Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Combined Use of Dexmedetomidine and Hydrocortisone to Prevent New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: A Randomized Clinical Trial.","authors":"Mohamed Alaaeldin Alhadidy, Adel Mohamed Alansary, Sarah Hamdy Elghareeb","doi":"10.1177/10892532251338374","DOIUrl":"https://doi.org/10.1177/10892532251338374","url":null,"abstract":"<p><p><b>Objective</b>: Postoperative atrial fibrillation (POAF) occurs in 20%-40% of patients following coronary artery bypass grafting (CABG), contributing to significant morbidity. POAF is linked to elevated catecholamines, oxidative stress, and inflammatory mediators. Dexmedetomidine, a centrally acting alpha-2 agonist with sympatholytic and anti-inflammatory effects, and hydrocortisone, which suppresses inflammatory mediators, may reduce the incidence of POAF. <b>Methods</b>: A prospective, double-blind randomized controlled trial was conducted on 248 patients undergoing elective on-pump CABG at Ain Shams University Hospital. Patients were randomized into 2 groups: the Treatment Group received dexmedetomidine and hydrocortisone, and the Placebo Group received standard care. The primary endpoint was the occurrence of POAF within 7 days postoperatively. <b>Results</b>: All 248 patients (124 per group) completed the study. The combined use of dexmedetomidine and hydrocortisone reduced POAF incidence (4.8% vs 12.9%). ICU and hospital length of stay were also shorter in the Treatment Group (2.77 ± 1.12 vs 3.16 ± 1.34 days, <i>P</i> = .012, and 6.63 ± 1.56 vs 7.11 ± 2 days, <i>P</i> = .035, respectively). No differences in hypotension, bradycardia, or wound infections were observed. Hyperglycemia, defined as blood glucose >180 mg/dl, occurred in 8.1% of the Treatment Group and 6.5% of the Placebo Group. <b>Conclusion:</b> Combining dexmedetomidine and hydrocortisone effectively reduces POAF incidence after CABG, with manageable side effects. Multicenter trials are warranted to confirm these findings. <i>Date and Number of IRB Approval and Clinical Trial Registry Number</i>. Ain Shams University Protocol Record (FMASU R 261/2022), ClinicalTrials.gov Identifier: NCT05674253.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251338374"},"PeriodicalIF":1.1,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Nerve Blocks Used in Renal Transplantation and Donor Nephrectomy: A Narrative Review.","authors":"Michael Hill-Oliva, Natalie K Smith, Ryan Wang","doi":"10.1177/10892532251334691","DOIUrl":"https://doi.org/10.1177/10892532251334691","url":null,"abstract":"<p><p>Perioperative opioid-related adverse drug events have been associated with increased length of hospitalization, higher costs, and increased patient mortality. Consequently, alternative means of analgesia, which may mitigate these risks, are important to explore. Peripheral nerve blocks (PNBs), including transversus abdominis block (TAPB), quadratus lumborum block (QLB), and erector spinae plane block (ESPB), have been used to reduce opioid requirements after renal transplant and donor nephrectomy. TAPB is most frequently studied; however, few studies compare approaches. PubMed was queried on July 13th 2022 and again on April 14th 2024 for studies on the use of regional analgesia for kidney transplantation and donor nephrectomy. This review surveys 29 publications that empirically investigated use of a PNB alone or as part of enhanced recovery after surgery (ERAS) protocols for patients undergoing renal transplant or donor nephrectomy, summarizing the evidence for each PNB. We found that TAPB was the most studied technique, and that few studies compared analgesic techniques. Overall, this body of research supports the use of TAPB to reduce pain and opioid requirements in the postoperative period after renal transplantation. Fewer studies support the use of TAPB following donor nephrectomy or the use of other PNBs for either procedure. Future studies may further investigate the use of TAPB after donor nephrectomy, compare various PNBs to TAPB, and investigate long-term outcomes.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251334691"},"PeriodicalIF":1.