Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Assessment of Perioperative Protamine Reactions in Patients With Fish Allergies: A Retrospective Observational Study 评估鱼过敏患者围手术期的原胺反应：一项回顾性观察研究

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-23 DOI: 10.1053/j.jvca.2024.08.024

Mohanad R. Youssef MD, Eryberto Martinez MD, Terrique M. Pinnock MD, Alexei Gonzalez-Estrada MD, Mark M. Smith MD, Bradford B. Smith MD

To retrospectively assess the incidence and severity of perioperative protamine reactions in adult patients with documented history of fish allergy. Retrospective observational study. Large academic tertiary referral center. Adults with fish allergies undergoing surgeries involving protamine, between January 1, 2008, and March 1, 2018. Perioperative protamine administration in patients with documented fish allergy. Perioperative protamine and anaphylactic reactions were reviewed. A diagnosis of anaphylaxis or protamine reaction was based on clinical suspicion, perioperative events, and postoperative evaluations. Among 214 patients, 2 cases (<1%) of anaphylaxis or protamine reactions occurred. Cardiac procedures were most common (67%). The median intraoperative heparin dosage was 46,000 IU, and the median protamine dosage was 310 mg. Nearly all patients (99%) were admitted to the intensive care unit postoperatively, with a median hospital stay of 6.5 days (interquartile range, 5.2-14.6 days). There were 3 deaths (1%) within 30 days, and 15 (7%) within 1 year. The study findings suggest that in patients with a history of fish allergy, cross-reactivity with protamine is unlikely, as anaphylaxis and/or protamine reactions were rare in this patient population in the perioperative environment. Based on these findings, this study does not recommend avoiding protamine solely based on a history of fish allergy when heparin reversal is required during surgery.

回顾性评估有鱼类过敏病史记录的成年患者围手术期原胺反应的发生率和严重程度。回顾性观察研究。大型学术三级转诊中心。2008年1月1日至2018年3月1日期间接受过涉及原胺手术的鱼过敏成人。有记录的鱼过敏患者围手术期使用原胺的情况。对围手术期的原胺和过敏反应进行了回顾。过敏性休克或原胺反应的诊断基于临床怀疑、围手术期事件和术后评估。在 214 名患者中，有 2 例（<1%）发生过敏性休克或原胺反应。心脏手术最为常见（67%）。术中肝素用量中位数为 46,000 IU，原胺用量中位数为 310 毫克。几乎所有患者（99%）术后都住进了重症监护室，住院时间中位数为 6.5 天（四分位间范围为 5.2-14.6 天）。30 天内死亡 3 例（1%），1 年内死亡 15 例（7%）。研究结果表明，在有鱼过敏史的患者中，与原胺发生交叉反应的可能性不大，因为在围手术期环境中，过敏性休克和/或原胺反应在这类患者中很少见。基于这些发现，本研究并不建议在手术期间需要逆转肝素时仅因有鱼过敏史而避免使用质胺。

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引用次数: 0

Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: To Predict or to Measure? 主动脉瓣置换术后患者与假体不匹配：预测还是测量？

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-23 DOI: 10.1053/j.jvca.2024.08.031

Nicole M. Maldari MD, Peter J. Neuburger MD FASE, Liliya Pospishil MD FASE

引用次数: 0

Amino Acids for Renal Protection: Promising, but Cautiously So 保护肾脏的氨基酸：前景光明，但需谨慎

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-23 DOI: 10.1053/j.jvca.2024.08.026

Daniel S. Cormican MD FCCP, David A. Broadbent MD, Meha Bhargava MD

引用次数: 0

Predictors of Postoperative Morphine Milligram Equivalents in Cardiac Surgery 心脏手术术后吗啡毫克当量的预测因素

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-23 DOI: 10.1053/j.jvca.2024.08.029

David Delijani BA, Hyungjoo Kim BA, Xueqi Huang BA, Joseph Pena MD, Alan Hartman MD, Pey-Jen Yu MD

Given both the short- and long-term deleterious effects of opioids, there has been an increased focused on reducing the use of postoperative opioid analgesia. As patients undergoing cardiac surgery often require high levels opioids postoperatively, understanding risk factors for increased postoperative opioid use may be helpful for the development of patient-specific opioid-sparing pain regimens for this patient population. A retrospective analysis of data from our electronic medical records and the Society of Thoracic Surgeon's database. A single-institution study at an academic medical center. All patients undergoing open adult cardiac surgery were included. Exclusion criteria were patients with continuous intravenous narcotic drips and operative mortality. As this was a retrospective study, no interventions were conducted on the participants. Data for patient postoperative opioid requirements were extracted from the electronic medical record. Total opioid use on postoperative days 0 to 3 was converted to morphine milligram equivalent (MME) via standard conversion factors. The study cohort comprised 1604 patients, including 456 females and 1066 coronary artery bypass grafting (CABG) recipients. MME was 31.0% greater in patients undergoing CABG (p < 0.001), 76.3% greater in patients with liver disease (p = 0.005), and 48.8% greater in patients with patient-controlled analgesia (p <0.001) during postoperative days 0 to 3. Younger age (p < 0.001) and higher body mass index (BMI) (p < 0.001) also were associated with increased MME prescription. CABG, liver disease, patient-controlled analgesia, younger age, and higher BMI are associated with increased narcotic use after cardiac surgery. Implementation of more aggressive perioperative multimodal opioid-sparing regimens should be considered for these patient groups.

