Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Local Versus General Anesthesia for Endovascular Repair of Abdominal Aortic Aneurysm: A Systematic Review and Meta-analysis.","authors":"Luis Eduardo Rodrigues Sobreira, Marilia Pereira Costa, Clara Rocha Dantas, Anna Lydia Machado Silva, Altino Ono Moraes","doi":"10.1053/j.jvca.2025.03.036","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.036","url":null,"abstract":"<p><strong>Background: </strong>Endovascular aneurysm repair (EVAR) has become increasingly popular compared with open repair due to its minimally invasive approach for treating abdominal aortic aneurysms (AAAs). However, the ideal anesthetic choice for patients undergoing EVAR remains debated. While some advocate for local anesthesia (LA), others believe that general anesthesia (GA) offers certain advantages.</p><p><strong>Objective: </strong>To compare LA with GA in patients undergoing EVAR.</p><p><strong>Methods: </strong>A search was conducted in the PubMed, Scopus, Embase, and Cochrane databases, focusing on studies that compared postoperative outcomes. Data were pooled using fixed- or random-effects models, and results are given in mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was calculated using the I² statistic. All statistical analyses were performed using R software.</p><p><strong>Results: </strong>A total of 16 studies were included, comprising 45,566 patients. LA was associated with a decline in total hospital stay (MD: -1.00 day, 95% CI: -1.38 to -0.63, p < 0.01), myocardial infarction (OR: 0.52, 95% CI: 0.29 to 0.93, p = 0.02), and pneumonia (OR: 0.25, 95% CI: 0.11 to 0.55, p < 0.01). The LA group had an insignificant association with lower incidence of mortality (OR: 0.85, 95% CI: 0.64 to 1.13, p = 0.26) and in intensive care unit length of stay (MD: -0.20 day, 95% CI: -0.47 to 0.07, p = 0.14).</p><p><strong>Conclusion: </strong>These results indicate that patients treated with LA are likely to be discharged more quickly and experience fewer adverse events.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036156","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":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(25)00153-3","DOIUrl":"10.1053/S1053-0770(25)00153-3","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 4","pages":"Page xii"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680041","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":"Clinical Approach to Central Airway Obstruction in Adult Patients: Perioperative Focus on Causes and Management Including Tracheobronchial Stenting.","authors":"Eugene MingJin Gan, Haoyuan Lim, Carrie Kah-Lai Leong, Sau Yee Chow, Kai Wen Hwang, Nian Chih Hwang","doi":"10.1053/j.jvca.2025.03.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.032","url":null,"abstract":"<p><p>Central airway obstruction (CAO) is a life-threatening condition associated with poor prognosis. Therapeutic bronchoscopy along with systemic therapies significantly improve survival and quality of life in patients with symptomatic benign and malignant CAO. Endoluminal therapies and tracheobronchial stenting may be used, and a multidisciplinary approach is essential for holistic management of CAO. Perioperative planning and evaluation, as well as attention to intraoperative and postoperative management are key to optimal outcomes. This review provides an overview of the etiology and clinical approach to CAO, perioperative considerations for endoluminal therapies and tracheobronchial stenting, perioperative evaluation and preparation for therapeutic bronchoscopy, and management of operative and postoperative challenges in CAO.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965590","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":"Does Benzodiazepine-Free Cardiac Anesthesia Reduce Postoperative Delirium?","authors":"Bridget Si Min Ng, Priscilla Hui Yi Phoon, Nian Chih Hwang","doi":"10.1053/j.jvca.2025.03.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019408","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":"Do or Do Not Anticoagulate After Catheter Ablation in Atrial Fibrillation","authors":"Christopher Collins MD ,&nbsp;Theodore J. Cios MD, MPH, FASA FASE ,&nbsp;Salman Zaheer MD","doi":"10.1053/j.jvca.2025.03.030","DOIUrl":"10.1053/j.jvca.2025.03.030","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1622-1625"},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016303","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":"Perioperative Incidence of Acute Renal Failure in Aortic Arch Reconstruction Using Retrograde Selective Lower Body Perfusion in Neonates and Infants","authors":"Thomas Simon Zajonz MD ,&nbsp;Fabian Edinger MD ,&nbsp;Ronja Beran BSc ,&nbsp;Niklas Sturm BSc ,&nbsp;Uygar Yoerueker MD ,&nbsp;Hakan Akintuerk MD ,&nbsp;Matthias Friedrich Mueller MD","doi":"10.1053/j.jvca.2025.03.028","DOIUrl":"10.1053/j.jvca.2025.03.028","url":null,"abstract":"<div><h3>Objective</h3><div>Examination of the impact of retrograde selective lower body perfusion (SLP) via a femoral arterial catheter on urine output and the incidence of acute kidney injury (AKI) during pediatric aortic arch reconstructions. The secondary objective was if the cannulation of the superficial femoral artery was associated with complications in the perfusion area.</div></div><div><h3>Design</h3><div>A retrospective study over an 8-year period (January 2015 to December 2023).</div></div><div><h3>Setting</h3><div>Pediatric heart center of a tertiary care hospital.