Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Remimazolam Use in Cardiac Anesthesia: A Narrative Review.","authors":"Brandon Muncan, Elliott Bennett-Guerrero","doi":"10.1053/j.jvca.2024.07.045","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.07.045","url":null,"abstract":"<p><p>Remimazolam, a novel ultra-short-acting intravenous benzodiazepine, has garnered recent attention for its use as a general anesthetic. This narrative review aims to summarize and analyze the available literature on the effects of remimazolam use in cardiac surgical patients, including its effects on hemodynamics, safety in patients with baseline myocardial dysfunction, and impact on postoperative management including time to emergence and extubation. Finally, there is discussion regarding potential drawbacks of adopting remimazolam as a routine anesthetic for cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107792","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":"Air Quality and Cardiovascular Mortality: Analysis of Recent Data","authors":"","doi":"10.1053/j.jvca.2024.07.042","DOIUrl":"10.1053/j.jvca.2024.07.042","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107805","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":"An Unusual Complication of Early Prosthetic Valve Endocarditis.","authors":"Meera Rajeev, Sarvesh Pal Singh, Dhruv Raheja, Mayank Yadav, Sourabh Agstam","doi":"10.1053/j.jvca.2024.07.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.07.028","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093192","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":"An Update on Guidelines to Prevent and Manage Atrial Fibrillation After Cardiac Surgery and a Survey of Practice in the UK","authors":"","doi":"10.1053/j.jvca.2024.07.043","DOIUrl":"10.1053/j.jvca.2024.07.043","url":null,"abstract":"<div><h3>Objectives</h3><p>Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and affects around 30% of patients. Variable guidelines from multiple organizations exist for the prevention of POAF after cardiac surgery. A survey of UK practice was conducted to define “usual care” for a platform trial of interventions to prevent POAF after cardiac surgery. To provide context for the survey, all current guidelines for the prevention and management of atrial fibrillation (AF) after cardiac surgery were reviewed.</p></div><div><h3>Design</h3><p>Online survey and literature review.</p></div><div><h3>Setting</h3><p>All 35 UK National Health Service Cardiac Surgery Centres participated in the survey. Guidelines from specialist societies and other guideline-making organizations from the UK, Europe, and North America were reviewed.</p></div><div><h3>Participants</h3><p>Established a link network of researchers.</p></div><div><h3>Measurements and Main Results</h3><p>Five relevant guidelines were identified from the literature review. All guidelines recommend β-blockade for prevention of AF after cardiac surgery. Treatment of AF is recommended using either rate or rhythm control. Cardioversion is recommended only for the hemodynamically unstable patient. Patients who remain in AF for over 48 hours should be considered for anticoagulation. Patients should be followed up within 60 days to review the need for antiarrhythmic and anticoagulant therapy. Of 35 centers, 31 (89%) responded. A total of 11 of 31 (35.5%) centers followed local guidance for prevention of POAF, 4 (13%) centers followed Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthesia guidelines, 4 (13%) followed UK National Institute of Health and Care Excellence guidance and 4 followed “other” guidance. Of 31 centers, 8 (26%) followed no guidelines to prevent POAF; 28 of 31 (90%) centers did not risk-stratify their patients for POAF. Most centers (23/31, 74%) did not have a care package in place to prevent POAF, but 14 of 31 (45%) try in some way to prevent AF in patients presenting with sinus rhythm. The most common interventions to prevent POAF are β-blocker use postoperatively (23/31, 74%), magnesium (20/31, 64.5%), and maintaining a serum K⁺ ≥4.5 mmol/L (26/31, 84%).