Journal of Cardiothoracic and Vascular Anesthesia (J CARDIOTHOR VASC AN)

Publications in this journal

• Article: Use of Recombinant Activated Factor VII for Controlling Refractory Postoperative Bleeding in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass

  Magdalena Pychyn´ ska-Pokorska, MD, Izabela Pa˛ gowska-Klimek, Wojciech Krajewski, Jacek Jan Moll, PhD†
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  ABSTRACT: Objective: To review the efficacy, safety, and dose of recombinant activated factor VII in off-label management of refractory bleeding in pediatric patients with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. Design: A retrospective database analysis with medical records review. Setting: A single research hospital. Participants: Ninety pediatric patients with uncontrolled postoperative hemorrhage after cardiac surgery with cardiopulmonary bypass for congenital heart disease. Interventions: Intravenous recombinant activated factor VII treatment according to institutional treatment protocol. Measurements and Main Results: The recombinant activated factor VII treatment was effective in reducing bleeding in 78 pediatric patients. The 12 patients who failed to respond had surgical sources of bleeding. The mean blood loss decreased from 51.04 mL/kg/2 h to 7.8 mL/kg/2 h (p < 0.001) in neonates, from 40.2 mL/kg/2 h to 7.7 mL/kg/2 h (p < 0.001) in infants, and from 29.1 mL/kg/2 h to 4.0 mL/kg/2 h in children (p < 0.001). The mean (standard deviation) total recombinant activated factor VII doses required to achieve hemostasis were 131.7 (69.8) �g/kg in neonates, 104.6 (36.0) �g/kg in infants, and 44.6 (15.3) �g/kg in children aged 1 to <18 years. There was no evidence of thrombosis in the first 24 hours after the administration of recombinant activated factor VII. Conclusions: Recombinant activated factor VII treatment reduced blood loss and transfusion requirements and prevented re-exploration in the majority (83.8%) of pediatric cardiac surgery patients. High doses were required to discontinue bleeding promptly in neonates, the majority of whom had hypoplastic left-heart syndrome. No treatmentrelated thrombotic events were observed.
  Journal of Cardiothoracic and Vascular Anesthesia 12/2011; 25(6):987-94..
• Article: What are the clinical questions for optimal conduct of deep hypothermic circulatory arrest for adult aortic arch repair?

  John G T Augoustides
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):918-9.
• Article: Success rate, decubitus position, and vagal reflex during a high thoracic epidural for coronary artery surgery.

  Luca Salvi, Erminio Sisillo, Nicola Rondello
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):919-20.
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  Available from: cardiologicomonzino.it

  Article: Anesthesiologists' placement of cannulae for cardiopulmonary bypass.

  James E Duckett
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):919.
• Article: Inflation of the distal cuff by saline reduces the incidence of malposition of the bronchial tube during lung separation in patients receiving nitrous oxide.

