Journal of cardiothoracic and vascular anesthesia最新文献

Objective: To compare clinical outcomes of patients with catecholamine-resistant vasodilatory shock (CRVS) receiving continuous renal replacement therapy who receive adjunctive angiotensin II (ANGII) to those who do not.

Design: Retrospective cohort analysis.

Setting: Multicenter, single health system consisting of one academic medical center and four community hospitals.

Participants: Critically ill adult patients with CRVS (norepinephrine or equivalent dose ≥0.5 mcg/kg/min).

Interventions: Adjunctive ANGII versus standard-of-care (SOC) vasopressors alone (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine).

Measurements and main results: The primary outcome was intensive care unit mortality. Secondary outcomes included 30-day mortality, Sequential Organ Failure Assessment (SOFA) score at 72 hours, time to shock resolution, and adverse effects. A multivariate logistic regression was used for the primary analysis. The study included 265 patients, of which 70 received ANGII and 195 received SOC. Intensive care unit and 30-day mortality were lower in patients that received ANGII (61.4% v 75.4%, adjusted odds ratio 0.438, 95% confidence interval: 0.239-0.805, p = 0.008; and 67.1% v 78.5%, adjusted odds ratio 0.479, 95% confidence interval: 0.256-0.898, p = 0.022). Differences in time to shock reversal and SOFA score at 72 hours were not statistically significant. The adverse effects evaluated were not statistically significant, apart from an increase in fungal infections in the ANGII group (17.1% v 7.2%, p = 0.016).

Conclusions: ANGII was associated with lower mortality in patients who received renal replacement therapy compared to SOC. This evaluation reaffirms a subgroup of patients that may benefit from the addition of ANGII.

Objectives: To investigate the efficacy and safety of combining alfentanil with dexmedetomidine for conscious sedation in outpatients undergoing transesophageal echocardiography (TEE).

Design: Prospective, randomized, double-blind clinical trial.

Setting: University-affiliated teaching hospital.

Participants: We recruited 80 patients scheduled to undergo transesophageal echocardiography examinations from May 2023 to July 2023.

Interventions: Eighty patients were randomly assigned into 2 groups, namely, the alfentanil + dexmedetomidine (AD) group (n = 40) and the oropharyngeal topical anesthesia with dyclonine + midazolam + dexmedetomidine (MD) group (n = 40).

Measurements and main results: Suppression of the patient's pharyngeal reflexes was assessed, and the hemodynamic parameters, along with the incidence of intraoperative adverse events, were also documented. The primary outcome was the initial sedation success rate, defined as achieving a pharyngeal reflex grade of less than 3, no excessive sedation (Ramsay sedation scores >4), and no serious adverse effects. This rate was significantly higher in the AD group (85%) compared with the MD group (35%) (p < .001). Compared with the MD group (47.5%), the incidence of hypotension in AD group (25.0%) decreased significantly (p < .05). Although the incidence of respiratory depression in AD group (42.5%) was higher than that in MD group (15.0%) (p < .01), no hypoxia and asphyxia occurred in either group. The recovery time of AD group (626.25 ± 295.80) was significantly shorter than that of MD group (768.33 ± 310.43) (p < .05). No serious complications occurred in either group.

Conclusions: Intravenous alfentanil combined with dexmedetomidine effectively inhibits pharyngeal reflexes and demonstrates a favorable safety profile, with fewer incidents of hypotension but a higher incidence of manageable respiratory depression compared with the MD protocol.

Objective: Hemoconcentration and cell saver use are blood conservation techniques that are often used in cardiac surgery to salvage the patient's own blood to reduce autologous transfusion. The purpose of this study was to examine the perioperative outcomes including transfusion rates in cardiac surgical patients receiving hemoconcentrated blood versus cell saver blood via retrospective chart review. We hypothesized that hemoconcentration would have better patient outcomes, including reduced transfusion rates, compared to only cell salvage technique.

Design: Single-center, retrospective chart review case-control study SETTING: Cardiac operating room of a tertiary care center PARTICIPANTS: Patients over 18 years old who underwent elective open-heart surgery with cardiopulmonary bypass between January 2015 to January 2018. Patients for emergencies, off-pump cases, transplants, and reoperations and with a need for second bypass were excluded.

Interventions: None.

Measurements and main results: The specific outcomes assessed include perioperative transfusion of packed red blood cells and blood products, intensive care unit (ICU) length of stay, hospital length of stay, and surgical site infections. Patient characteristics such as ejection fraction and comorbidities, pulmonary hypertension, atrial fibrillation history, and coagulation dysfunction were also analyzed. Propensity score matching was done to balance the covariates between the groups. The differences for each outcome outlined above were calculated. Of the 744 observations, 735 were used for analysis after propensity matching. Postoperative ICU red blood cell transfusions recorded a mean difference of -0.37 (95% CI: -0.78, 0.04). Postoperative ICU platelets and fresh frozen plasma recorded mean differences of -0.01 (95% CI: -0.11, 0.09) and -0.08 (95% CI: -0.19, 0.03), respectively. There were no significant differences in outcomes in bivariate- and covariate-adjusted models.

Conclusions: There is no significant difference in postoperative blood transfusion rates in hemoconcentrated versus cell saver blood usage in cardiac surgery patients. Further studies are needed to analyze specific quantities and ratios of hemoconcentrated and cell saver blood used in these patients for a more clinically relevant analysis. This would allow incorporation of hemoconcentration and cell saver techniques into better blood conservation processes and guide overall transfusion strategies to reduce transfusion rates of blood and blood products in cardiac surgical patients.