Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Myocardial Infarction of Distal Left Anterior Descending Artery Myocardial Distribution due to Coronary Embolus via Left Internal Mammary Artery-Left Anterior Descending Artery Bypass Grafting after Transcatheter Aortic Valve Replacement: A Clinical Challenge and Proposed Prevention Strategies.","authors":"Jordan Holloway, Matthew Greene, Michael Essandoh, Hamdy Awad","doi":"10.1053/j.jvca.2025.05.035","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325836","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":"Impact of Obesity on Neurologic Outcomes in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Jin Kook Kang, Jiah Kim, Haerin Chung, Andrew Kalra, Shivalika Khanduja, Zachary E Darby, Ifeanyi D Chinedozi, Jessica B Briscoe, Bo Soo Kim, Glenn J R Whitman, Sung-Min Cho","doi":"10.1053/j.jvca.2025.05.029","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.029","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of body mass index (BMI) on neurologic outcomes in venoarterial extracorporeal membrane oxygenation (VA-ECMO) DESIGN: Retrospective observational study SETTING: Single center PARTICIPANTS: Adults INTERVENTIONS: VA-ECMO MEASUREMENTS AND MAIN RESULTS: Obese (BMI≥30 kg/m²) and nonobese (BMI<30 kg/m²) patient groups were compared. The primary outcome was neurologic outcomes at discharge, with \"good\" (modified Rankin Scale [mRS] score 0-3) and \"poor\" (mRS score 4-6). Secondary outcomes were acute brain injury (ABI) and mortality. Multivariable Cox regression was used to investigate risk factors for poor neurologic outcomes, adjusting for demographics, comorbidities, pre-ECMO PaO₂, pericannulation PaCO₂ change, lactate, central cannulation, and ABI. Spline regression was performed to assess the relationship between BMI and neurologic outcomes. The Kaplan-Meier estimator was used to evaluate 90-day survival. Among 214 patients (median age 58 years, 63% male), 104 were obese (median BMI, 35.4; interquartile range [IQR], 32.2-39.9), and 110 were nonobese (median BMI, 25; IQR, 23.2-27.5). Obese patients had higher rates of poor neurologic outcomes (91% vs 69%; p < 0.001) and ABI (50% vs 36%; p = 0.04). The Cox model identified associations of obesity (adjusted hazard ratio [aHR], 1.63, 95% confidence interval [CI], 1.15-2.31; p = 0.006) and ABI (aHR, 1.41; 95% CI, 1.01-1.96; p = 0.04) were associated with increased hazards of poor neurologic outcomes. Spline regression showed a fairly linear relationship between BMI and poor neurologic outcomes. Kaplan-Meier analysis suggested that the obese patients had a lower 90-day survival probability (p < 0.0001, log-rank test).</p><p><strong>Conclusions: </strong>Obesity increased the hazard of poor neurologic outcomes, ABI, and mortality in this cohort of patients undergoing VA-ECMO, highlighting the importance of standardized neuromonitoring and early ABI detection, especially for obese patients. Further research is needed to explore the impact of obesity on neurologic outcomes independent of ABI.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302170","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":"Managing Cardiovascular Risk in Noncardiac Surgery-Insights and Highlights From the Latest American Heart Association/American College of Cardiology Perspective.","authors":"John G Augoustides","doi":"10.1053/j.jvca.2025.05.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.028","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325835","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":"Evaluating Large Language Models on American Board of Anesthesiology-style Anesthesiology Questions: Accuracy, Domain Consistency, and Clinical Implications.","authors":"Sagar Patel, Vinh Ngo, Brian Wilhelmi","doi":"10.1053/j.jvca.2025.05.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.033","url":null,"abstract":"<p><p>Recent advances in large language models (LLMs) have led to growing interest in their potential applications in medical education and clinical practice. This study evaluated whether five widely used and highly developed LLMs-ChatGPT-4, Gemini, Claude, Microsoft CoPilot, and Meta-could achieve a passing score on the American Board of Anesthesiology (ABA) BASIC Exam. Each model completed three separate sets of 200 multiple-choice questions derived from a widely used review resource, with the content distribution mirroring the ABA BASIC Exam blueprint. All five models demonstrated statistically significant performance above the 70% passing threshold (p < 0.05), with the following averages: ChatGPT-4: 92.0%, Gemini: 89.0%, Claude: 88.3%, Microsoft CoPilot: 91.5%, and Meta: 85.8%. Furthermore, an analysis of variance comparing their mean accuracy scores found no statistically significant difference among them (F = 1.88, p = 0.190). These findings suggest that current LLMs can surpass the minimum competency required for board certification, raising