Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Assessment of Perioperative Protamine Reactions in Patients With Fish Allergies: A Retrospective Observational Study","authors":"Mohanad R. Youssef MD, Eryberto Martinez MD, Terrique M. Pinnock MD, Alexei Gonzalez-Estrada MD, Mark M. Smith MD, Bradford B. Smith MD","doi":"10.1053/j.jvca.2024.08.024","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.024","url":null,"abstract":"To retrospectively assess the incidence and severity of perioperative protamine reactions in adult patients with documented history of fish allergy. Retrospective observational study. Large academic tertiary referral center. Adults with fish allergies undergoing surgeries involving protamine, between January 1, 2008, and March 1, 2018. Perioperative protamine administration in patients with documented fish allergy. Perioperative protamine and anaphylactic reactions were reviewed. A diagnosis of anaphylaxis or protamine reaction was based on clinical suspicion, perioperative events, and postoperative evaluations. Among 214 patients, 2 cases (<1%) of anaphylaxis or protamine reactions occurred. Cardiac procedures were most common (67%). The median intraoperative heparin dosage was 46,000 IU, and the median protamine dosage was 310 mg. Nearly all patients (99%) were admitted to the intensive care unit postoperatively, with a median hospital stay of 6.5 days (interquartile range, 5.2-14.6 days). There were 3 deaths (1%) within 30 days, and 15 (7%) within 1 year. The study findings suggest that in patients with a history of fish allergy, cross-reactivity with protamine is unlikely, as anaphylaxis and/or protamine reactions were rare in this patient population in the perioperative environment. Based on these findings, this study does not recommend avoiding protamine solely based on a history of fish allergy when heparin reversal is required during surgery.","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247500","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":"Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: To Predict or to Measure?","authors":"Nicole M. Maldari MD, Peter J. Neuburger MD FASE, Liliya Pospishil MD FASE","doi":"10.1053/j.jvca.2024.08.031","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.031","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247474","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":"Amino Acids for Renal Protection: Promising, but Cautiously So","authors":"Daniel S. Cormican MD FCCP, David A. Broadbent MD, Meha Bhargava MD","doi":"10.1053/j.jvca.2024.08.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247495","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":"Predictors of Postoperative Morphine Milligram Equivalents in Cardiac Surgery","authors":"David Delijani BA, Hyungjoo Kim BA, Xueqi Huang BA, Joseph Pena MD, Alan Hartman MD, Pey-Jen Yu MD","doi":"10.1053/j.jvca.2024.08.029","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.029","url":null,"abstract":"Given both the short- and long-term deleterious effects of opioids, there has been an increased focused on reducing the use of postoperative opioid analgesia. As patients undergoing cardiac surgery often require high levels opioids postoperatively, understanding risk factors for increased postoperative opioid use may be helpful for the development of patient-specific opioid-sparing pain regimens for this patient population. A retrospective analysis of data from our electronic medical records and the Society of Thoracic Surgeon's database. A single-institution study at an academic medical center. All patients undergoing open adult cardiac surgery were included. Exclusion criteria were patients with continuous intravenous narcotic drips and operative mortality. As this was a retrospective study, no interventions were conducted on the participants. Data for patient postoperative opioid requirements were extracted from the electronic medical record. Total opioid use on postoperative days 0 to 3 was converted to morphine milligram equivalent (MME) via standard conversion factors. The study cohort comprised 1604 patients, including 456 females and 1066 coronary artery bypass grafting (CABG) recipients. MME was 31.0% greater in patients undergoing CABG (p < 0.001), 76.3% greater in patients with liver disease (p = 0.005), and 48.8% greater in patients with patient-controlled analgesia (p <0.001) during postoperative days 0 to 3. Younger age (p < 0.001) and higher body mass index (BMI) (p < 0.001) also were associated with increased MME prescription. CABG, liver disease, patient-controlled analgesia, younger age, and higher BMI are associated with increased narcotic use after cardiac surgery. Implementation of more aggressive perioperative multimodal opioid-sparing regimens should be considered for these patient groups.","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247475","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":"Remimazolam in Cardiac Anesthesia: Analysis of Recent Data","authors":"Juan G. Ripoll MD, Rayssa Becerra Orjuela MD, Anuradha Kanaparthi MD, Juan C. Diaz Soto MD, Mariam A. ElSaban MBBS, Thais R. Peclat MD PhD, Patrick M. Wieruszewski PharmD RPh, Arnoley S. Abcejo MD, Marvin G. Chang MD PhD, Edward A. Bittner MD PhD FCCM, Harish Ramakrishna MD FACC FESC","doi":"10.1053/j.jvca.2024.08.030","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.030","url":null,"abstract":"Interest