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etomidate vs Ketamine-Propofol for Induction of Anesthesia in Coronary Artery Bypass Grafting: An Updated Systematic Review and Meta-Analysis.","authors":"Nicolas Kumar, Amit Bardia, Michael G Fitzsimons, Michael Essandoh, Justin Mitchell, Samuel R Falkson, Adam Dalia, Jonathan Tang, Tamara R Sawyer, Manoj H Iyer","doi":"10.1177/10892532251332079","DOIUrl":"https://doi.org/10.1177/10892532251332079","url":null,"abstract":"<p><p><b>Background:</b> Etomidate has minimal cardiovascular depressant effects at the cost of endogenous cortisol production suppression, whereas propofol has vasodilatory and myocardial depressant properties, which may be poorly tolerated in the cardiac surgical population. To offset the undesirable effects of propofol, ketamine can be co-administered to harness its cardiac stimulatory properties. Though etomidate is a more cardio-stable induction agent than propofol, its superiority over the combination of propofol and ketamine-colloquially known as \"ketofol\"-remains controversial. <b>Methods:</b> United States National Library of Medicine Database (MEDLINE) and Excerpta Medica Database (EMBASE) were searched for randomized controlled trials published since 2010 comparing etomidate and ketofol relative to propofol alone for induction of general anesthesia for coronary artery bypass grafting (CABG). Key data collected included post-induction nadir mean arterial pressure (MAP), heart rate, cardiac index, systemic vascular resistance (SVR), and serum cortisol levels at 24 hours postoperatively. Variables were compared by calculating a weighted mean difference (WMD) [95% confidence interval (CI)]. <b>Results:</b> This analysis included 15 studies (1125 patients). Anesthetic induction with etomidate was associated with a higher nadir MAP and SVR compared to ketofol during the peri-induction period by WMD 4.77 mmHg [95% CI 0.31, 9.23, <i>P</i> = 0.04] and 42.22 dynes/cm⁵ [95% CI 0.49-83.94, <i>P</i> = 0.05]. However, there was no difference in the frequency of needed boluses of vasopressors or fluids for peri-induction hypotension. <b>Conclusions:</b> Though etomidate appears to provide a superior hemodynamic profile compared to ketofol, both agents require similar degrees of clinical response to hypotension during the induction of CABG surgery patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251332079"},"PeriodicalIF":1.1,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Three Mathematical Models of the Pharmacokinetics of Heparin to Guide the Use of Protamine in a Large Simulated Cohort of Patients.","authors":"Stanislaw Vander Zwaag, Imre Kukel, Asen Petrov, Jens Fassl","doi":"10.1177/10892532251332464","DOIUrl":"https://doi.org/10.1177/10892532251332464","url":null,"abstract":"<p><p><b>Background:</b> In cardiac surgery, protamine is used to reverse the effects of heparin after separation from cardiopulmonary bypass (CPB). Excess of protamine has been demonstrated to cause platelet dysfunction and coagulopathy. A protamin-to-heparin ratio of less than 1:1 is endorsed by the European guidelines. Pharmacokinetic models of heparin decay have been proposed to allow for individualised dosing rather than fixed ratios. The objective of this study is to compare three such models in a large cohort of simulated patients. <b>Methods:</b> The doses of protamine were calculated using the models proposed by Meesters et al., Miles et al., and in the PRODOSE trial. We employed data from the VitalDB database to calculate the doses of heparin and randomly generated time intervals in-between. We tested two scenarios: with an initial dose and heparin added to the priming solution, and where additional heparin was administered over the course of the CPB. <b>Results:</b> We simulated 1166 cases with a mean interval between heparin and protamine administration of 90 ± 22 minutes in the first and 140 ± 28 minutes in the second scenario. The PRODOSE formula produced the lowest protamine-to-heparin ratios, followed by Meesters' formula in the first scenario (0.68:1 vs 0.72:1, <i>P</i> < .001) and the Miles' formula in the second scenario (0.55:1 vs 0.62:1, <i>P</i> < .001). <b>Conclusion:</b> The doses calculated with pharmacokinetic models exhibited discrepancies of up to 13.6%. While confirmation of complete reversal with alternative methods is necessary, the models facilitate a more individualised dose selection than the fixed ratios proposed in the literature.