鉴于阿片类药物的短期和长期有害影响，人们越来越重视减少术后阿片类镇痛药物的使用。由于接受心脏手术的患者术后通常需要大量阿片类药物，因此了解术后阿片类药物使用增加的风险因素可能有助于为这类患者制定针对特定患者的阿片类药物镇痛方案。我们对电子病历和胸外科医师协会数据库中的数据进行了回顾性分析。这是一项在学术医疗中心进行的单机构研究。纳入了所有接受开放式成人心脏手术的患者。排除标准是持续静脉滴注麻醉剂和手术死亡率高的患者。由于这是一项回顾性研究，因此没有对参与者进行干预。患者术后阿片类药物需求数据来自电子病历。术后第 0 至 3 天的阿片类药物总用量通过标准换算系数换算成吗啡毫克当量（MME）。研究对象包括1604名患者，其中包括456名女性和1066名冠状动脉旁路移植术（CABG）受术者。在术后第0至3天，接受CABG手术的患者的MME增加了31.0%（p < 0.001），肝病患者的MME增加了76.3%（p = 0.005），患者自控镇痛患者的MME增加了48.8%（p < 0.001）。年龄越小（p < 0.001）、体重指数（BMI）越高（p < 0.001）也与MME处方量增加有关。CABG、肝脏疾病、患者自控镇痛、年龄较轻和体重指数较高与心脏手术后麻醉药用量增加有关。对于这些患者群体，应考虑实施更积极的围手术期多模式阿片类药物保留治疗方案。

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引用次数: 0

Remimazolam in Cardiac Anesthesia: Analysis of Recent Data 雷马唑仑在心脏麻醉中的应用：最新数据分析

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-22 DOI: 10.1053/j.jvca.2024.08.030

Juan G. Ripoll MD, Rayssa Becerra Orjuela MD, Anuradha Kanaparthi MD, Juan C. Diaz Soto MD, Mariam A. ElSaban MBBS, Thais R. Peclat MD PhD, Patrick M. Wieruszewski PharmD RPh, Arnoley S. Abcejo MD, Marvin G. Chang MD PhD, Edward A. Bittner MD PhD FCCM, Harish Ramakrishna MD FACC FESC

Interest in remimazolam has surged in recent years, thanks to its advantageous pharmacologic profile. This ultra-short-acting benzodiazepine is noted for its rapid onset and termination of action, organ-independent elimination, availability of a reversal agent, and excellent hemodynamic stability. Although the use of remimazolam has been explored in various anesthesia settings and procedures, data on its application in cardiovascular anesthesia and catheterization laboratory procedures remain limited. This review evaluates the latest literature to assess remimazolam's role in cardiovascular anesthesia across different settings and procedures. The analysis shows that remimazolam offers anesthesia without significant hemodynamic instability and a reduced need for vasopressors, with an incidence of perioperative adverse events comparable to that of other agents. These findings are relevant for both the induction and maintenance of general anesthesia in catheterization laboratory procedures and general anesthesia in elective cardiac surgery. Although further research is needed to fully understand remimazolam's role in cardiovascular anesthesia, its favorable hemodynamic and safety profile suggests that it is a promising option for cardiac anesthesiologists in both the catheterization laboratory and the operating room.

近年来，人们对瑞马唑仑的兴趣急剧上升，这要归功于它的药理特性。这种超短效苯二氮卓类药物因其起效和终止作用迅速、不依赖器官消除、可使用逆转剂以及出色的血液动力学稳定性而备受关注。虽然在各种麻醉环境和手术中都探索过使用雷马唑仑，但有关其在心血管麻醉和导管室手术中应用的数据仍然有限。本综述评估了最新的文献，以评估雷马唑仑在不同环境和手术中的心血管麻醉作用。分析表明，remimazolam 可提供无明显血流动力学不稳定的麻醉，减少对血管加压药的需求，围术期不良反应的发生率与其他药物相当。这些发现对导管室手术中的全身麻醉诱导和维持以及择期心脏手术中的全身麻醉都有意义。尽管还需要进一步的研究来充分了解雷马唑仑在心血管麻醉中的作用，但其良好的血流动力学和安全性表明，它是导管室和手术室中心脏麻醉师的一个很有前途的选择。

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引用次数: 0

ENGAGES-Canada: Has This “Burst” the Bubble of Processed EEG? ENGAGES - 加拿大：处理脑电图的泡沫 "破灭 "了吗？

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-22 DOI: 10.1053/j.jvca.2024.08.025

