Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients: A Report by Society of Cardiovascular Anesthesiologists","authors":"Benu Makkad MBBS, MD ,&nbsp;Timothy Lee Heinke MD ,&nbsp;Raiyah Sheriffdeen MD ,&nbsp;Marie-Louise Meng MD ,&nbsp;Bessie Kachulis MD ,&nbsp;Michael Conrad Grant MD ,&nbsp;Wanda Maria Popescu MD ,&nbsp;Jessica Louise Brodt MD ,&nbsp;Diana Khatib MD ,&nbsp;Christopher L. Wu MD ,&nbsp;Miklos D. Kertai MD, MMHC, PhD ,&nbsp;Bruce Allen Bollen MD","doi":"10.1053/j.jvca.2024.10.014","DOIUrl":"10.1053/j.jvca.2024.10.014","url":null,"abstract":"<div><div>Moderate to severe pain after cardiac surgery is relatively common, which increases the risk of postoperative cardiopulmonary complications and delays hospital discharge. Opioids have been useful agents for postoperative pain control after cardiac surgery, but are associated with serious adverse effects. As a result, multimodal analgesia has been adopted widely to decrease reliance on opioids for treating postoperative pain, reduce opioid-related adverse effects, and promote early recovery. The advent of fascial plane blocks has expanded the use of regional analgesia for pain management after cardiac surgery that was otherwise limited due to the fear of devastating neurological sequelae in the setting of systemic anticoagulation. This practice advisory reviews and evaluates the recent literature related to the use of pharmacological and non-pharmacological therapies to treat pain after cardiac surgery to help providers with the selection of appropriate pain management interventions for their patients.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 770-784"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038711","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 BSc ,&nbsp;Jeffrey Balzer PhD","doi":"10.1053/j.jvca.2024.12.030","DOIUrl":"10.1053/j.jvca.2024.12.030","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 849-851"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","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":"Intraoperative Hemolysis Monitoring by Real-time Point-of-care in Patients Undergoing Cardiopulmonary Bypass in Cardiac Surgery: A Single-centre Prospective Observational Study","authors":"Lorenzo Schiavoni MD ,&nbsp;Mariapia Stifano MD ,&nbsp;Francesca La Verde MD ,&nbsp;Alessandro Strumia MD ,&nbsp;Annalaura Di Pumpo MD ,&nbsp;Domenico Sarubbi MD ,&nbsp;Stefano Rizzo MD ,&nbsp;Maria Cristina Conti MD ,&nbsp;Lara Mortini MD ,&nbsp;Rita Cataldo MD ,&nbsp;Fabio Costa MD ,&nbsp;Giuseppe Pascarella MD ,&nbsp;Alessandro Rita ,&nbsp;Elena Casali ,&nbsp;Felice Eugenio Agrò MD ,&nbsp;Massimiliano Carassiti MD ,&nbsp;Alessia Mattei MD","doi":"10.1053/j.jvca.2025.02.048","DOIUrl":"10.1053/j.jvca.2025.02.048","url":null,"abstract":"<div><h3>Objective</h3><div>Hemolysis is a complication in surgical procedures requiring cardiopulmonary bypass (CPB). The primary aim of this study was to evaluate the effectiveness of the point-of-care device Hemcheck Helge V-Test, quantifying hemolysis during cardiac surgery with CPB.</div></div><div><h3>Design</h3><div>Prospective-observational study.</div></div><div><h3>Setting</h3><div>Single-center study.</div></div><div><h3>Participants</h3><div>Patients undergoing elective cardiac surgery with CPB.</div></div><div><h3>Interventions</h3><div>Blood samples of 78 patients were simultaneously collected during surgery at T0: pre-CPB; T1: at aorta clamping; T2: at 20 minutes after the CPB start; T3: at the end of CPB; and T4: at the end of surgery. Samples were analyzed by the Hemcheck Helge V-Test device, which offers a real-time assessment of hemolysis through the value of plasma-free hemoglobin (PfHb) expressed in mg/dL.</div></div><div><h3>Measurements and Main Results</h3><div>No case of hemolysis (PfHb ≥50 mg/dL) was recorded at T0. The results recorded median PfHb values at T0 = 0.5 (0-7.1) mg/dL, T1 = 3.75 (0-14.4) mg/dL; T2 = 8.25 (0.4-19.1) mg/dL, T3 = 27.5 (9.9-50) mg/dL, and T4 = 18.5 (2.4-41) mg/dL; for all T times, p-values were &lt; 0.001. A statistically significant correlation was recorded between hemolysis values &gt;50 mg/dL at T3 and CPB time &gt;100 minutes (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>The use of Hemcheck Helge V-Test allows effective identification of hemolysis directly in the operating room, reducing wasted time for laboratory analyses. This could help the anesthesiologist, perfusionist, or cardiac surgeon address intraoperative hemolysis and its effects on organ function earlier and improve the postoperative course of patients undergoing cardiac surgery with CPB.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1432-1440"},"PeriodicalIF":2.