Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Preoperative Hypoalbuminemia and Mortality in Elective Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.","authors":"Julián M Corso-Ramirez, Sergio Alzate-Ricaurte, Sebastián Gómez-Galán, Paola A Munive-Gnecco, Luis E Londoño-Mejia, Lina M Sanabria-Arevalo, Carlos J Villamil-Angulo, Karen Moreno-Medina, Edgar Dario Alzate Gallego, Jaime Camacho-Mackenzie, Juan G Barrera-Carvajal","doi":"10.1177/10892532251405006","DOIUrl":"10.1177/10892532251405006","url":null,"abstract":"<p><p>ObjectivesThe prognostic value of preoperative serum albumin in patients undergoing elective aortic aneurysm repair remains uncertain. This systematic review and meta-analysis evaluated whether hypoalbuminemia predicts mortality in this population.MethodsA comprehensive search of PubMed, Scopus, Cochrane Library, Ovid, and CENTRAL was conducted up to January 21, 2024. Eligible studies included patients undergoing elective aortic aneurysm repair, comparing mortality between those with hypoalbuminemia and those with normal serum albumin levels. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias. Adjusted data were pooled to calculate odds ratios (ORs), and sensitivity analysis was performed.ResultsFour studies, comprising 14 136 patients were included. Meta-analysis demonstrated that hypoalbuminemia was significantly associated with increased odds of all-cause mortality (OR 3.18; 95% CI 1.78-5.67; <i>P</i> < 0.0001; I² = 88%). Subgroup analysis of endovascular procedures (EVAR, fenestrated or branched devices [F/B], and TEVAR) demonstrated a similar trend (OR 3.85; 95% CI 2.52-5.89; <i>P</i> < 0.00001; I² = 68%). Sensitivity analysis confirmed the validity of these findings.ConclusionsDespite the limited number of available studies and evidence level, preoperative hypoalbuminemia appears to be an independent predictor of mortality following elective aortic aneurysm repair, with most available evidence derived from endovascular procedures. Given its association with comorbidity decompensation, inflammation, and malnutrition, serum albumin assessment may serve as a valuable preoperative risk stratification tool. Further high-quality research is needed to validate these findings and explore their clinical applicability.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"63-72"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655818","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":"Advancing Cardiothoracic Anesthesiology: Right Ventricular Function, Cannabis Use, Ventilation Techniques, and Emerging Trends.","authors":"Aden W Smith, Benjamin Abrams, Miklos D Kertai","doi":"10.1177/10892532261419198","DOIUrl":"https://doi.org/10.1177/10892532261419198","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"30 1","pages":"5-7"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144123","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 Short-Term Outcomes of Extubation in the Operating Room and Extubating in the Intensive Care Unit After Cardiac Surgery: Systematic Review and Meta-Analysis.","authors":"Noritsugu Naito, Hisato Takagi","doi":"10.1177/10892532251346646","DOIUrl":"10.1177/10892532251346646","url":null,"abstract":"<p><p><b>Objectives:</b> This study aimed to compare short-term outcomes in patients extubated in the operating room (ORE) vs those extubated in the intensive care unit (ICUE) following cardiac surgery. <b>Methods:</b> A systematic search of MEDLINE and EMBASE was conducted from inception through September 2024. Pooled outcome estimates were calculated, and subgroup analyses were performed focusing on studies utilizing propensity score matching, weighting, or randomization. <b>Results:</b> Fourteen studies published between 2000 and 2024, encompassing 679,749 patients, were included. Of these, 6 utilized propensity score matching, 1 applied overlap weighting, and 1 employed randomization. Overall, ORE group had shorter aortic cross-clamp (<i>P</i> = 0.02) and cardiopulmonary bypass (<i>P</i> < 0.01) times. ORE patients had shorter ICU (<i>P</i> < 0.01) and hospital stays (<i>P</i> < 0.01). Rates of reintubation (<i>P</i> = 0.78), reoperation for bleeding (<i>P</i> = 0.18), prolonged mechanical ventilation (<i>P</i> = 0.12), and hospital readmission (<i>P</i> = 0.71) were comparable between the groups. Postoperative stroke rate (<i>P</i> < 0.01) and short-term mortality (<i>P</i> = 0.04) were lower in the ORE group. In the subgroup analysis, ICU stay, hospital stay, and cardiopulmonary bypass time remained shorter in ORE groupfund, while reoperation for bleeding was significantly higher (<i>P</i> < 0.01). However, the differences in postoperative stroke (<i>P</i> = 0.52) and short-term mortality (<i>P</i> = 0.42) were no longer statistically significant. <b>Conclusion:</b> This meta-analysis demonstrates that ORE after cardiac surgery can be performed in selected patients, with comparable postoperative outcomes to ICUE. The ORE strategy may result in shorter ICU and hospital stays.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"46-62"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183053","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}