Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Retracted: \"The Impact of Dexmedetomidine Infusion in Sparing Morphine Consumption in Off-Pump Coronary Artery Bypass Grafting\".","authors":"","doi":"10.1177/10892532231179573","DOIUrl":"10.1177/10892532231179573","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541477","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":"Opioid-free anesthesia versus opioid-based anesthesia in patients undergoing cardiovascular and thoracic surgery: a meta-analysis and systematic review.","authors":"Dave M Mathew, Peter J Fusco, Kathryn S Varghese, Ahmed K Awad, Eamon Vega, Serena M Mathew, Mia Polizzi, Jerrin George, Christopher S Mathew, Jeremiah J Thomas, Rose Calixte, Adham Ahmed","doi":"10.1177/10892532231180227","DOIUrl":"10.1177/10892532231180227","url":null,"abstract":"<p><strong>Background: </strong>Despite their extensive clinical use, opioids are characterized by several side effects. These complications, coupled with the ongoing opioid epidemic, have favored the rise of opioid-free-anesthesia (OFA). Herein, we perform the first pairwise meta-analysis of clinical outcomes for OFA vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery.</p><p><strong>Methods: </strong>We comprehensively searched medical databases to identify studies comparing OFA and OBA in patients undergoing cardiovascular or thoracic surgery. Pairwise meta-analysis was performed using the Mantel-Haenszel method. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% confidence intervals (95% CI).</p><p><strong>Results: </strong>Our pooled analysis included 919 patients (8 studies), of whom 488 underwent surgery with OBA and 431 with OFA. Among cardiovascular surgery patients, compared to OBA, OFA was associated with significantly reduced post-operative nausea and vomiting (RR, 0.57; <i>P</i> = .042), inotrope need (RR .84, <i>P</i> = .045), and non-invasive ventilation (RR, .54; <i>P</i> = .028). However, no differences were observed for 24hr pain score (SMD, -.35; <i>P</i> = .510) or 48hr morphine equivalent consumption (SMD, -1.09; <i>P</i> = .139). Among thoracic surgery patients, there was no difference between OFA and OBA for any of the explored outcomes, including post-operative nausea and vomiting (RR, 0.41; <i>P</i> = .025).</p><p><strong>Conclusion: </strong>Through the first pooled analysis of OBA vs OFA in a cardiothoracic-exclusive cohort, we found no significant difference in any of the pooled outcomes for thoracic surgery patients. Although limited to 2 cardiovascular surgery studies, OFA was associated with significantly reduced postoperative nausea and vomiting, inotrope need, and non-invasive ventilation in these patients. With growing use of OFA in invasive operations, further studies are needed to assess their efficacy and safety in cardiothoracic patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9705753","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":"Left-Sided Double-Lumen Tube vs EZ-Blocker for One-Lung Ventilation in Thoracic Surgery: A Systematic Review and Meta-Analysis.","authors":"Nicolas Kumar,&nbsp;Justin Mitchell,&nbsp;Andrew Siemens,&nbsp;Selina Deiparine,&nbsp;Daniel Saddawi-Konefka,&nbsp;Nasir Hussain,&nbsp;Manoj H Iyer,&nbsp;Michael Essandoh,&nbsp;Tamara R Sawyer,&nbsp;David Hao","doi":"10.1177/10892532231184781","DOIUrl":"10.1177/10892532231184781","url":null,"abstract":"<p><p><i>Background.</i> The EZ-Blocker is the newest generation of bronchial blocker and offers a potential alternative to left-sided double lumen tubes for lung isolation and one-lung ventilation during thoracic surgery. <i>Methods.</i> Databases were searched for randomized controlled trials comparing left-sided double lumen tube to the EZ-Blocker for one-lung ventilation during thoracic surgery. The time for placement, incidence of intraoperative displacement, and surgeons' rating of lung collapse quality were designated as coprimary outcomes. The safety profiles of the two devices, including the incidence of airway trauma and post-extubation discomfort were also examined. <i>Results.</i> Six randomized controlled trials (495 patients) were analyzed. Compared to the EZ-Blocker, the left-sided double lumen tube was faster to place by a weighted mean difference of [95% CI] of -61.24 seconds [-102.48, -20.00] (P = .004) and was much less likely to become displaced during lung isolation with an odds ratio [95% CI] of .56 [.34, .91] (P = .02). The left-sided double lumen tube and the EZ-Blocker provided similar surgeon-rated quality of lung isolation. Although the left-sided double lumen tube caused a greater degree of post-extubation sore throat, there was a similar incidence of carinal trauma and post-extubation hoarseness compared to the EZ-Blocker. <i>Conclusion.</i> Our analysis suggests that the left-sided double lumen tube can be placed more quickly and is less prone to intraoperative displacement compared to the EZ-Blocker; the quality of lung collapse is similar. Thus, evidence appears to support the continued utilization of the left-sided double lumen tube for routine thoracic surgery requiring one-lung ventilation.