Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"RNA Interference in Amyloid: What's New From HELIOS-B?","authors":"Christopher Collins, Theodore J Cios, Justin Walker","doi":"10.1053/j.jvca.2024.12.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970867","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":"Pausing Anticoagulation in Preparation for Transcatheter Aortic Valve Implantation: Prying Open Pandora's Box.","authors":"Liem Nguyen, Swapnil Khoche","doi":"10.1053/j.jvca.2024.12.035","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005917","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":"Benefits of Intraoperative Neuromonitoring for Detection of Cerebral Ischemia.","authors":"Urvish Jain, Jeffrey Balzer","doi":"10.1053/j.jvca.2024.12.030","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.030","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970866","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, Parthasarathy D Thirumala","doi":"10.1053/j.jvca.2024.12.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.032","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-21","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":"Effects of Neuraxial or General Anesthesia on the Incidence of Postoperative Pulmonary Complications in Patients Undergoing Peripheral Vascular Surgery: A Randomized Controlled Trial.","authors":"André P Schmidt, Daiane Silvello, Clovis T Bevilacqua Filho, Deborah Bergmann, Luiz Eduardo C Ferreira, Marcos F Nolasco, Tales D Pires, Walter C Braga, Cristiano F Andrade","doi":"10.1053/j.jvca.2024.12.027","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.027","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative complications after major surgery, especially in vascular procedures, are associated with a significant increase in costs and mortality. Postoperative pulmonary complications (PPCs) have a notable impact on morbidity and mortality. The primary aim of this present study was to evaluate the effects of spinal anesthesia compared with general anesthesia on the incidence of PPCs in patients undergoing lower extremity bypass surgery.</p><p><strong>Design: </strong>This study was designed as a prospective, randomized controlled clinical trial with 2 parallel arms.</p><p><strong>Setting: </strong>Two tertiary teaching hospitals.</p><p><strong>Participants: </strong>We enrolled 128 adult patients with American Society of Anesthesiologists status II to IV who were scheduled to undergo elective lower extremity arterial bypass surgery.</p><p><strong>Interventions: </strong>Patients were assigned randomly to receive either general anesthesia or spinal anesthesia.</p><p><strong>Measurements and main results: </strong>The primary outcome was the incidence of PPCs and secondary end points included hemodynamic and blood gas analysis perioperatively. A total of 128 patients were included in the study, with 123 patients completing the study protocol. Approximately 26.7% of patients who received general anesthesia experienced PPC, compared with 12.7% of those who received spinal anesthesia (p = 0.051). Patients who underwent spinal anesthesia had a lower incidence of hypotension and required fewer intraoperative vasoactive drugs (p < 0.001).</p><p><strong>Conclusions: </strong>In this study, spinal anesthesia did not significantly reduce the incidence of PPCs in patients undergoing peripheral vascular surgery compared with general anesthesia. Neuraxial anesthesia may reduce the incidence of hypotension and the need for hemodynamic pharmacological support in patients undergoing peripheral arterial surgery, although further dedicated studies are required to validate these findings.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949340","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":"Adjunctive Fresh Frozen Plasma Versus Adjunctive Cryoprecipitate in Cardiac Surgery Patients Receiving Platelets for Perioperative Bleeding.","authors":"Calvin M Fletcher, Jake V Hinton, Luke A Perry, Noah Greifer, Jenni Williams-Spence, Reny Segal, Julian A Smith, Tim G Coulson, Christopher M Reid, Rinaldo Bellomo","doi":"10.1053/j.jvca.2024.12.034","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.034","url":null,"abstract":"<p><strong>Objective(s): </strong>This study was designed to assess the relative association between adjunctive fresh frozen plasma (FFP) or adjunctive cryoprecipitate and morbidity and mortality in cardiac surgery patients receiving platelets for perioperative bleeding.