</p></div><div><h3>Conclusions</h3><p>Guidance to prevent AF after cardiac surgery centers around the use of β-blockade. Although patients in the UK do not appear to be risk-assessed for POAF, the main interventions used to prevent it are similar: β-blockade and maintenance of serum K⁺ and Mg²⁺ levels.</p></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053077024005032/pdfft?md5=48503418537ec89e080e1775c42e5143&pid=1-s2.0-S1053077024005032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Scleroderma and Coronary Vasospasm After Cardiac Surgery: A Serious Combination","authors":"","doi":"10.1053/j.jvca.2024.07.030","DOIUrl":"10.1053/j.jvca.2024.07.030","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843111","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":"Effect of Bilateral Erector Spinae Plane Block versus Fentanyl Infusion on Postoperative Recovery in Cardiac Surgeries via Median Sternotomy: A Randomized Controlled Trial","authors":"","doi":"10.1053/j.jvca.2024.07.041","DOIUrl":"10.1053/j.jvca.2024.07.041","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) on the time to extubation in patients who had undergone cardiac surgery through a midline sternotomy.</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>Cairo University Hospital and National Heart Institute, Egypt.</div></div><div><h3>Participants</h3><div>Patients aged 18 to 70 years who underwent a cardiac surgical procedure through a midline sternotomy.</div></div><div><h3>Interventions</h3><div>Recruited patients were randomized to receive either preoperative single-shot ultrasound-guided bilateral ESPB or fentanyl infusion.</div></div><div><h3>Measurements</h3><div>The primary outcome was the time to extubation. Other outcomes included total perioperative fentanyl consumption, pain score using the numerical rating score (NRS), length of intensive care unit (ICU) stay, and incidence of perioperative complications.</div></div><div><h3>Main Results</h3><div>Two hundred and nineteen patients were available for final analysis. The mean time to extubation was significantly shorter In the ESPB group compared to the control group (159.5 ± 109.5 minutes vs 303.2 ± 95.9 minutes; mean difference, -143.7 minutes; 95% confidence interval, -171.1 to -116.3 minutes; p = 0.0001). Ultra-fast track (immediate postoperative) extubation was achieved in 23 patients (21.1%) in the ESPB group compared to only 1 patient (0.9%) in the control group. The ICU stay was significantly reduced in the ESPB group compared to the control group (mean, 47.2 ± 13.3 hours vs 78.9 ± 25.2 hours; p = 0.0001). There was a more significant reduction in NRS in the ESPB group compared to the control group for up to 24 hours postoperatively (p = 0.001).</div></div><div><h3>Conclusions</h3><div>Among adult patients undergoing cardiac surgery through a midline sternotomy, the extubation time was halved in patients who received single-shot bilateral ESPB compared to patients who received fentanyl infusion.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841504","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":"Association Between Right Ventricular Systolic Parameters Measured by Echocardiography and Stroke Volume Derived From Pulmonary Artery Catheter in Ischemic Cardiogenic Shock","authors":"","doi":"10.1053/j.jvca.2024.07.024","DOIUrl":"10.1053/j.jvca.2024.07.024","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the right ventricular (RV) systolic function echocardiographic parameter best associated with native stroke volume (SV) by thermodilution via a pulmonary artery catheter (PAC) in patients admitted to intensive care with ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS).</div></div><div><h3>Design, Setting, and Participants</h3><div>An observational cohort study of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, United Kingdom.</div></div><div><h3>Interventions</h3><div>Simultaneous collection of comprehensive transthoracic echocardiographic, clinical, and PAC-derived hemodynamic data. Seven RV systolic function parameters were correlated with the PAC-derived SV.