  Manzo Suzuki, Shuji Haraguchi, Akira Kitamura, Yoichi Shimada, Atsuhiro Sakamoto
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  ABSTRACT: A common problem during lung separation is malposition of the double-lumen tube (DLT). It was hypothesized that inflation of the distal cuff with saline instead of air may reduce the incidence of malposition of the endobronchial tube. Fifty-two patients who were scheduled to undergo thoracic surgery with lung separation by a DLT were randomly assigned to 1 of 2 groups: the distal cuff was inflated with 2 mL of air in the air group (n = 26), whereas the distal cuff was inflated with 1.2 mL of saline in the saline group (n = 26). Anesthesia was maintained by isoflurane, 50% oxygen and nitrous oxide mixture, and incremental injection of epidural ropivacaine, 0.75%. Respiration was controlled by pressure-controlled ventilation. The peak airway pressure was maintained between 20 to 25 cmH2O. The position of the bronchial cuff was evaluated with a fiberoptic bronchoscope just after intubation and 1 and 2 hours after intubation by using a 3-point scale: 0, in exactly the same position as the previous inspection; 1, not in exactly the same position as that in the previous inspection, but there was no possibility that the tube was malpositioned; and 2, the cuff looked as if it was going to become herniated or dislodged. Signs suggesting malposition such as air leakage, high airway pressure, or inflation of the independent lung were recorded. When repositioning was required, the anesthesiologist repositioned the DLT using bronchoscopic observation or clinical signs. The endpoint of this study was the number of patients who required repositioning during surgery. The malposition score at 1 hour and 2 hours after intubation was comparable in the 2 groups (0.6 +/- 0.6 v 0.4 +/- 0.6 and 0.5 +/- 0.8 v 0.2 +/- 0.5, mean +/- standard deviation, air group v saline group, 1 hour and 2 hours after positioning, p = 0.27 and p = 0.33, respectively). However, a significantly higher cumulative number of air-group patients required repositioning of the tube than saline-group patients (13:6, air group:saline group, p = 0.04). Inflation of the distal cuff with saline may reduce the incidence of malpositioning of DLTs during lung separation.
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):838-42.
• Article: A rare cause of subtotal airway obstruction during anesthetic induction in a patient with facial trauma.

  Elena J Holak, Robert F Anderson, Paul S Pagel
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):903-5.
• Article: The effect of routine intraoperative transesophageal echocardiography on surgical management.

  Mohammed Minhaj, Komal Patel, David Muzic, Avery Tung, Valluvan Jeevanandam, Jai Raman, Mark A Chaney
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  ABSTRACT: To assess the effects of routine intraoperative transesophageal echocardiography (TEE) on surgical management of patients undergoing all types of cardiac surgery. Prospective, observational. Setting: A single-institution, clinical investigation, university-affiliated hospital. Two hundred eighty-three consecutive patients undergoing cardiac surgery. A comprehensive TEE examination was performed in every patient after the induction of anesthesia. An appropriate surgical plan was then developed. A focused TEE examination was also performed at the conclusion of surgery. Whether or not TEE findings represented new information and whether or not this new information altered surgical management was documented. There were 106 new TEE findings in 87 patients (31%). Half of the new findings involved the mitral valve, and a quarter involved the tricuspid valve. The new TEE information altered surgical management 77 ways in 71 patients (25%). Half of the altered surgical managements involved the mitral valve, and a third involved the tricuspid valve. In 8 patients (3%), TEE information influenced decisions regarding use/nonuse of cardiopulmonary bypass (CPB). In 2 patients, TEE examination after the separation from CPB prompted reinitiation of CPB. In 1 patient, TEE examination after the induction of general anesthesia prompted cancellation of surgery. The routine use of TEE during cardiac surgery revealed new cardiac pathology in 1 of every 3 patients and led to altered surgical management in 1 of every 4 patients. TEE information also influenced decisions regarding use/nonuse of CPB in 3% of patients. Thus, the authors suggest that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery.
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):800-4.
• Source

  Available from: cardiologicomonzino.it

  Article: High thoracic epidural anesthesia in coronary artery bypass surgery: a propensity-matched study.

