study.</div></div><div><h3>Participants</h3><div>Seventy pediatric patients aged 2 to 10 years who underwent video-assisted thoracoscopic surgery were enrolled.</div></div><div><h3>Interventions</h3><div>Patients were equally randomized into 2 groups. In the SAPB group, patients were injected with 0.4 mL/kg 0.25% bupivacaine under ultrasound guidance into the deep SAPB and in the PVB group, patients were injected with 0.4 mL/kg 0.25% bupivacaine under ultrasound guidance into the thoracic paravertebral space.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome was morphine consumption within the first 24 hours after surgery. The secondary outcomes were Children's Hospital of Eastern Ontario Pain Scale pain score, intraoperative fentanyl consumption, and the time required to perform the block. The median (Q1, Q3) morphine consumption (mg/kg) in the first postoperative 24 hours was similar in the SAPB and PVB groups (0.15 [0.1-0.2], 0.1 [0.1-0.2], respectively). The Children's Hospital of Eastern Ontario Pain Scale pain score was similar in both the SAPB and PVB groups at all-time points. Intraoperative fentanyl consumption was comparable in both groups. Time needed to perform the block was shorter in SAPB than PVB.</div></div><div><h3>Conclusions</h3><div>SAPB provides effective postoperative pain control, similar to thoracic PVB. Moreover, it is technically easier and has a shorter time to perform than PVB. Therefore, SAPB is an effective and safe alternative to thoracic PVB.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 742-749"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}