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674044","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":"Acute Pain Management with Ultrasound-Guided Erector Spinae Plane Block and Serratus Anterior Plane Block in Patients Undergoing Coronary Artery Bypass via Mini-thoracotomy: A Randomized Controlled Trial","authors":"Ling Xin MD ,&nbsp;Lu Wang MD ,&nbsp;Yi Feng MD","doi":"10.1053/j.jvca.2025.02.045","DOIUrl":"10.1053/j.jvca.2025.02.045","url":null,"abstract":"<div><h3>Objective</h3><div>This study was designed to examine the analgesic efficacy of erector spinae plane (ESP) block or combined ESP and superficial serratus anterior plane (SAP) block in patients undergoing elective coronary artery bypass via mini-thoracotomy.</div></div><div><h3>Design</h3><div>Randomized controlled study.</div></div><div><h3>Setting</h3><div>Operating room, intensive care unit, and ward.</div></div><div><h3>Patients</h3><div>Fifty-four patients undergoing elective coronary artery bypass via mini-thoracotomy.</div></div><div><h3>Interventions</h3><div>Eligible patients were randomly allocated to single-ESP block (ESP group) or combined ESP and superficial SAP block (ESP+SAP group).</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome was dynamic numerical rating scale (NRS) scores (on coughing) for the surgical incision site 6 hours after skin closure. Secondary outcomes included dynamic NRS scores for surgical incision at 12, 18, 24, and 48 hours postoperatively plus NRS scores for the chest tube, hydromorphone consumption, quality of recovery, and adverse events within 48 hours postoperatively. The ESP+SAP group had lower dynamic NRS scores for surgical incision at postoperative 6 hours (mean difference: –2.1, 95% CI –2.8 to –1.4, adjusted p &lt; 0.001) and 12 hours (–1.3, 95% CI –2.0 to –0.7, adjusted p &lt; 0.001) compared to the ESP group. The ESP+SAP group also showed lower dynamic NRS scores for the chest tube at 6 hours (–1.4, 95% CI –2.0 to –0.9, adjusted p &lt; 0.001) and 12 hours (–1.2, 95% CI –1.7 to –0.6, adjusted p &lt; 0.001) postoperatively. Linear mixed-model analysis showed that NRS scores for the surgical incision and chest tube were lower in the ESP+SAP group compared to the ESP group (both p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Compared with ESP block alone, ESP combined with superficial SAP block reduced pain scores in patients undergoing coronary artery bypass via mini-thoracotomy.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1514-1521"},"PeriodicalIF":2.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691936","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 Starry Night: Dynamics of Color Doppler","authors":"Andrew Nguyen MD ,&nbsp;M. Haseeb Zubair MD","doi":"10.1053/j.jvca.2025.02.029","DOIUrl":"10.1053/j.jvca.2025.02.029","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1604-1605"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615488","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 Considerations for Robotic Liver Transplantation","authors":"Shourik Dutta MD ,&nbsp;Adeel S. Khan MD ,&nbsp;Chideraa C. Ukeje MD ,&nbsp;William C. Chapman MD ,&nbsp;Majella B. Doyle MD ,&nbsp;Meranda Scherer CRNFA ,&nbsp;G. Richard Benzinger MD, PhD ,&nbsp;Ivan M. Kangrga MD, PhD ,&nbsp;Jonathan K. Zoller MD","doi":"10.1053/j.jvca.2025.02.044","DOIUrl":"10.1053/j.jvca.2025.02.044","url":null,"abstract":"<div><div>Liver transplantation has traditionally been performed through a large, bilateral subcostal incision. Recently, liver transplant programs across the world, including our own, have reported successful liver transplants via total robotic approaches on recipients with low Model for End-stage Liver Disease scores and preexisting abdominal wall laxity. This review discusses the unique anesthetic considerations of robotic liver transplantation based on our group's initial experience with this novel surgical approach. Robotic liver transplantation presents a unique set of considerations and challenges for the anesthesiologist, and a thorough understanding of liver disease, liver transplant surgery, venovenous bypass, and the various implications of robotic surgery is essential to ensure optimal patient outcomes. Specific management topics discussed here include appropriate patient selection, preoperative assessment, and intraoperative management. We also discuss certain theoretical and actual challenges that our group has experienced.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1571-1582"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669996","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":"Multimodal Brain Monitoring in Cardiac Surgery and Postoperative Patient Outcomes","authors":"Tanya Mailhot RN, PhD ,&nbsp;Stéphanie Jarry MSc ,&nbsp;Zineb Bouaouina RN, BSc ,&nbsp;Soledad Tétreault BSc ,&nbsp;Marie Ouellet ,&nbsp;Rafal Fyda ,&nbsp;Camilla Lunghi ,&nbsp;Patrick Lavoie RN, PhD ,&nbsp;André Denault MD, PhD","doi":"10.1053/j.jvca.2025.02.046","DOIUrl":"10.1053/j.jvca.2025.02.046","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the occurrence of cerebral desaturation (≥10% decrease or &lt;50% in regional cerebral oxygen saturation [rSO₂]), deep anesthetic states (processed electroencephalography patient state index [PSI] &lt;25), and cerebral emboli load (high-intensity transient signals [HITS]) using multimodal neuromonitoring.