  Luca Salvi, Alessandro Parolari, Fabrizio Veglia, Claudio Brambillasca, Sebastiana Gregu, Erminio Sisillo
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  ABSTRACT: To assess if 2 different anesthesia strategies, high-thoracic epidural anesthesia (HTEA) plus inhalation anesthesia and total intravenous anesthesia (TIVA) with sufentanil/propofol had different influence on outcomes of coronary artery bypass graft (CABG) surgery patients. Retrospective comparison of outcomes between HTEA and TIVA patients using propensity score pair-wise matching of patients. A university teaching hospital. Participants: A study of 1,473 consecutive patients undergoing elective CABG surgery; of these, 476 (32%) received HTEA combined with inhalation anesthesia, whereas 997 (68%) underwent TIVA alone. The patients undergoing CABG surgery were offered the epidural-inhalation anesthetic approach. Propensity matching yielded 389 pairs of patients. Patients were well matched in preoperative and operative features. Postoperative mortality, myocardial infarction, stroke, acute renal failure rates, and intensive care unit (ICU) stay were not statistically different in HTEA and TIVA groups. On the other hand, patients treated with HTEA had shorter ventilation times (5.8 +/- 3.11 v 6.9 +/- 5.0 hours, HTEA and TIVA, respectively, p < 0.001); in addition, vasoconstrictors were more frequently used in cases of HTEA, whereas vasodilators were mainly used with TIVA both intra- and postoperatively. No neurologic complications related to the use of HTEA were observed. HTEA and TIVA provided similar early outcomes after CABG surgery, and there were no major differences between these 2 strategies in the average risk CABG patient populations. Although HTEA did not cause neurologic problems and yielded a significant reduction in time to extubation, a consistent benefit over standard techniques could not be shown.
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):810-5.
• Article: Influence of intraoperative conversion from off-pump to on-pump coronary artery bypass grafting on costs and quality of life: a cost-effectiveness analysis.

  Toshiya Shiga, Christian C Apfel, Zen'ichiro Wajima, Yoko Ohe
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  ABSTRACT: Off-pump coronary artery bypass (OPCAB) surgery has become a widely accepted alternative to standard coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass; however, the influence of intraoperative conversion from OPCAB to standard CABG on costs and quality of life is unclear. The objective of this study was to determine whether intraoperative conversion affects costs and quality of life. A decision-analysis model and Monte Carlo simulation. The US healthcare system over a maximum 10-year lifetime horizon. A hypothetical cohort of 60-year-old male patients undergoing elective OPCAB surgery or standard CABG surgery. Each patient was entered into the decision tree with varying transition probabilities. Outcome measures included quality-adjusted life-years (QALYs) and costs in US dollars. In base-case analysis, OPCAB surgery led to a discounted lifetime cost of $91,282 and 7.64 discounted QALYs, and standard CABG surgery led to $91,685 and 7.52 QALYs. Patients who required conversion from off-pump to on-pump surgery incurred a cost of $103,909 and gained 6.63 QALYs. OPCAB is dominant (less costly and more effective) if the conversion rate is below 8.5%, whereas costs increase exponentially if the probability of conversion exceeds 15%. Sixty-one percent of the Monte Carlo simulations favored cost-effectiveness of the OPCAB strategy. In low-risk patients, OPCAB surgery, in comparison to standard CABG surgery, would increase QALYs by reducing complications related to cardiopulmonary bypass, but it would result in lifetime costs similar to those of standard CABG surgery. The benefit of OPCAB may be offset by the risk of intraoperative conversion.
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):793-9.
• Article: Induction of anesthesia triggers hypertensive crisis in a patient with undiagnosed pheochromocytoma: could rocuronium be to blame?

  Holger J Holldack
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):858-62.
• Article: Reexpansion pulmonary edema.

  Steven M Neustein
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):887-91.
• Article: Effects of intrapleural analgesia on pulmonary function and postoperative pain in patients with chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery.

