Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Effect of Stellate Ganglion Block on Internal Mammary Artery Dynamics: A Randomized Controlled Clinical Trial.","authors":"Diaaeldin Badr Aboelnile, Mahmoud AbdAlaziz Ghallab, Ehab Hamed Abdelsalam Attia, Amira Yousry Hawas, Farouk Kamal Eldin","doi":"10.1177/10892532261428565","DOIUrl":"https://doi.org/10.1177/10892532261428565","url":null,"abstract":"<p><p>The left internal mammary artery (LIMA) is commonly selected as the graft of choice for coronary artery bypass procedures. Various pharmacological agents have been used to enhance LIMA blood flow. Left stellate ganglion block (LSGB) has been utilized to achieve sympathetic blockade, promote vasodilation in the upper extremities, and manage refractory angina. This randomized controlled clinical trial aimed to evaluate the effect of preoperative LSGB on LIMA blood flow in patients undergoing elective coronary artery bypass grafting (CABG). Seventy patients (aged 18-80 years, of both genders) scheduled for elective CABG were equally divided into two groups: the LSGB group and the control group. Patients in the intervention group received an ultrasound-guided LSGB using 8 mL of 0.25% bupivacaine. Both groups received topical nitroglycerin during LIMA harvesting. LIMA diameter was measured at baseline and again after an equal time interval before the induction of anaesthesia. Additionally, LIMA free flow after harvesting and mean graft flow were measured using a transit time flow metre (TTFM). LIMA free blood flow was significantly increased in the LSGB group (50.57 ± 5.79 mL/min) compared to the control group (46.86 ± 8.32 mL/min), with a <i>P</i>-value = 0.034. Similarly, the LIMA diameter was significantly greater in the LSGB group (2.38 ± 0.17 mm) than in the control group (2.31 ± 0.14 mm), with a <i>P</i>-value = 0.04, suggesting that preoperative LSGB significantly enhances LIMA blood flow and diameter in patients undergoing CABG.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261428565"},"PeriodicalIF":1.0,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221026","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":"Net Atrioventricular Compliance: A Determinant of Pulmonary Artery Pressure in Patients Undergoing Mitral Valve Replacement for Severe Mitral Stenosis.","authors":"Nischitha Gowda, Sunder Lal Negi, Goverdhan Dutt Puri, Rupesh Kumar, Prashant Panda","doi":"10.1177/10892532261425015","DOIUrl":"https://doi.org/10.1177/10892532261425015","url":null,"abstract":"<p><p>. This single-center prospective observational study aimed to assess the correlation of net atrioventricular compliance (Cn) with pulmonary artery pressure in 26 adult patients with severe mitral stenosis (MS) undergoing surgical mitral valve replacement (MVR). Cn was estimated by doppler echocardiography, and pulmonary artery pressures measured by pulmonary artery catheter. Early outcomes including duration of intensive care unit (ICU) stay, mechanical ventilation duration, and vasoactive inotropic scores (VIS) were recorded. Cn showed moderate to strong negative correlation with systolic, diastolic, and mean pulmonary artery pressures at all time points. Receiver operating characteristic (ROC) curve analysis determined a cut-off of 2.31 to predict postoperative pulmonary artery systolic pressure. Cn with a cut-off value of 2.3 ml/mmHg serves as an indicator of persistent pulmonary hypertension following MVR surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261425015"},"PeriodicalIF":1.0,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150985","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":"Intraoperative Discovery of Bioprosthetic Mitral Valve Thrombus on TEE During HeartMate 3 Implantation: Implications for Anesthetic Management and Surgical Planning.","authors":"Jenny Huang, Lida Shaygan","doi":"10.1177/10892532251414559","DOIUrl":"https://doi.org/10.1177/10892532251414559","url":null,"abstract":"<p><p>We present the case of a 73-year-old female with chemotherapy-induced cardiomyopathy, severe mitral regurgitation status post bioprosthetic mitral valve (MV) replacement one year prior, and atrial fibrillation, admitted for evaluation for left ventricular assist device (LVAD) implantation. While her preoperative transthoracic echocardiogram (TTE) did not reveal a discrete mass, it showed a mean mitral gradient of 7 mmHg; intraoperative transesophageal echocardiography (TEE) identified a 2 cm × 1.2 cm thrombus on the bioprosthetic MV. Given these findings, the surgical team decided to replace the mitral valve concurrently with LVAD implantation. Although this approach is not routine, the goal was to improve her quality of life and reduce postoperative complications. Post-procedure TEE showed an improved MV mean gradient of 3 mmHg with no evidence of paravalvular leak. The patient was subsequently discharged home in stable condition without any thromboembolic events. This case highlights the challenges of managing complex valvular pathology in patients undergoing LVAD placement.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532251414559"},"PeriodicalIF":1.