Kelly Byrne MBChB FANZCA, Mark Grivas BPhty MD, Amy Gaskell MBChB BMedSci FANZCA PhD

引用次数: 0

Stepwise Mechanical Circulatory Support in a Pediatric Patient With Respiratory Failure Facilitating Mobilization and Recovery 为一名呼吸衰竭的儿科患者提供分步式机械循环支持，促进其活动和康复

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-22 DOI: 10.1053/j.jvca.2024.08.023

Mitchell Lippy MD, Brady Still MD, Richa Dhawan MD MPH, Ingrid Moreno-Duarte MD, Hiroto Kitahara MD

引用次数: 0

Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis. 用于围手术期功能性肾保护的氨基酸输注：一项 Meta 分析。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-22 DOI: 10.1053/j.jvca.2024.08.033

Alessandro Pruna, Rosario Losiggio, Giovanni Landoni, Yuki Kotani, Martina Baiardo Redaelli, Marta Veneziano, Todd C Lee, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo

Objectives: Acute kidney injury (AKI) is a common perioperative complication. To date, no single intervention has been proven effective for AKI prevention in this setting. However, intravenous amino acids (AA) administration may recruit renal functional reserve and, thereby, attenuate the perioperative loss of the glomerular filtration rate.

Design: We performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection.

Setting and participants: We performed a meta-analysis of controlled studies in perioperative patients evaluating intravenous AA infusion versus any comparator.

Measurements: The primary outcome was AKI at longest follow-up. We performed a random effects meta-analysis on the relative risk (RR) scale to assess the effect of AA infusion. We used a Bayesian approach to estimate the probability of benefit (RR < 1) for the primary outcome. Secondary outcomes included renal replacement therapy, serum creatinine, and estimated glomerular filtration rate. Tertiary outcomes included mechanical ventilation duration, intensive care unit and hospital length of stay and mortality (PROSPERO: CRD42024547225).

Results: We identified 15 studies (14 randomized controlled trials and 1 prospective before-after study) reporting at least one outcome of interest (4,544 patients), with 6 studies (4,084 patients) reporting the primary outcome. AKI occurred 504 of 2,041 (24.7%) in AA patients versus 614 of 2,041 (30.1%) in controls (RR, 0.66; 95% confidence interval, 0.47-0.94; I² = 50%; p = 0.02), which corresponded with a 99.1% probability of AKI reduction with AA. Moreover, consistent with these findings, AA decreased serum creatinine and hospital length of stay and increased the estimated glomerular filtration rate.

Conclusions: This meta-analysis suggests that AA administration likely decreased the perioperative incidence of AKI.

目的：急性肾损伤（AKI）是一种常见的围手术期并发症。迄今为止，还没有任何一种干预措施能有效预防这种情况下的急性肾损伤。然而，静脉注射氨基酸（AA）可恢复肾功能储备，从而减轻围手术期肾小球滤过率的下降：我们进行了一项荟萃分析，以评估输注 AA 对围手术期肾功能保护的功效：我们对围术期患者的对照研究进行了荟萃分析，评估了静脉输注AA与任何对比研究的效果：主要结果是随访时间最长的AKI。我们根据相对风险（RR）表进行了随机效应荟萃分析，以评估AA输注的效果。我们采用贝叶斯方法来估计主要结果的获益概率（RR < 1）。次要结果包括肾脏替代治疗、血清肌酐和估计肾小球滤过率。三级结果包括机械通气持续时间、重症监护室和住院时间以及死亡率（PROSPERO：CRD42024547225）：我们确定了 15 项研究（14 项随机对照试验和 1 项前瞻性前后研究）至少报告了一项相关结果（4544 名患者），其中 6 项研究（4084 名患者）报告了主要结果。在 2,041 例 AA 患者中，504 例（24.7%）发生了 AKI，而在 2,041 例对照患者中，614 例（30.1%）发生了 AKI（RR，0.66；95% 置信区间，0.47-0.94；I2 = 50%；P = 0.02），AA 减少 AKI 的概率为 99.1%。此外，与这些研究结果一致的是，AA可减少血清肌酐和住院时间，增加肾小球滤过率：这项荟萃分析表明，使用 AA 有可能降低围手术期 AKI 的发生率。

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引用次数: 0

“The Ventilator Stress Index: Timing Is Everything” "呼吸机压力指数：时机就是一切"

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-22 DOI: 10.1053/j.jvca.2024.08.022

Danisa K. Daubenspeck

引用次数: 0

Anesthetic Management of Tracheal Tumor Debulking and Stenting as an Emergency Procedure in a Rare Case of Infiltrating Lower Tracheal Malignancy 在一例罕见的气管下段浸润性恶性肿瘤急诊手术中对气管肿瘤切除和支架植入术的麻醉管理

IF 2.8 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-08-21 DOI: 10.1053/j.jvca.2024.08.021

Kiran Muthu Rajah MD, V. Rajesh Kumar Kodali MD, Mahesh Vakamudi MD

引用次数: 0

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of cardiothoracic and vascular anesthesia

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