</p><p><strong>Design: </strong>Retrospective cohort study using inverse probability of treatment weighting with entropy balancing.</p><p><strong>Setting: </strong>Multi-institutional study of 58 centers using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database from January 1, 2005, to December 31, 2021.</p><p><strong>Participants: </strong>Cardiac surgery patients who received platelets for perioperative bleeding.</p><p><strong>Interventions: </strong>Adjunctive FFP versus adjunctive cryoprecipitate transfusion in the perioperative period.</p><p><strong>Measurements and main results: </strong>A total of 12,889 platelet-transfused patients were assessed. Of these, 8,764 received adjunctive FFP and 4,125 received adjunctive cryoprecipitate, with cryoprecipitate increasing over time relative to FFP. After entropy balancing, compared with adjunctive cryoprecipitate, adjunctive FFP transfusion was associated with increased operative mortality (relative risk [RR]: 1.49, 95% confidence interval [CI]: 1.24, 1.79, p < 0.001); 1-year mortality (RR: 1.37, 95% CI: 1.13, 1.66, p = 0.001); increased risk of acute kidney injury (RR: 1.16, 95% CI: 1.02, 1.33, p = 0.024); all-cause infection (RR: 1.14, 95% CI: 1.02, 1.29, p = 0.026), and intensive care length of stay in days (adjusted mean difference: 8.02, 95% CI: 1.72, 14.33, p = 0.013).</p><p><strong>Conclusions: </strong>In cardiac surgery patients receiving platelets for perioperative bleeding, adjunctive FFP was independently associated with greater morbidity and mortality compared with adjunctive cryoprecipitate. These hypothesis-generating findings warrant further prospective investigation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965129","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":"Pain Management in Open Abdominal Aortic Aneurysm Repair: Potential Alternatives to Epidural Anesthesia.","authors":"Keisuke Yoshida, Tatsumi Yakushiji, Ryosuke Sasaki, Shinju Obara, Satoki Inoue","doi":"10.1053/j.jvca.2024.12.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.028","url":null,"abstract":"<p><p>Despite significant advances in endovascular techniques, open abdominal aortic aneurysm (AAA) repair continues to play an important role in vascular surgery. Many studies have described the advantages of epidural anesthesia combined with general anesthesia over general anesthesia alone as an analgesic method for open AAA repair. Several recent guidelines have recommended epidural anesthesia as the first option for pain management in open AAA repair. However, AAA repair requires perioperative anticoagulation, and bleeding complications are an inevitable concern. In the past 2 decades, new methods of analgesia, represented by ultrasound-guided nerve blocks, have been developed and become popular in major abdominal surgery. These analgesic methods may address the concern of bleeding complications associated with epidural anesthesia in open AAA repair. Although the efficacy and safety of ultrasound-guided nerve blocks, continuous local wound infiltration, and intravenous administration of lidocaine in open AAA repair have been evaluated in several studies, few studies have evaluated the efficacy of continuous nerve blocks compared with epidural anesthesia. In this article, the authors present a narrative review of pain management techniques used in open AAA repair, focusing on pain management techniques other than epidural anesthesia. Research gaps and the need for further studies on this topic are also discussed.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931906","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":"Successful Perioperative Monitoring of the Right Ventricular Pressure: Development and Evaluation of a New Pulmonary Artery Catheter.","authors":"Aaron Wozolek, Leah Soto, Etienne Couture, Tjorvi Perry, Jennifer Cutler, Peiman Lahsaei, Jonathan Leff, Kevin Moses, Cristhian Potes, Daniel Scherb, Antoine Rochon, André Y Denault","doi":"10.1053/j.jvca.2024.12.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.033","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931909","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":"Sex-Based Differences in Ruptured Abdominal Aortic Aneurysm Management and Outcomes: An Update.","authors":"Shirin Saeed, Mark Robitaille, Usman Ahmed, Rayaan A Yunus, Mahnoor Sohail, Nadav Levy, Sara Neves, Marc L Schermerhorn, Robina Matyal, Feroze Mahmood","doi":"10.1053/j.jvca.2024.12.025","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.025","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate sex-based differences in outcomes following ruptured abdominal aortic aneurysm (AAA) repair, focusing on mortality, morbidity, and postoperative complications.