in remimazolam has surged in recent years, thanks to its advantageous pharmacologic profile. This ultra-short-acting benzodiazepine is noted for its rapid onset and termination of action, organ-independent elimination, availability of a reversal agent, and excellent hemodynamic stability. Although the use of remimazolam has been explored in various anesthesia settings and procedures, data on its application in cardiovascular anesthesia and catheterization laboratory procedures remain limited. This review evaluates the latest literature to assess remimazolam's role in cardiovascular anesthesia across different settings and procedures. The analysis shows that remimazolam offers anesthesia without significant hemodynamic instability and a reduced need for vasopressors, with an incidence of perioperative adverse events comparable to that of other agents. These findings are relevant for both the induction and maintenance of general anesthesia in catheterization laboratory procedures and general anesthesia in elective cardiac surgery. Although further research is needed to fully understand remimazolam's role in cardiovascular anesthesia, its favorable hemodynamic and safety profile suggests that it is a promising option for cardiac anesthesiologists in both the catheterization laboratory and the operating room.","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247499","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":"ENGAGES-Canada: Has This “Burst” the Bubble of Processed EEG?","authors":"Kelly Byrne MBChB FANZCA, Mark Grivas BPhty MD, Amy Gaskell MBChB BMedSci FANZCA PhD","doi":"10.1053/j.jvca.2024.08.025","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.025","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247497","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":"Stepwise Mechanical Circulatory Support in a Pediatric Patient With Respiratory Failure Facilitating Mobilization and Recovery","authors":"Mitchell Lippy MD, Brady Still MD, Richa Dhawan MD MPH, Ingrid Moreno-Duarte MD, Hiroto Kitahara MD","doi":"10.1053/j.jvca.2024.08.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.023","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247498","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":"Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis.","authors":"Alessandro Pruna, Rosario Losiggio, Giovanni Landoni, Yuki Kotani, Martina Baiardo Redaelli, Marta Veneziano, Todd C Lee, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo","doi":"10.1053/j.jvca.2024.08.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.033","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) is a common perioperative complication. To date, no single intervention has been proven effective for AKI prevention in this setting. However, intravenous amino acids (AA) administration may recruit renal functional reserve and, thereby, attenuate the perioperative loss of the glomerular filtration rate.</p><p><strong>Design: </strong>We performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection.</p><p><strong>Setting and participants: </strong>We performed a meta-analysis of controlled studies in perioperative patients evaluating intravenous AA infusion versus any comparator.</p><p><strong>Measurements: </strong>The primary outcome was AKI at longest follow-up. We performed a random effects meta-analysis on the relative risk (RR) scale to assess the effect of AA infusion. We used a Bayesian approach to estimate the probability of benefit (RR < 1) for the primary outcome. Secondary outcomes included renal replacement therapy, serum creatinine, and estimated glomerular filtration rate. Tertiary outcomes included mechanical ventilation duration, intensive care unit and hospital length of stay and mortality (PROSPERO: CRD42024547225).</p><p><strong>Results: </strong>We identified 15 studies (14 randomized controlled trials and 1 prospective before-after study) reporting at least one outcome of interest (4,544 patients), with 6 studies (4,084 patients) reporting the primary outcome. AKI occurred 504 of 2,041 (24.7%) in AA patients versus 614 of 2,041 (30.1%) in controls (RR, 0.66; 95% confidence interval, 0.47-0.94; I² = 50%; p = 0.02), which corresponded with a 99.1% probability of AKI reduction with AA. Moreover, consistent with these findings, AA decreased serum creatinine and hospital length of stay and increased the estimated glomerular filtration rate.</p><p><strong>Conclusions: </strong>This meta-analysis suggests that AA administration likely decreased the perioperative incidence of AKI.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390821","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 Ventilator Stress Index: Timing Is Everything”","authors":"Danisa K. Daubenspeck","doi":"10.1053/j.jvca.2024.08.022","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.022","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247506","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":"Anesthetic Management of Tracheal Tumor Debulking and Stenting as an Emergency Procedure in a Rare Case of Infiltrating Lower Tracheal Malignancy","authors":"Kiran Muthu Rajah MD, V. Rajesh Kumar Kodali MD, Mahesh Vakamudi MD","doi":"10.1053/j.jvca.2024.08.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.08.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247501","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}