Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Impact of Dipyrone Administration on Postoperative Analgesia and Aspirin Effect in Patients Undergoing Coronary Artery Bypass Grafting: The Prospective Randomized DipASA Study.","authors":"Walter Petermichl, Peter-Paul Ellmauer, Anne Benning, Florian Zeman, Christof Schmid, Andrea Stadlbauer, Susanne Heimerl, Timo Seyfried, Sebastian Blecha","doi":"10.1053/j.jvca.2024.10.009","DOIUrl":"10.1053/j.jvca.2024.10.009","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to investigate the impact of dipyrone administration on postoperative analgesia and acetylsalicylic acid (ASA) effect in patients undergoing coronary artery bypass grafting (CABG).</p><p><strong>Design: </strong>A prospective randomized study.</p><p><strong>Setting: </strong>Single-university hospital setting.</p><p><strong>Participants: </strong>Ninety-eight patients who underwent CABG between April 2022 and May 2023.</p><p><strong>Interventions: </strong>The ASA effect was measured at 6 time points with impedance aggregometry (Multiplate) and thromboelastography (TEG6s Platelet Mapping). Patients were randomized to 1 of 3 groups: intravenous ASA and dipyrone at the same time (group 1), intravenous ASA and dipyrone with a 2-hour delay (group 2), and intravenous ASA alone (group 3). Postoperative analgesic effects (numeric rating scale) and the prevalence of potential ASA non-response (defined as ASPI >40 U and TEG-ASA inhibition <50%) were recorded.</p><p><strong>Measurements and main results: </strong>Of 90 analyzed patients, 80 took ASA preoperatively. All patients received intravenous ASA 100 mg from postoperative day 1. The effect of ASA did not significantly differ between the study groups at any time for either platelet function test. NRS values did not differ between the study groups at any time (p = 0.469). Patients in group 3 received significantly more additional co-analgesics than patients who received dipyrone (p = 0.005). ASA non-response was detected in 38.9% and 67.8% on the seventh postoperative day, respectively.</p><p><strong>Conclusions: </strong>Dipyrone given after CABG seems safe and did not show any significant effect on platelet inhibition after ASA administration. Patients taking dipyrone postoperatively need significantly fewer additional coanalgesics. The ASA effect on platelet function should be checked at least once after surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"121-130"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568655","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":"Hemodynamic Impact of the Trendelenburg Position: A Systematic Review and Meta-analysis.","authors":"Valery V Likhvantsev, Giovanni Landoni, Levan B Berikashvili, Petr A Polyakov, Mikhail Ya Yadgarov, Pavel V Ryzhkov, Georgii P Plotnikov, Roman A Kornelyuk, Valeriia V Komkova, Luisa Zaraca, Ivan V Kuznetsov, Anastasia V Smirnova, Kristina K Kadantseva, Maria M Shemetova","doi":"10.1053/j.jvca.2024.10.001","DOIUrl":"10.1053/j.jvca.2024.10.001","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the impact of the Trendelenburg position on hemodynamic parameters in adult patients.</p><p><strong>Design: </strong>Systematic literature review and meta-analysis using PubMed and Medline.</p><p><strong>Setting: </strong>All prospective interventional studies comparing the hemodynamic characteristics of patients in the horizontal supine position and Trendelenburg position.</p><p><strong>Measurements and main results: </strong>A total of 16 studies including 333 patients were found. The Trendelenburg position led to a statistically significant 11% increase in stroke volume compared with the supine position (mean difference [MD] = 8.27, 95% confidence interval [CI]: 1.79; 14.76, p = 0.012). A decrease in stroke volume variation (MD = -1.36, 95% CI: 2.26; -0.46, p = 0.003) and heart rate (MD = -1.65, 95% CI: -2.86; -0.44, p = 0.008) and an increase in cardiac output (MD = 0.33, 95% CI: 0.1; 0.57, p = 0.006), mean arterial pressure (standardized MD, = 0.42, 95% CI: 0.1; 0.74, p = 0.011), central venous pressure (MD = 4.13, 95% CI: 2.42; 5.84, p < 0.001), mean pulmonary artery pressure (MD = 4.25, 95% CI: 2.69; 5.81, p < 0.001), and left ventricular end-diastolic volume (MD = 16.89, 95% CI: 3.17; 30.61, p = 0.016) were found.</p><p><strong>Conclusions: </strong>The Trendelenburg position significantly increases stroke volume and improves multiple hemodynamic parameters in adult patients. These results confirm the position's potential clinical relevance in hemodynamic management and suggest the possibility of a tailored application in selected clinical settings. The duration of the beneficial effects of the Trendelenburg position and the possible side effects should be the focus of further investigation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"256-265"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583346","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":"Comparison of Four Intensive Care Scores in Predicting Outcomes After Venoarterial Extracorporeal Membrane Oxygenation: A Single-center Retrospective Study.","authors":"Suraj Sudarsanan, Praveen Sivadasan, Prem Chandra, Amr S Omar, Kathy Lynn Gaviola Atuel, Hafeez Ulla Lone, Hany O Ragab, Irshad Ehsan, Cornelia S Carr, Abdul Rasheed Pattath, Abdulaziz M Alkhulaifi, Yasser Shouman, Abdulwahid Almulla","doi":"10.1053/j.jvca.2024.10.027","DOIUrl":"10.1053/j.jvca.2024.10.027","url":null,"abstract":"<p><strong>Objective: </strong>To assess the capability of the Acute Physiology and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA) scores, Cardiac Surgery Score (CASUS), and Survival After VA-ECMO (SAVE) in predicting outcomes among a cohort of patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO).</p><p><strong>Design: </strong>This is an observational retrospective study of 142 patients admitted to the cardiothoracic intensive care unit (CTICU) after undergoing VA-ECMO insertion.</p><p><strong>Setting: </strong>CTICU of a tertiary care center.</p><p><strong>Participants: </strong>All patients admitted to the CTICU for a minimum of 24 hours, post-VA-ECMO insertion, between 2015 and 2022.</p><p><strong>Interventions: </strong>Review of electronic patient records.</p><p><strong>Measurements and results: </strong>Scores for APACHE-II, SOFA, and CASUS were calculated 24 hours after intensive care units (ICU) admission. The SAVE score was computed from the last available patient details within 24 hours of ECMO insertion. Relevant demographic, clinical, and laboratory data for the study was retrieved from electronic patient records. Pre-ECMO serum levels of lactates and creatinine were significantly associated with mortality. Lower ECMO flow rates at 4 and 12 hours post-ECMO cannulation were significantly correlated with survival to discharge. The development of arrhythmias, acute kidney injury, and the need for continuous renal replacement therapy while on ECMO were significantly associated with mortality. The APACHE-II, SOFA, and CASUS scores, calculated at 24 hours of ICU admission, were significantly higher amongst nonsurvivors. Following risk score categorization using receiver operating characteristic curve analysis, it was found that APACHE-II, SOFA, and CASUS scores calculated 24 hours post-ICU admission after ECMO insertion demonstrated moderate predictive ability for mortality. In contrast, the SAVE score failed to predict mortality. APACHE-II >27 (area under the curve = 0.66), calculated 24 hours post-ICU admission after ECMO insertion, showed the greatest predictive ability for mortality. Multivariate logistic regression analysis of the four scores showed that APACHE-II >27 and SOFA >14, calculated 24 hours post-ICU admission after ECMO insertion, were independently significantly predictive of mortality.</p><p><strong>Conclusion: </strong>The APACHE-II, SOFA, and CASUS, calculated at 24 hours of ICU admission, were significantly higher among nonsurvivors compared with survivors. The APACHE-II demonstrated the highest mortality predictive ability. APACHE-II scores of 27 or above and SOFA scores of 14 or above at 24 hours of ICU admission after ECMO cannulation can predict mortality and assist physicians in decision-making.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"131-142"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644258","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 Hemodynamic Effects of Protamine in Pediatric Patients Undergoing Pulmonary Artery Reconstruction and Unifocalization Surgery: A Pilot StudyHemodynamic Effects of Protamine in Children.","authors":"Xi Li, Zhe Amy Fang, M Michael Andrew Lennig, Alexandra Klein, Danton Char, Andrew James Giustini, Madalane G Boltz, Zoel A Quiñónez","doi":"10.1053/j.jvca.2024.11.001","DOIUrl":"10.1053/j.jvca.2024.11.001","url":null,"abstract":"<p><strong>Objectives: </strong>To determine protamine administration increases pulmonary artery pressures (PAPs) in patients undergoing unifocalization or pulmonary artery reconstruction surgeries.</p><p><strong>Design: </strong>Retrospective database study.</p><p><strong>Setting: </strong>A large pediatric heart center within an academic quaternary care facility.</p><p><strong>Participants: </strong>All patients undergoing pulmonary artery reconstruction or a unifocalization procedure identifiable within the data warehouse.</p><p><strong>Interventions: </strong>We collected data from Stanford University's data repository, formatted it, and analyzed it using RStudio (v 2023.06.1+524).</p><p><strong>Measurements and main results: </strong>Our primary outcome is the change in PAP after the administration of protamine. Secondary outcomes include changes in the mean arterial pressure, the ratio of systolic pulmonary artery to systemic artery pressure, right-sided filling pressure, and left atrial pressure. After a protamine bolus, we found a difference in PAP (Friedman χ² = 49.46; p < 0.001). When compared with 2 minutes before its administration, the PAP was higher at 2 minutes (29.00 mmHg versus 25.00 mmHg; p < 0.001), 5 minutes (30.00 mmHg versus 25.00 mmHg; p < 0.001) and 10 minutes (31 mmHg versus 25 mmHg; p < 0.001). When coadministered with calcium, there was also a significant increase in PAP (Friedman χ² = 28.11; p < 0.001), with a higher PAP 10 minutes after calcium administration when compared with 2 minutes before (32 mmHg versus 26 mmHg; p < 0.001).