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251332464"},"PeriodicalIF":1.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response on Rapid Review to Inform Policy Guidance on Welsh Respiratory ECMO Provision.","authors":"Manish Pandey","doi":"10.1177/10892532251325653","DOIUrl":"https://doi.org/10.1177/10892532251325653","url":null,"abstract":"<p><p>Internationally, extracorporeal membrane oxygenation (ECMO) is now a core and standard organ support tool to provide tertiary critical care and cardiac services within a network of hospitals and a key tool for running an effective and efficient cardio-respiratory pathways. The letter aims to put the spotlight on some of the missing clinical evidence on respiratory ECMO and including them will help to arrive at a better-informed national ECMO policy decision.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251325653"},"PeriodicalIF":1.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Acute Respiratory Distress Syndrome in an Adult Patient With Human Metapneumovirus Infection Successfully Managed With Veno-Venous Extracorporeal Membrane Oxygenation.","authors":"Mafdy N Basta","doi":"10.1177/10892532241301195","DOIUrl":"10.1177/10892532241301195","url":null,"abstract":"<p><p>Human metapneumovirus (hMPV), a ubiquitous RNA virus of the Pneumoviridae family, has been associated with respiratory tract infections for decades in various age groups and populations. Though most of the infections, especially in children, are mild and self-limited, severe infections ranging from bronchiolitis or asthma exacerbation to severe pneumonia and acute respiratory distress syndrome (ARDS) have occasionally been reported. Among patients who require hospitalization for severe infections, treatment is supportive as no current antivirals or vaccines are effective or recommended. The following is a 45-year-old Caucasian man who developed severe ARDS complicating hMPV infection, and despite maximal medical support, he developed refractory life-threatening hypoxemia that required rescue therapy with veno-venous extracorporeal membrane oxygenation (V-V ECMO). After several days of ECMO support, the patient eventually recovered and was discharged home. This case highlights the importance of recognizing hMPV as an occasional culprit for severe respiratory infections, discusses the new global definition of ARDS, and delineates the updated recommended management, including the early application of V-V ECMO as a rescue therapy in severe cases with refractory, life-threatening respiratory failure.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"74-81"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Function Decline After General Anesthesia and Cardiac Catheterization in Pediatric Cardiac Transplant Recipients.","authors":"Gokul Thimmarayan, Michael Schmitz, Beverly J Spray, Kenneth Knecht, Xiomara Garcia, Jorge Guerrero, Amy Dossey, Brian Reemtsen, Lawrence Greiten, Thomas Heye, Destiny F Chau","doi":"10.1177/10892532241304295","DOIUrl":"10.1177/10892532241304295","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cardiac transplant recipients undergo elective cardiac catheterization and endomyocardial biopsy (CC/EMB) for graft dysfunction surveillance often facilitated by general anesthesia (GA). GA and positive pressure ventilation (PPV) also depress cardiac function confounding the graft's functional assessment. We aimed to evaluate the frequency of cardiac function decline, going from the awake to the anesthetized state, and determine its association with anesthetic and patient-related factors.</p><p><strong>Methods: </strong>Electronic medical records of pediatric heart transplant recipients undergoing CC/EMB under GA/PPV were retrospectively reviewed. Patients with awake normal cardiac function, assessed by same-day preoperative echocardiographic left ventricular shortening fraction (LVSF) ≥28% were included. A priori, groups were: (1) cardiac function decline (post- catheterization under GA, LVSF< 28%), and (2) no cardiac function decline. Univariate and logistic regression analysis accounting for repeated encounters per patient were performed.