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906943","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":"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":"258-264"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12579717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017448","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":"Corrigendum to \"A Year of Advances in Cardiac Surgery, Transplantation, and Anesthetic Management\".","authors":"","doi":"10.1177/10892532251358936","DOIUrl":"10.1177/10892532251358936","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"305"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001684","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":"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":"246-257"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","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":"Statistics for the Clinician I: Categorical Variables.","authors":"Roy Madrid, Jordan A Buttner, Mark Shilling, Sherwin Thiyagarajan, Ross S Hanson, Reza Ehsanian, Timothy R Petersen","doi":"10.1177/10892532251389293","DOIUrl":"10.1177/10892532251389293","url":null,"abstract":"<p><p>Categorical variables are an integral part of clinical research. This article introduces their uses and most common analyses for clinicians seeking additional statistics exposure to more critically engage with literature and refine their own research endeavors. We describe and demonstrate the two most common tests of association for categorical variables: chi-square and Fisher's exact tests, along with their underlying logic, result interpretations, and relative strengths and weaknesses. We also introduce and explain two of the most common measurements of effect size in analyses of categorical outcomes: relative risk (RR) and odds ratio (OR).</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"240-245"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313782","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":"Anesthesia Management of Acquired Adult Broncho-Esophageal Fistula Repair Using Endoscopic Submucosal Dissection: A Case Report.","authors":"Bin Zhu, Jiao Li, Zhigang Li, Jing Chang","doi":"10.1177/10892532251335183","DOIUrl":"10.1177/10892532251335183","url":null,"abstract":"<p><p><b>Purpose:</b> Acquired broncho-esophageal fistula (BEF) presents significant challenges in perioperative anesthesia management, especially when direct repair is not feasible. This case report highlights the anesthesia management strategies used during endoscopic submucosal dissection (ESD), an indirect repair method for BEF, focusing on airway preservation and minimizing intraoperative complications. <b>Result:</b> A 64-year-old male with BEF caused by small cell lung cancer underwent ESD. Anesthesia management focused on preserving spontaneous breathing and preventing air leaks through continuous endotracheal aspiration. A double-lumen tracheal tube was used to achieve selective lung ventilation, and recruitment maneuvers were performed postoperatively to improve lung function. The surgery was successfully completed without significant adverse effects, and postoperative follow-up showed improvement in the patient's condition. <b>Conclusion:</b> ESD represents a viable option for the indirect repair of BEF in patients unsuitable for direct surgical repair. Perioperative anesthetic strategies, such as spontaneous breathing preservation and continuous airway suction, may reduce complications. This case highlights the importance of a tailored, multidisciplinary approach in managing complex thoracic surgical cases.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"279-283"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041724","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":"Advances in Medicine: The Convergence of Data, Experience, and Story.","authors":"Paul Abboud, Timothy R Petersen, Reza Ehsanian, Miklos D Kertai, Benjamin Abrams, Ross Hanson","doi":"10.1177/10892532251391796","DOIUrl":"10.1177/10892532251391796","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"237-239"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318737","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":"Acute Intraoperative Pulmonary Embolism Management in the Era of Pulmonary Embolism Response Teams and Minimally Invasive Therapy: A Case Report.","authors":"Kelsei P Keene, Pete P Fong, John M Trahanas, Bantayehu Sileshi","doi":"10.1177/10892532251356125","DOIUrl":"10.1177/10892532251356125","url":null,"abstract":"<p><p>Intraoperative acute pulmonary embolism (PE) is a rare and life-threatening event with symptoms such as pleuritic chest pain, shortness of breath, and anxiety, which are easily masked by general anesthesia. To diagnose PE in a patient under general anesthesia, anesthesiologists must rely on alternative data points such as hypoxia, decreased end-tidal carbon dioxide (ETCO2), tachycardia, electrocardiogram changes, and intraoperative echocardiography. We present a case of acute intraoperative massive PE in a patient undergoing posterior spinal fusion. We discuss the management of acute perioperative PE, focusing on surgical risk, bleeding potential with thrombolytic therapies and anticoagulation, recent advances in catheter-based therapies, and the role of Pulmonary Embolism Response Teams (PERTs) in the assessment and perioperative management of high-risk patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"300-304"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12579718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545455","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}