</p><p><strong>Conclusions: </strong>Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium coadministration did not lead to a greater increase in PAP.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"168-176"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728922","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":"Enhanced Recovery after Surgery (ERAS) in Pediatric Cardiac Surgery: Status Quo of Implementation in Europe.","authors":"Sascha Meier, Jonas Borzel, Nicolas Hellner, Daniel Catena, Christiane E Beck, Ehrenfried Schindler, Maren Kleine-Brueggeney","doi":"10.1053/j.jvca.2024.10.005","DOIUrl":"10.1053/j.jvca.2024.10.005","url":null,"abstract":"<p><strong>Objectives: </strong>Enhanced recovery after surgery (ERAS) is a multimodal care pathway to enhance recovery after surgery that is well established in various surgical disciplines. In pediatric cardiac surgery, implementation of ERAS protocols remains inconsistent. We conducted a survey of active European pediatric cardiac surgical centers to assess the current state of ERAS concepts and the current practice in perioperative pediatric cardiac care.</p><p><strong>Design: </strong>Prospective, 79-item, web-based cross-sectional survey.</p><p><strong>Setting: </strong>Web-based survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care.</p><p><strong>Participants: </strong>Anesthesiologists of European pediatric cardiac surgical centers.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of a total of 98 centers, 50 responded. Eight responses were excluded due to incomplete survey forms or non-European location, leaving 42 responses (42.9%) for statistical analysis. Sixteen of the 42 centers (38.1%) follow an ERAS concept. Only 3 (7.1%) have formalized and detailed the ERAS concept in a written document, covering the entire perioperative period, while 13 (31%) have formalized it solely for the intraoperative period. Regarding regional and local anesthesia, 13 (31%) centers regularly practice regional anesthesia blocks, and 11 (26.2%) centers use wound infiltration by the surgical team.</p><p><strong>Conclusion: </strong>This European survey revealed that implementation of ERAS concepts in pediatric cardiac surgery is generally low, with considerable heterogeneity in clinical practice regarding the timing of extubation, the choice of surgical procedures triggering on-table extubation, the choice of anesthetic drugs and the use of regional anesthesia. More coordinated efforts are needed to implement ERAS concepts in pediatric cardiac surgery and harvest the benefits of ERAS concepts for the pediatric cardiac population.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"177-186"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568652","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":"Multimodality Imaging of the Right Ventricle: Looking Beyond the Usual Angles.","authors":"Swapnil Khoche, Timothy Maus","doi":"10.1053/j.jvca.2023.08.130","DOIUrl":"10.1053/j.jvca.2023.08.130","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"24-25"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47782128","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":"Operating Room Extubation After Cardiac Surgery: Routine for Some or Routine for None?","authors":"Jamel P Ortoleva, Dominic V Pisano, Christina M Tull, Alexander D Shapeton","doi":"10.1053/j.jvca.2024.10.035","DOIUrl":"10.1053/j.jvca.2024.10.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"1-3"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681777","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":"Minimally Invasive Mitral Valve Repair Under Transthoracic Echocardiography Guidance.","authors":"Brian J Kinsman, Serguei Melnitchouk, Margaret Connolly, Tim Rosborough, Scott Streckenbach","doi":"10.1053/j.jvca.2024.10.019","DOIUrl":"10.1053/j.jvca.2024.10.019","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"201-203"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568663","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":"Protective Hemodynamics: C.L.E.A.R.!","authors":"Filippo D'Amico, Marilena Marmiere, Giacomo Monti, Giovanni Landoni","doi":"10.1053/j.jvca.2024.10.021","DOIUrl":"10.1053/j.jvca.2024.10.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"13-19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568669","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":"Aortic Valve Prolapse Resulting in Coronary Obstruction and Recurrent Ventricular Fibrillation After Subaortic Membrane Resection in a Child: Case Report.","authors":"Nandhu Subramonian, Mamatha Munaf, Kartheek Hanumansetty, Baiju S Dharan, Thomas Koshy","doi":"10.1053/j.jvca.2024.10.036","DOIUrl":"10.1053/j.jvca.2024.10.036","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":"196-200"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639177","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}