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9677278","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":"Racial and Ethnic Disparities in U.S Children Undergoing Surgery for Congenital Heart Disease: A Narrative Literature Review.","authors":"Faith J Ross,&nbsp;Gregory Latham,&nbsp;Lie Tjoeng,&nbsp;Kelly Everhart,&nbsp;Nathalia Jimenez","doi":"10.1177/10892532221145229","DOIUrl":"10.1177/10892532221145229","url":null,"abstract":"<p><p>Congenital Heart Disease (CHD) is a significant source of pediatric morbidity and mortality. As in other fields of medicine, studies have demonstrated racial and ethnic disparities in congenital heart disease outcomes. The cause of these outcome disparities is multifactorial, involving biological, behavioral, environmental, sociocultural, and systemic medical factors. Potential contributors include differences in preoperative illness severity secondary to coexisting medical conditions, differences in the rate of prenatal and early postnatal detection of CHD, and delayed access to care, as well as discrepancies in socioeconomic and insurance status, and systemic disparities in hospital care. Understanding the factors that contribute to these disparities is an essential step towards developing strategies to address them. As stewards of the perioperative surgical home, anesthesiologists have an important role in developing institutional policies that mitigate racial disparities. Here, we provide a thorough narrative review of recent research concerning perioperative factors contributing to surgical outcomes disparities for children of all ages with CHD, examine potentially modifiable contributing factors, discuss avenues for future research, and suggest strategies to address disparities both locally and nationally.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10330830","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 Surgeons Highlight the Need for Innovation Stewardship: Noteworthy in 2022.","authors":"Adom Netsanet,&nbsp;Jake Cotton,&nbsp;Alejandro Suarez-Pierre,&nbsp;Jordan Hoffman,&nbsp;Muhammad Aftab,&nbsp;Brett Reece,&nbsp;Jessica Y Rove","doi":"10.1177/10892532231173090","DOIUrl":"https://doi.org/10.1177/10892532231173090","url":null,"abstract":"<p><p>Modern cardiac surgery has rapidly evolved to treat complex cardiovascular disease. This past year boasted noteworthy advances in xenotransplantation, prosthetic cardiac valves, and endovascular thoracic aortic repair. Newer devices often offer incremental design changes while demanding significant cost increases that leave surgeons to decide if the benefit to patients justifies the increased cost. As innovations are introduced, surgeons must continuously aim to harmonize short- and long-term benefits with financial costs). We must also ensure quality patient outcomes while embracing innovations that will advance equitable cardiovascular care.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9528638","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":"Abdominal Organ Transplantation: Noteworthy Literature in 2022.","authors":"Lyle Nolasco,&nbsp;Divya Igwe,&nbsp;Natalie K Smith,&nbsp;Tetsuro Sakai","doi":"10.1177/10892532231169075","DOIUrl":"https://doi.org/10.1177/10892532231169075","url":null,"abstract":"<p><p>This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9534837","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":"The Year in Review: Anesthesia for Congenital Heart Disease 2022.","authors":"Matthew M Goodmanson,&nbsp;Gregory J Latham,&nbsp;Leah M Landsem,&nbsp;Faith J Ross","doi":"10.1177/10892532231173801","DOIUrl":"https://doi.org/10.1177/10892532231173801","url":null,"abstract":"<p><p>This review focuses on the literature published during the calendar year 2022 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease (CHD). Four major themes are discussed: enhanced recovery after surgery(ERAS); diversity, equity, and inclusion; the state of pediatric cardiac anesthesiology as a subspecialty in the United States; and neuromonitoring for pediatric cardiac surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9907031","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":"The Year 2022 in Review and a Glimpse into the Future.","authors":"Eric Leiendecker,&nbsp;Dan Viox,&nbsp;Miklos D Kertai,&nbsp;Benjamin Abrams","doi":"10.1177/10892532231178860","DOIUrl":"https://doi.org/10.1177/10892532231178860","url":null,"abstract":"Innovation has consistently been the hallmark of progress in the care of cardiac surgery and transplant patients— forward thinking in hopes of creating a better future. From the moment Ludwig Rehn sutured a myocardial laceration in 1896, or in 1954 when Joseph Murray performed the first successful solid organ transplant, there has been a clear eye towards the future and using innovative means of tackling the