important questions about their future role in medical education and clinical decision-making. Performance on topics central to cardiac, thoracic, and vascular anesthesiology-such as hemodynamic management, cardiopulmonary physiology, and coagulation-was particularly robust, suggesting relevance to both fellowship-level education and complex intraoperative care. While these results highlight the capability of artificial intelligence (AI) to meet standardized medical knowledge benchmarks, their broader implications extend beyond examination performance. As AI continues to evolve, its integration into real-time patient care may transform anesthesiology practice, offering decision-support tools that assist physicians in synthesizing complex clinical data. Further research is needed to explore the reliability, ethical considerations, and real-world applications of AI-driven technologies in patient care settings.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302169","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":"Continuous Erector Spinae Plane Block Reduces Hospital Length of Stay After Minimally Invasive Cardiac Surgery: Preliminary Meta-Analytic Insights.","authors":"Burhan Dost, Yunus Emre Karapinar, Mirac Selcen Ozkal Yalin, Alessandro De Cassai","doi":"10.1053/j.jvca.2025.05.024","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.024","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248005","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":"Pulmonary Embolism: Unanswered Questions and Ongoing Evidence Gaps.","authors":"Omar Elmadhoun, Michael P Merren, Patrick M Wieruszewski, Juan G Ripoll, Jeffrey Huang, Harish Ramakrishna","doi":"10.1053/j.jvca.2025.05.027","DOIUrl":"10.1053/j.jvca.2025.05.027","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368876","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":"Comparing the Efficacy and Safety of Two Analgesic Regimens After Cardiac Surgery: Slow Release and Breakthrough Tapentadol versus Slow Release and Breakthrough Oxycodone.","authors":"Robert Wojnar, Seo Hyeon Jeong, Mohammad Asghari-Jafarabadi, Steve Philpot","doi":"10.1053/j.jvca.2025.05.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.032","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the analgesic outcome of two oral opioid regimens after cardiac surgery.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>A single tertiary-care facility.</p><p><strong>Participants: </strong>Opioid-naïve adult patients following cardiac surgery via a sternotomy.</p><p><strong>Interventions: </strong>Patients received 1 of 2 regimens after extubation, an oxycodone protocol or a tapentadol protocol. Each protocol contained at least 3 doses of a slow-release oral formulation with immediate-release doses of the same opioid for breakthrough analgesia. Both protocols included regular paracetamol. Other analgesia for refractory pain was as directed by the physician.</p><p><strong>Measurements and main results: </strong>Daily worst pain score was documented at rest and on movement in patients prescribed the oxycodone protocol and those prescribed the tapentadol protocol for 7 days after extubation. There was no significant difference between the tapentadol and oxycodone groups in worst pain at rest (odds ratio [OR] 1.77; 95% confidence interval [CI], 0.56-5.65; p = 0.334) or worst pain on movement (OR, 3.23; 95% CI, 0.85-12.32; p = 0.086) over the first 7 days post extubation. Despite a rapid de-escalation of opioids, the documented worst pain at rest and on movement by day 7, decreased by 96% in the tapentadol group and by 94% in the oxycodone group.</p><p><strong>Conclusions: </strong>This retrospective cohort study demonstrates that tapentadol compared to oxycodone is an effective alternative for managing pain after cardiac surgery performed via sternotomy.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284498","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 OPTION Trial and Its Implications for Cardiac Anesthesiologists.","authors":"Jordan Holloway, Adam Dalia, Michael Essandoh, Ryan Dodge","doi":"10.1053/j.jvca.2025.05.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.023","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325837","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":"Can Sodium-glucose Cotransporter Inhibitors Alter the Life Cycle of Aortic Stenosis?","authors":"Nadim Choudhury, Ellen Richter, Abimbola Faloye","doi":"10.1053/j.jvca.2025.05.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248004","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":"Extracorporeal Membrane Oxygenation for Vasoplegia: Walking Before Running.","authors":"Jamel Ortoleva, Dominic V Pisano, Patrick M Wieruszewski","doi":"10.1053/j.jvca.2025.05.030","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.030","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248006","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}