Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Native Whole Blood (TRUE-NATEM) and Recalcified Citrated Blood (NATEM) Reference Value Validation with ROTEM Delta.","authors":"Uzung Yoon","doi":"10.1177/10892532231151528","DOIUrl":"10.1177/10892532231151528","url":null,"abstract":"<p><p><i>Background:</i> Thromboelastography is a viscoelastic test of whole blood hemostasis. Currently, no reference value exists for native whole blood and recalcified citrated blood without activators. The aim of this study was to compare the results of ROTEM^® tests using fresh native blood without decalcification \"TRUE-NATEM\" with those using decalcified citrated blood \"NATEM\" and provide reference values for each. <i>Methods:</i> Inclusion criteria were healthy adult volunteers (18-65 years). Exclusion criteria were any medical condition or medication affecting coagulation. Native whole blood testing was defined as \"TRUE-NATEM-test.\" For recalcified citrated blood testing, the NATEM function was used on ROTEM^®. <i>Result:</i> The reference value for TRUE-NATEM was CT: 872-1595s, A10: 14-34 mm, A20: 26-48 mm, CFT: 314-839s, MCF: 34-55 mm, and alpha angle: 17-40°. The reference value for NATEM was CT: 757-1327s, A10: 19-43 mm, A20: 33-55 mm, CFT: 219-615s, MCF: 37-61 mm, alpha angle: 24-51°, and ML: 0-3%. When comparing the reference value of NATEM to TRUE-NATEM, the CT and CFT values are decreased and the MCF and alpha angle are increased. The recalcification process of citrated blood in NATEM shows significant activation of coagulation. Female healthy volunteers had enhanced coagulation when activators were used. Age-related statistical difference was seen when activators were used. Ethnicity did not show any difference on the ROTEM values. <i>Conclusion:</i> We determined the reference value for native whole blood and recalcified whole blood using ROTEM®. A significant discrepancy in native whole blood and recalcified citrated blood coagulation was found. Our study underlines the importance of native whole blood as the gold standard reference value in coagulation.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"199-207"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10521027","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":"Refractory Hypotension During Implantation of a 70 mL Total Artificial Heart in a Patient With Pectus Excavatum: A Case Report.","authors":"Brendon Hart,&nbsp;Nahush A Mokadam,&nbsp;Karina Anam,&nbsp;Samiya Saklayen,&nbsp;Galina Dimitrova,&nbsp;Alix Zuleta-Alarcon,&nbsp;Jordan Holloway,&nbsp;Hamdy Awad,&nbsp;David Convissar,&nbsp;Michael Essandoh","doi":"10.1177/10892532231157529","DOIUrl":"10.1177/10892532231157529","url":null,"abstract":"<p><p>The Syncardia total artificial heart system is the only commercially approved durable device for treating biventricular heart failure patients awaiting heart transplantation. Conventionally, the Syncardia total artificial heart system is implanted based on the distance from the anterior aspect of the 10th thoracic vertebra to the sternum and the patient's body surface area. However, this criterion does not account for chest wall musculoskeletal deformities. This case report describes a patient with a pectus excavatum who developed compression of the inferior vena cava after Syncardia total artificial heart implantation and how transesophageal echocardiography guided chest wall surgery to accommodate the total artificial heart system.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"239-243"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10752204","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":"Embracing Scrutiny: The Importance of Critical Evaluation and Transparency in Research.","authors":"Ross S Hanson,&nbsp;Ollin G Venegas,&nbsp;Lindsey A Alverson,&nbsp;Benjamin A Abrams,&nbsp;Miklos D Kertai","doi":"10.1177/10892532231189788","DOIUrl":"10.1177/10892532231189788","url":null,"abstract":"In its 1952 second annual report, the fledgling National Science Foundation framed the process of technological innovation as a “sequence [consisting] of basic research, applied research, and development... each of the successive stages [depending] upon the preceding.” Medical advancement has proven no exception to this, and the relationship between basic science, applied research, and clinical development underpins the modern framework of evidencebased medicine. As much as we may bias toward thinking of this sequence as linear, it is imperative that we also look at innovation critically and publish studies that detail what doesn’t work. This issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) is true to this ethos and encompasses the entirety of this arc. We present both positive and negative Original Research spanning basic science in thromboelastographic testing, applied research in arterial line ultrasound and video laryngoscopy training, as well as clinical development of lung isolation devices and opioid sparing cardiothoracic anesthetic techniques. Rounding this out is an excellent review of