problems we see before us. The year 2022 was no exception, with a major advance made in xenotransplantation with a cardiac graft that functioned adequately for 7 weeks after implantation, as 1 example. Many such advancements are highlighted in this issue of Seminars in Cardiothoracic and Vascular Anesthesia, which compiles a series of review articles summarizing the notable research and innovations from this past year. The relevant publications have been divided into 5 separate categories for the reader, including critical care medicine, abdominal transplantation, congenital heart disease, cardiac anesthesia, and cardiac surgery. It was a busy year in critical care medicine and Alber et al have done a wonderful job summarizing the advancements made in the care of post-cardiac arrest patients, resuscitation, mechanical ventilation, septic shock, and nutritional support, as well as improving neurologic outcomes in the critically ill. The use of VA-ECMO as a means of rescue in the care of post-cardiac arrest patients has gained more attention this year, where there has been a focus towards temperature management and cytokine adsorption. Additionally, following the COVID-19 pandemic there was work done describing the neurocognitive outcomes of ECMO survivors. Building on prior work done evaluating the utility of targeted temperature management (TTM), the HYPO-ECMO group randomized patients with cardiac arrest or refractory cardiogenic shock that received ECLS to either moderate hypothermia (33-34°C) or normothermia (36-37°C) finding a non-statistically significant differences in the primary outcome of 30 day mortality though the composite outcome of death, or escalation to LVAD or heart transplant at 30 days favored the mild hypothermia group, and importantly there were no increased risks of adverse events in the mild hypothermia group. Post-cardiac arrest syndrome (PCAS) is a well-established inflammatory condition following ROSC that results in ischemia-reperfusion injury and the release of proinflammatory cytokines, such as interleukin-6 (IL-6). The CYTER Trial Group utilized a hemoadsorber in the ECMO circuit at the time of VA ECMO cannulation in the setting of ECPR, postulating that it maymitigate reperfusion injury at the time of cannulation. There was not a statistically significant fall in the IL-6 levels or any differences in a host of secondary outcomes, including mortality and SOFA score, though this single-center study was limited by a relatively small and heterogeneous population. Fernando et al added additional insight into neurocog","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9993453","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":"Year in Review 2022: Noteworthy Literature in Cardiac Anesthesiology.","authors":"Elijah Christensen,&nbsp;Joseph Morabito,&nbsp;Markus Kowalsky,&nbsp;John-Paul Tsai,&nbsp;Douglas Rooke,&nbsp;Nathan Clendenen","doi":"10.1177/10892532231173074","DOIUrl":"https://doi.org/10.1177/10892532231173074","url":null,"abstract":"<p><p>Last year researchers made substantial progress in work relevant to the practice of cardiac anesthesiology. We reviewed 389 articles published in 2022 focused on topics related to clinical practice to identify 16 that will impact the current and future practice of cardiac anesthesiology. We identified 4 broad themes including risk prediction, postoperative outcomes, clinical practice, and technological advances. These articles are representative of the best work in our field in 2022.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445401/pdf/nihms-1920352.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10057727","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":"Year in Review 2022: Noteworthy Literature in Cardiothoracic Critical Care.","authors":"Sarah Alber,&nbsp;Kenji Tanabe,&nbsp;Hans Tregear,&nbsp;Andrew Hennigan,&nbsp;Samuel Gilliland","doi":"10.1177/10892532231176854","DOIUrl":"https://doi.org/10.1177/10892532231176854","url":null,"abstract":"<p><p>The past year in critical care medicine was notable for ongoing sequelae of the COVID-19 pandemic, including nationwide shortages and critical care demand in many regions in excess of usual operating capacity. Despite these challenges, evidence-based medicine and investigations into the optimal management of the critically ill continued to be at the forefront. This article is a collection of studies published in 2022 which are specifically relevant to cardiothoracic critical care. These noteworthy publications add to the existing literature across a broad spectrum of topics, from optimal timing of mechanical circulatory support (MCS), delirium prevention, updates in nutrition guidelines, alternative defibrillation techniques, novel ventilator management, and observing the downstream psychological impact of extracorporeal membrane oxygenation (ECMO) therapy.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9537862","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}