</div></div><div><h3>Participants</h3><div>Neonates and infants (N = 104) undergoing elective aortic arch reconstruction with cardiopulmonary bypass, of whom 45 received retrograde SLP.</div></div><div><h3>Interventions</h3><div>Retrograde SLP via ultrasound-guided, weight-adapted femoral artery catheters for retrograde perfusion during clamping of the descending aorta under surgery, compared to a control group with identical surgical, perfusion, and anesthesiologic management but without SLP.</div></div><div><h3>Measurements and Main Results</h3><div>Perioperative AKI incidence was analyzed using KDIGO criteria at multiple predetermined time points, along with urinary output. The SLP group showed a significantly lower AKI incidence immediately and 6 hours postsurgery (p = 0.001). Higher urine output postoperatively until day 3 (p ≤ 0.045) in the SLP group. No vascular complications were observed until hospital discharge.</div></div><div><h3>Conclusions</h3><div>Retrograde SLP is associated with a reduced AKI incidence and increased postoperative urine output, without vascular complications. Further studies are needed to investigate the long-term effects of retrograde SLP on renal function.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1738-1745"},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968337","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":"Associations Between Base Excess, Alactic Base Excess, and Kidney Function Deterioration in Patients Undergoing Coronary Artery Bypass Grafting Surgery: A Retrospective Cohort Study","authors":"Zheng Li ,&nbsp;Da Qian ,&nbsp;Yanfei Xia ,&nbsp;Kai Kang ,&nbsp;Tonghui Feng","doi":"10.1053/j.jvca.2025.03.033","DOIUrl":"10.1053/j.jvca.2025.03.033","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore the relationship between base excess (BE), alactic BE (aBE), and the deterioration of kidney function in patients undergoing coronary artery bypass grafting (CABG) surgery.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting</h3><div>The Medical Information Mart for Intensive Care IV (MIMIC-IV) database.</div></div><div><h3>Participants</h3><div>Patients undergoing CABG surgery.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>The outcome was kidney function deterioration, including new-onset acute kidney injury (AKI) and increased severity of AKI. Univariate and multivariate logistic regression models were conducted to explore the associations between baseline BE, aBE levels, and kidney function deterioration in patients undergoing CABG surgery. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Covariates were adjusted for, including sepsis, weight, pulse oximetry-derived oxygen saturation, Simplified Acute Physiology Score II, Charlson Comorbidity Index, partial thromboplastin time, vasopressor use, loop diuretics, blood infusions, and acetaminophen use. In total, 5,634 individuals were included who underwent CABG surgery. BE ≤2.61 (OR= 1.22, 95% CI: 1.05-1.41) and aBE ≤1.038 (OR = 1.19, 95% CI: 1.02-1.38) were related to the higher incidence of kidney function deterioration. aBE ≤1.038 (OR = 1.26, 95% CI: 1.01-1.57) was linked to a higher incidence of new onset of AKI. In patients who had AKI at baseline, BE ≤2.61 (OR = 1.88, 95% CI: 1.47-2.41) and aBE ≤1.038 (OR = 1.82, 95% CI: 1.42-2.33) were also related to increased odds of AKI recovery. The relationships between lower BE and aBE and higher odds of kidney function deterioration were also found in those aged ≥65 years, males, patients without chronic kidney disease, patients given vasopressors, and those not administered loop diuretics, nephrotoxic antibiotics, blood infusions, and acetaminophen.</div></div><div><h3>Conclusion</h3><div>Lower BE and aBE values are associated with an increased risk of kidney function deterioration in patients undergoing CABG surgery. BE and aBE could serve as early markers of kidney injury.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1706-1714"},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020205","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":"Advances in Cardiovascular Pharmacotherapy. II. Ivabradine, an Inhibitor of the Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel","authors":"Paul S. Pagel MD, PhD ,&nbsp;Dustin Hang MD ,&nbsp;Julie K. Freed MD, PhD ,&nbsp;George J. Crystal PhD","doi":"10.1053/j.jvca.2025.03.029","DOIUrl":"10.1053/j.jvca.2025.03.029","url":null,"abstract":"<div><div>Ivabradine selectively reduces heart rate by inhibiting the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel in the sinoatrial node. Unlike other medications that produce negative chronotropic effects [beta-blockers, calcium channel blockers], ivabradine does not affect systemic, pulmonary, and coronary hemodynamics. Despite several proof-of-concept clinical studies suggesting that ivabradine may exert anti-ischemic effects, two large randomized trials did not support its use in patients with chronic stable angina. Preliminary data also did not support the use of ivabradine in patients with acute ST-segment elevation myocardial infarction or acutely decompensated heart failure. However, ivabradine improved outcome in patients with heart failure with reduced ejection fraction (HFrEF), leading to its approval by the Food and Drug Administration, but the drug failed to do so in those with heart failure with preserved ejection fraction (HFpEF). Ivabradine may also be useful in cardiac electrophysiology disorders characterized by tachycardia (e.g., inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome), but it has not yet gained wide acceptance for these indications. In this article, the authors briefly review the structure and function of the cardiac HCN channel; discuss the development and actions of drugs, including ivabradine, that modulate the channel's activity; describe in detail the potential clinical applications of ivabradine in patients with coronary artery disease, HFrEF and HFpEF, and cardiac electrophysiology; comment on the adverse effects of ivabradine therapy; and finally, consider the potential anesthetic implications of ivabradine in patients undergoing noncardiac and cardiac surgery.