  Halide Ogus, Ozer Selimoglu, Murat Basaran, Cuneyt Ozcelebi, Murat Ugurlucan, Omer Ali Sayin, Eylul Kafali, Temucin Noyan Ogus
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  ABSTRACT: Pain after coronary artery bypass graft (CABG) surgery remains a significant problem and may cause serious complications because of restricted breathing and limited early mobilization. The aim of this study was to assess the effects of intrapleural analgesia on the relief of postoperative pain in patients undergoing CABG surgery. Postoperative pain, pulmonary function tests, and outcomes were compared with a placebo group after CABG surgery in a double-blind randomized clinical trial. Settings: Cardiovascular surgery clinic. One hundred twenty-five patients with decreased lung function were studied. Group A (62 patients) received 20 mL of 0.5% bupivacaine bilaterally in the intrapleural spaces every 6 hours for 4 days, and group B (63 placebo patients) received sterile saline solution. Group A had a significantly shorter extubation time than the placebo group (8 +/- 1 h v 10 +/- 4 hours, p < 0.001). Blood gas analysis showed higher PaO2 and lower PaCO2 levels in group A. The patients receiving bupivicaine had significantly higher FEV1, FCV, VC, MVV, PEF, and FEF 25-75% values postoperatively when compared with the placebo group. Postoperative analgesic requirements and visual analog pain scales were significantly lower in group A. The intensive care unit stay in group A was shorter (1.2 +/- 0.7 v 1.4 +/- 0.6 days, p = 0.04); however, the hospital stay did not differ between groups. Improvement in lung function parameters correlating with decreased postoperative pain with intrapleural bupivacaine was observed. Intrapleural analgesia provided a good level of analgesia, improved respiratory performance, and allowed rapid mobilization, which led to a reduction of postoperative respiratory complications.
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):816-9.
• Article: Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study.

  Andrea A Cogliati, Raffaella Vellutini, Antonia Nardini, Sali Urovi, Mazen Hamdan, Giovanni Landoni, Paolo Guelfi
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  ABSTRACT: The purpose of this study was to evaluate the renoprotective effects of fenoldopam in patients at high risk of postoperative acute kidney injury undergoing elective cardiac surgery requiring cardiopulmonary bypass. A double-blind randomized clinical trial. Setting: Hospital. Participants: One hundred ninety-three patients. Interventions: Patients undergoing cardiac surgery were randomly assigned to receive a continuous infusion of fenoldopam, 0.1 microg/kg/min (95 patients), or placebo (98 patients) for 24 hours. Patients were included if at least 1 of the following risk factors was present: preoperative serum creatinine > or =1.5 mg/dL, age >70 years, diabetes mellitus, or prior cardiac surgery. Serum creatinine and urinary output were measured at baseline (T1), 24 hours (T2), and 48 hours after surgery (T3). Acute kidney injury was defined as a postoperative serum creatinine level of > or =2 mg/dL with an increase in serum creatinine level of 0.7 mg/dL or greater from preoperative to maximum postoperative values. Acute kidney injury developed in 12 of 95 (12.6%) patients receiving fenoldopam and in 27 of 98 (27.6%) patients receiving placebo (p = 0.02), whereas renal replacement therapy was started in 0 of 95 and 8 of 98 (8.2%) patients, respectively (p = 0.004). Serum creatinine was similar at baseline (1.8 +/- 0.4 mg/dL v 1.9 +/- 0.3 mg/dL) in the fenoldopam and placebo groups but differed significantly (p < 0.001 and p < 0.001) 24 hours (1.6 +/- 0.2 mg/dL v 2.5 +/- 0.6 mg/dL) and 48 hours (1.5 +/- 0.3 mg/dL v 2.8 +/- 0.4 mg/dL) after the operation. A 24-hour infusion of 0.1 mug/kg/min of fenoldopam prevented acute kidney injury in a high-risk population undergoing cardiac surgery.
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):847-50.
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  Available from: comfypage.com

  Article: Resistant hypoxemia in an infant with a right ventricle-to-pulmonary artery (Sano) shunt.

  Benjamin Pieters, Troy A Johnston, Thomas K Jones, Gordon Cohen, Christer Jonmarker
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):880-2.
• Article: Anesthesia technique for endobronchial ultrasound-guided fine needle aspiration of mediastinal lymph node.

  Mona Sarkiss, Marcus Kennedy, Bernhard Riedel, Peter Norman, Rodolfo Morice, Carlos Jimenez, George Eapen
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):892-6.
• Article: Cardiovascular collapse during living-directed orthotopic liver transplantation associated with the transfusion of contaminated red blood cells.

  Edward C Nemergut, Paul D Mintz, Pamela Clark, Robert G Sawyer, Timothy L Pruett
  Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):870-2.