</div></div><div><h3>Measurements and Main Results</h3><div>The median patient age was 61 years (interquartile range [IQR], 52-67 years), and 36 of the 43 patients (84%) were male. The median PAC-derived SV and left ventricular ejection fraction were 57 mL (IQR, 39-70 mL) and 31% (IQR, 22%-35%), respectively. The RV outflow tract velocity time integral (RVOT VTI) and tricuspid plane systolic excursion (TAPSE) correlated significantly with the PAC-derived SV (<em>r</em> = 0.42 [p = 0.007] and <em>r</em> = 0.37 [p = 0.02], respectively). The RVOT VTI was independently associated with and predicted low PAC-derived SV (odds ratio, 1.3; p = 0.03) with a good area under the curve (AUC = 0.71; p = 0.02). An RVOT VTI &lt;12.7 cm predicted low PAC-derived SV with a sensitivity of 66% and specificity of 72%.</div></div><div><h3>Conclusions</h3><div>RVOT VTI is the echocardiographic RV systolic function parameter that best correlates with PAC-derived native SV in patients with STEMI complicated by CS. This parameter can help guide the hemodynamic management of this cohort.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842505","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":"Unraveling a Cause for Right Ventricular Dilation","authors":"","doi":"10.1053/j.jvca.2024.07.034","DOIUrl":"10.1053/j.jvca.2024.07.034","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843590","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":"Intrinsic or Nonintrinsic End-stage Liver Disease and Its Association With Thromboelastography-based Coagulation States in Patients Undergoing Liver Transplantation: A Retrospective Cohort Study","authors":"","doi":"10.1053/j.jvca.2024.07.036","DOIUrl":"10.1053/j.jvca.2024.07.036","url":null,"abstract":"<div><h3>Objectives</h3><p>Perioperative coagulation management in liver transplantation recipients is challenging. Viscoelastic testing with rotational thromboelastography (TEG) can help quantify hemostatic profiles. The current work aimed to investigate whether the etiology of end-stage liver disease, pretransplant disease severity, or pretransplant thrombotic or bleeding complications are associated with specific TEG patterns.</p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting</h3><p>Single quaternary care hospital.</p></div><div><h3>Participants</h3><p>A total of 1,078 adult liver transplant patients.</p></div><div><h3>Interventions</h3><p>The primary exposure was the etiology of end-stage liver disease classified as either intrinsic or nonintrinsic (eg, biliary obstruction or cardiovascular). Secondary exposures were patients’ preoperative Model for End-Stage Liver Disease (MELD) score, Child-Pugh class, presence of major preoperative thrombotic complications, and major bleeding complications.</p></div><div><h3>Measurements and Main Results</h3><p>Patients with intrinsic liver disease (84%) showed higher odds of hypocoagulable (odds ratio [OR]: 3.70, 95% confidence interval [CI]: 1.94-7.07, p &lt; 0.0001) and mixed TEG patterns (OR: 4.59, 95% CI: 2.07-10.16, p = 0.0002) compared with those with nonintrinsic disease. Increasing MELD scores correlated with higher odds of hypocoagulable (OR: 1.14, 95% CI: 1.08-1.19, p &lt; 0.0001) and mixed TEG patterns (OR: 1.08, 95% CI: 1.03-1.14, p = 0.0036). Child-Pugh class C was associated with higher odds of hypocoagulable (OR: 8.55, 95% CI: 3.26-22.42, p &lt; 0.0001) and mixed patterns (OR: 12.48, 95% CI: 3.89-40.03, p &lt; 0.0001). Major preoperative thrombotic complications were not associated with specific TEG patterns, although an interaction with liver disease severity was observed.</p></div><div><h3>Conclusions</h3><p>Liver transplantation candidates with intrinsic liver disease tend to exhibit hypocoagulable TEG patterns, while nonintrinsic disease is associated with hypercoagulability. Increasing end-stage liver disease severity, as evidenced by increasing MELD scores and higher Child-Pugh classification, was also associated with hypocoagulable TEG patterns.</p></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053077024004968/pdfft?md5=0b1bab0af67a1e48a64dd91251819295&pid=1-s2.0-S1053077024004968-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Arrest in a Patient Unveils Pheochromocytoma With Rare Clinical Manifestation Requiring Extracorporeal Membrane Oxygenation and Urgent Surgery","authors":"","doi":"10.1053/j.jvca.2024.07.026","DOIUrl":"10.1053/j.jvca.2024.07.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}