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1795-1814"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811406","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":"Evaluation of the Spread and Effect of Local Anesthetic Administered Using Thoracic Muscle Plane Block on Internal Thoracic Artery Grafts","authors":"Tomohiro Yamamoto MD, PhD ,&nbsp;Nobuko Ohashi MD, PhD ,&nbsp;Takehito Mishima MD, PhD ,&nbsp;Shuichi Shiraishi MD, PhD","doi":"10.1053/j.jvca.2025.03.027","DOIUrl":"10.1053/j.jvca.2025.03.027","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the spread and effect of local anesthetic administered using transverse thoracic muscle plane block (TTPB) in the tissue surrounding the internal thoracic artery (ITA) during ITA graft harvesting.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>Single hospital.</div></div><div><h3>Participants</h3><div>This study included 60 adult patients undergoing cardiac surgery with a median sternotomy.</div></div><div><h3>Interventions</h3><div>The change in peri-ITA tissue properties before and after TTPB with 20 mL local anesthetics on each side at the T4-T5 intercostal level was evaluated using transthoracic echocardiography in 47 patients. The peri-ITA tissue properties were evaluated from the internal side of sternum using a T-shaped ultrasound probe at the T4-T5 intercostal level after median sternotomy and the dissection of the sternal back side tissue to the ITA region in 30 patients. Seventeen patients underwent both evaluations.</div></div><div><h3>Measurements and Main Results</h3><div>The ITA identifying rate using transthoracic echocardiography was 90.4%. A weak correlation was observed between the distance from the sternum to ITA and patient height. The 20 mL local anesthetics administered using TTPB spread laterally to the ITA area in all identified ITAs. However, the evaluation from the internal side of the sternum using a T-shaped ultrasound probe revealed that the property changes in the peri-ITA tissue had completely disappeared in all cases. The minimum time from TTPB implementation to this observation was 50 minutes.</div></div><div><h3>Conclusions</h3><div>TTPB can be performed safely on patients undergoing coronary artery bypass grafting using ITAs without affecting the ITA graft properties and patency.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1715-1721"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795421","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":"Low versus High Fraction of Inspired Oxygen During Lung Separation in Thoracic Surgery: A Randomized Controlled Trial","authors":"Patrick Spraider PhD ,&nbsp;Julia Abram MD ,&nbsp;Dieter Wally MD ,&nbsp;David Bernardi ,&nbsp;Florian Augustin MD ,&nbsp;Tobias Hell PhD ,&nbsp;Pia Tscholl MDS ,&nbsp;Hannes Dejaco MD","doi":"10.1053/j.jvca.2025.03.031","DOIUrl":"10.1053/j.jvca.2025.03.031","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate whether a lower fraction of inspired oxygen (FiO₂) during the early phase of lung separation is able to improve overall oxygenation of the blood assessed by the arterial partial pressure of oxygen (PaO₂)/FiO₂ ratio, and to investigate its effect on lung collapse and postoperative pulmonary complications (PPC).</div></div><div><h3>Design</h3><div>Prospective, nonblinded, randomized controlled trial.</div></div><div><h3>Setting</h3><div>Single-center trial at a university hospital.</div></div><div><h3>Participants</h3><div>Patients scheduled for thoracic surgery requiring one-lung ventilation (OLV).</div></div><div><h3>Interventions</h3><div>Study participants received either a low and then increasing oxygen concentration after lung separation or pure oxygen and then a decreasing oxygen concentration.</div></div><div><h3>Measurements and Main Results</h3><div>The primary endpoint was the PaO₂/FiO₂ ratio 30 minutes after the start of OLV. Secondary endpoint included lung collapse defined as none, partial, or complete during the early phase of OLV and incidence of PPC. A total of 55 patients were enrolled, 53 of whom were included in the analysis. The primary endpoint, PaO₂/FiO₂ ratio, was comparable in the 2 groups, and the secondary endpoint, lung collapse, was similar. However, the incidence of PPC was significantly reduced with a low oxygen content strategy (19% vs 48%; p = 0.042).</div></div><div><h3>Conclusions</h3><div>A strategy of low FiO₂ before and after lung separation did not improve the oxygenation capacity of the lungs, and lung collapse was comparable in the 2 study groups. However, the occurrence of PPC was significantly reduced in the group treated with low FiO₂.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1746-1754"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003277","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}