</p><p><strong>Results: </strong>225 eligible encounters occurred in 102 patients. Cardiac function declined in 17.3% (39/225) encounters, and in 25% (26/102) of patients. Logistic regression identified independent predictors as: older age (OR 1.4, 95% CI: 1.1-1.7, <i>P</i> = 0.002), angiotensin-converting enzyme inhibitor (ACEI) use (OR 2.5, 95% CI: 1.2-4.3, <i>P</i> = 0.018), and elevated right ventricular end diastolic pressure (RVEDP) (OR 2.4, 95% CI: 1.1-5.4, <i>P</i> = 0.039), with AUC 0.75. Older age and ACEI use (<i>P</i> = 0.001) and, older age and elevated RVEDP (<i>P</i> = 0.037) were correlated.</p><p><strong>Conclusions: </strong>One in 4 patients demonstrated cardiac function decline from the awake to the anesthetized state, occurring most commonly in older children with elevated RVEDP using ACEI. Most cardiac function declines are unrelated to rejection.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"64-73"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Considerations for Endovascular Repair of the Thoracic Aorta.","authors":"Olivia M Valencia, Thomas Powell, Ali Khalifa, Vicente Orozco-Sevilla, Daniel A Tolpin","doi":"10.1177/10892532241297608","DOIUrl":"10.1177/10892532241297608","url":null,"abstract":"<p><p>Thoracic aorta pathologies, especially those of the ascending aorta and aortic arch, were traditionally approached via open surgical repair. This carries risk of ischemic end-organ damage and other complications. Endovascular repair of ascending aorta and aortic arch pathologies is becoming more successful and widespread, thereby posing numerous challenges to the anesthesiologist. This article reviews the anesthesia-pertinent pathophysiology, repair techniques, preoperative evaluation, intraoperative management, and postoperative care of patients presenting for endovascular repair of thoracic aorta pathologies.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"49-63"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management for Proximal Aortic Repair.","authors":"Thomas R Powell, Emily B Shah, Ali Khalifa, Vicente Orozco-Sevilla, Daniel A Tolpin","doi":"10.1177/10892532251318061","DOIUrl":"10.1177/10892532251318061","url":null,"abstract":"<p><p>Surgical repair of the proximal aorta is a complex endeavor, requiring cardiopulmonary bypass (CPB) and often the use of hypothermic circulatory arrest (HCA). In addition to the normal considerations for patients undergoing cardiopulmonary bypass, additional challenges include cerebral and end-organ protection during periods of circulatory arrest. This review aims to provide an up-to-date, evidence-based review on anesthetic management for proximal aortic repair.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"8-36"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Use of Intraoperative Modified Valsalva Maneuver for Atrial Flutter Reversal in Pediatric Cardiac Surgery: Case Report and Review of Literature.","authors":"Gustavo A Cruz Suárez, Andrés Pombo Jiménez, Camilo A Calderón Miranda, Juan F Vélez Moreno, Sergio Alzate-Ricaurte, Juan C Arias Millán","doi":"10.1177/10892532241304278","DOIUrl":"10.1177/10892532241304278","url":null,"abstract":"<p><p>This case report describes the successful use of an intraoperative modified Valsalva maneuver to reverse atrial flutter in a pediatric patient with complex congenital heart disease undergoing systemic-to-pulmonary shunt surgery. The technique involved manipulating the Adjustable Pressure Limiting (APL) valve on the anesthesia machine to simulate the hemodynamic effects of the modified Valsalva maneuver, allowing for non-invasive management of supraventricular tachycardia without pharmacological intervention or electrical cardioversion. This intervention stabilized the patient's arrhythmia, maintaining hemodynamic stability throughout the procedure. The case highlights the potential of the maneuver as a safe, effective, and non-invasive alternative for arrhythmia management in pediatric cardiac surgeries, advocating for further research to validate this approach and possibly integrate it into standard practice for similar clinical scenarios.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"82-89"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}