</div></div><div><h3>Design</h3><div>Retrospective single-center cohort study.</div></div><div><h3>Setting</h3><div>University-affiliated cardiology center.</div></div><div><h3>Participants</h3><div>374 adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</div></div><div><h3>Intervention</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>Patients were categorized into 4 cerebral states based on rSO₂ desaturation and PSI &lt;25. In a subsample of 175 patients with transcranial Doppler (TCD) monitoring, patients were further classified into 8 groups based on desaturation, PSI &lt;25, and HITS severity. Logistic regression and analysis of variance were used to examine associations between cerebral states and outcomes, including CPB separation, duration of ventilation, length of intensive care unit (ICU)/hospital stay, and mortality. Patients with desaturation and PSI &lt;25 (state 4) had a higher EuroSCORE II, more comorbidities, longer CPB/aortic clamping times, and worse postoperative outcomes, including extended ICU and hospital stays. Within the TCD subsample, those with moderate-to-severe HITS alongside desaturation and PSI &lt;25 experienced the poorest outcomes, such as prolonged hospitalization and difficult CPB separation. Multivariable models confirmed associations with adverse outcomes, although some effects were attenuated after adjustment.</div></div><div><h3>Conclusions</h3><div>Multimodal neuromonitoring during cardiac surgery identified high-risk patients, particularly those with concurrent desaturation and burst suppression, who had significantly worse outcomes. Targeted interventions for these patients could improve outcomes. Future studies should investigate optimal management strategies for this high-risk group.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1422-1431"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811408","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":"Non–ST-Segment Elevation Myocardial Infarction in the Elderly: Is Medicine the Best Medicine?","authors":"John Guzzi MD ,&nbsp;Andrew P. Notarianni MD FASE FASA","doi":"10.1053/j.jvca.2025.02.038","DOIUrl":"10.1053/j.jvca.2025.02.038","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1376-1379"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673365","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":"2024 Clinical Update in Liver Transplantation","authors":"Trevor J. Wilke MD ,&nbsp;Emily A. Vail MD, MSc ,&nbsp;Andrew K. Gold MD ,&nbsp;Philip Mannes PhD ,&nbsp;Asad Ali Uman MD, MPH ,&nbsp;Dmitri Bezinover MD, PhD ,&nbsp;Jacek Cywinski MD, FASA ,&nbsp;Jean Beresian MD, FASE ,&nbsp;Matt W. Vanneman MD ,&nbsp;Cale A. Kassel MD, FASA","doi":"10.1053/j.jvca.2025.02.032","DOIUrl":"10.1053/j.jvca.2025.02.032","url":null,"abstract":"<div><div>In this review, the authors highlight recent advances in the care of liver transplantation patients important to anesthesiologists. The number of liver transplants continues to increase annually, and the challenges of managing complex patients require knowledge of the unique pathophysiology of end-stage liver disease. Regional anesthesia, specifically fascial plane blocks, allows for improved nonopioid pain control in recipients and potentially decreases length of stay. The use of transesophageal echocardiography (TEE) in liver transplantation allows for real-time assessment of cardiac function. Diagnosing the dreaded intracardiac thrombus with TEE during liver transplantation is essential for prompt treatment. Additionally, existing structural cardiac disease may lead to left ventricular outflow obstruction and require specific treatment modalities. Again, the use of TEE is important in making this diagnosis. Combined heart-liver transplantations are complex surgical procedures. The use of mechanical circulatory support may be necessary in some cases and anesthesiologists should understand the underlying disease process to inform the use of such support. Finally, living donation for liver transplantation remains an option for directed or anonymous donation. Anesthesiologists' role in managing donors starts in the evaluation process through postoperative pain management and showcases the broad skillset of anesthesiologists.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1547-1555"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585244","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":"Rescue Spinal Drain After High-Risk Thoracic Endovascular Aortic Repair Is a Patient Safety Issue for Anesthesiologists: The Need for Institutionalized Protocols.","authors":"Bradley Gigax, Anthony Wang, Kristine Orion, Hilary Grocott, Hamdy Awad","doi":"10.1053/j.jvca.2025.02.034","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.034","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615391","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}