perioperative point of care ultrasound (POCUS) for hemodynamic assessment and 2 case reports describing ingenuity in the face of the unexpected. Finally, we present a retraction of a previously published study to correct the evidence-based medical record as well as reflect on the risks inherent in stepping away from the process of innovation framed by the National Science Foundation so many years ago. In the first Original Research article, Mathew et al report the results of the first pairwise meta-analysis of clinical outcomes for opioid-free anesthesia (OFA) vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery. Including 919 patients across 8 studies, they found that OFA in cardiovascular surgery patients was associated with significantly reduced postoperative nausea and vomiting (PONV), inotrope need, and non-invasive ventilation while there was no observed difference in 24-hour pain scores, 48-hour morphine equivalent consumption, or length of hospital stay. Interestingly, these same trends were not observed in thoracic surgery patients, among whom there was no significant difference in any of the explored outcomes. In this first meta-analysis of OFA techniques specific to cardiothoracic surgical patients, the findings echo similar patterns of reduced PONV in the absence of increased pain scores across multiple surgical specialties. Taken together with literature demonstrating reductions in long-term opioid dependence and concurrent improvements in clinical outcomes and patient satisfaction with cardiac Enhanced Recovery After Surgery (ERAS), this study offers compelling support of OFA techniques within cardiothoracic-specific Enhanced Recovery After Surgery programs. While innovation is a constant driver of clinical care improvement and medical device development, not all novel techniques and t","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"149-152"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9775519","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":"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":" ","pages":"244"},"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":"Ultrasound-Guided Radial Arterial Catheterization in Patients With Regurgitant and Stenotic Left-Sided Cardiac Valvular Lesions.","authors":"C M Rakhi Krishna,&nbsp;Sandeep Kumar Mishra,&nbsp;Ajay Kumar Jha,&nbsp;Muthapillai Senthilnathan,&nbsp;Satyen Parida","doi":"10.1177/10892532231181481","DOIUrl":"10.1177/10892532231181481","url":null,"abstract":"<p><p><i>Background.</i> The pulse characteristics of arterial circulation might affect radial artery catheterization's success rate. Therefore, we hypothesized that the success rate of radial artery catheterization would be lower in the left-sided severe stenotic valvular lesion group than severe regurgitant valvular lesion group. <i>Methods.</i> This prospective study was conducted among patients with left-sided cardiac valvular lesions undergoing cardiac and non-cardiac surgery. The patients with left-sided severe valvular stenosis and left-sided severe valvular regurgitation were included in the study. Radial artery cannulation was performed using an ultrasound-guided out-of-plane short-axis approach. The outcome measures were success rate, number of attempts, and cannulation time. <i>Result.</i> One hundred fifty-two patients were recruited for the study, and all were eligible for final analysis. The first attempt success rate was non-significantly higher in the stenotic valvular lesion group than the regurgitant group (69.7% vs 56.6%; <i>P</i> = .09). Furthermore, the number of attempts (median; 95% CI) was significantly higher in the regurgitant group (1; 1.2-1.43 vs 1; 1.38-1.67; <i>P</i> = .04). However, it may not be of clinical relevance. Moreover, the cannulation time and the number of redirections of the cannula were comparable. Heart rate was significantly higher in the regurgitant group (91.8 ± 13.9 vs 82.26 ± 15.92 beats/min; <i>P</i> = .00), while the incidence of atrial fibrillation was significantly higher in the stenotic lesion (<i>P</i> = .00). No failure was reported, and the incidence of periarterial hematoma was comparable. <i>Conclusion.</i> The success rate of ultrasound-guided radial arterial catheterization is comparable in left-sided stenotic valvular and regurgitant lesion groups.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"153-161"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569324","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":" ","pages":"162-170"},"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":"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":" ","pages":"224-234"},"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":"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":" ","pages":"171-180"},"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":"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":"27 2","pages":"136-144"},"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":"27 2","pages":"97-113"},"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}