</p><p><strong>Design: </strong>Retrospective cohort study SETTING: Multi-institutional data from the Vascular Quality Initiative national database, covering a period from January 2003 to December 2022.</p><p><strong>Participants: </strong>We included 7,548 patients undergoing open or endovascular repair for ruptured AAA: 5,829 men (77.2%) and 1,719 women (22.8%).</p><p><strong>Interventions: </strong>Patients underwent either open surgical repair or endovascular aneurysm repair for ruptured AAA.</p><p><strong>Measurements and main results: </strong>Between 2003 and 2022, the rate of mortality decreased significantly for both sexes (57.1% to 31.6% in women and 38.5% to 19.6% in men). Men had a higher incidence of coronary artery disease (22.7% v 17.3%; p < 0.001), more frequent occurrences of prior percutaneous coronary intervention (12.8% v 10.2%; p = 0.004), and previous aneurysm repair (7.2% v 5.3%; p = 0.005) compared with women. Men demonstrated worse cardiovascular (OR 0.82 [0.72-0.94]; p = 0.005) and pulmonary (OR 0.86 [0.73-1.00]; p = 0.025) complications. Women exhibited higher in-hospital mortality (OR 1.27 (1.12-1.44); p < 0.001) and presented at an older age (76.0 years v 71.0 years; p < 0.001), with a higher incidence of hypertension (78.1% v 75.0%; p = 0.008). Women experienced a significantly longer average time from symptom onset to repair (8.00 hours v 7.00 hours; p = 0.002).</p><p><strong>Conclusions: </strong>Significant sex-based disparities were found in AAA repair outcomes. Men had higher comorbidity burdens while women presented at an older age with an increased time from symptom onset to repair. These findings support the need for sex-specific guidelines and interventions to improve outcomes for both women and men.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965130","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 Effect of Extracorporeal Membrane Oxygenation on the Pharmacokinetics of Dexmedetomidine Hydrochloride.","authors":"Tao Wang, Huifang Zhang, Rui Tian, Liu Rong, Kaige Yang, Yan Wang, Ruilan Wang","doi":"10.1053/j.jvca.2024.12.029","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.029","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to explore the effects of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics of dexmedetomidine hydrochloride via vitro and in vivo experiments DESIGN: A single-center animal investigation.</p><p><strong>Setting: </strong>An experimental animal facility in a tertiary hospital.</p><p><strong>Participants: </strong>Eighteen male Landrace pigs.</p><p><strong>Interventions: </strong>For the in vitro experiment, ECMO circuits were primed with whole blood solutions of dexmedetomidine at different concentrations and ran ex vivo. The adsorption rates of dexmedetomidine hydrochloride in ECMO circuits and control glass tubes were compared at 60 minutes, 5 hours, and 10 hours after the start of the in vitro experiment. In the in vivo experiment, 12 Landrace pigs were randomly allocated to the venovenous ECMO group or the control group. Dexmedetomidine hydrochloride (1 μg/kg) was administered to both groups. Blood samples were collected at 0 minutes, 5 minutes, 10 minutes, 15 minutes, 20 minutes, 30 minutes, 45 minutes, 60 minutes, 90 minutes, 2 hours, 3 hours, 5 hours, 7 hours, and 10 hours after administration. The plasma concentrations of dexmedetomidine were measured, and pharmacokinetic analysis was conducted in both groups.</p><p><strong>Measurements and main results: </strong>The results revealed no significant difference in adsorption rates of dexmedetomidine hydrochloride in ECMO circuits at 60 minutes and 5 hours, but differences were observed at 10 hours. In vivo experiment, pharmacokinetic analysis revealed no significant difference in the area under the curve (AUC_0-t), AUC_0-∞, distribution half-life, elimination half-life, clearance, apparent volume of distribution, mean residence time or peak drug concentrations between the 2 groups (p > 0.05).</p><p><strong>Conclusions: </strong>The ECMO circuit had an adsorption effect on dexmedetomidine hydrochloride, but this effect was not sufficient to impact the in vivo pharmacokinetics of dexmedetomidine significantly. The effect of ECMO on the pharmacokinetics of dexmedetomidine hydrochloride was not significant.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949350","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}