7451
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De Bonis M, Lapenna E, Buzzatti N, Taramasso M, Calabrese MC, Nisi T, Pappalardo F, Alfieri O. Can the edge-to-edge technique provide durable results when used to rescue patients with suboptimal conventional mitral repair? Eur J Cardiothorac Surg 2013; 43:e173-9. [DOI: 10.1093/ejcts/ezt056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7452
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Risk of renal dysfunction after less invasive multivessel coronary artery bypass grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 7:180-6. [PMID: 22885458 DOI: 10.1097/imi.0b013e3182614f80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Several centers have established that off-pump, multivessel coronary artery bypass grafting performed via a small thoracotomy (MVST) is feasible. However, this procedure can be challenging when posterolateral coronary targets need to be grafted. We hypothesized that use of cardiopulmonary bypass via peripheral access (MVST-PA) would improve outcomes compared with a completely off-pump approach (OP-MVST). METHODS This was a prospective observational study of patients undergoing OP-MVST (n = 46) versus MVST-PA (n = 45) using bilateral internal mammary artery grafts onto the left anterior descending coronary artery and circumflex/right coronary artery distribution. Hemostasis was quantified by measuring platelet function (aggregometry), chest tube output, thrombolysis in myocardial infarction bleeding score (%hematocrit change at 24 hours), and transfusion requirements. The rate of mortality and major morbidity at 30 days was defined according to The Society of Thoracic Surgeons criteria. Estimated glomerular filtration rate (normalized to baseline levels) was determined daily until discharge. RESULTS The OP-MVST versus MVST-PA groups had similar risk factors at baseline and risks of composite morbidity/mortality at 30 days. However, renal failure was significantly increased after OP-MVST (10.87 vs 0%, P = 0.05), and MVST-PA affected hemostasis as evidenced by inhibition of platelet function (latency to response on aggregometry, 29.9 vs 17.9 seconds; P = 0.04) and higher transfusion requirement (2.31 vs 0.85 units of red blood cells/patient, P = 0.04; 55.6% vs 34.8% transfused; P = 0.059). However, 24-hour chest tube output was similar (645 vs 750 mL; P = 0.53). CONCLUSIONS In comparison with a completely off-pump strategy, use of cardiopulmonary bypass to assist MVST reduced the risk of renal dysfunction with only modest tradeoffs in other morbidities, for example, altered coagulation and higher transfusion requirements. These data justify further study of the effect of MVST-PA on renal complications.
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7453
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Abstract
In the tradition of Dr Arom, who had many interests in his clinical and research career, I will touch on three things that will impact the practice of clinical cardiac surgery over the next several years: use of bilateral internal mammary arteries, use of external mesh support to improve saphenous vein graft patency, and anticoagulation of mechanical heart valves. The remainder of the presentation goes into depth on the development of a bloodless heart surgery program, which is contemporary and timely as it encompasses some thoughts of this society.
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7454
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Clinical and economic outcomes associated with blood transfusions among elderly Americans following coronary artery bypass graft surgery requiring cardiopulmonary bypass. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s90-9. [PMID: 23399371 DOI: 10.2450/2013.0170-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/08/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Blood transfusion occurring during hospitalisation for heart surgery has been shown to be associated with increased morbidity and mortality and with increased time spent in hospital, use of healthcare services, and costs. The objective of this study was to assess how perioperative blood transfusion among adults 65 years and older who underwent coronary artery bypass graft surgery requiring cardiopulmonary bypass in the United States is associated with immediate and longer term clinical and economic outcomes. MATERIALS AND METHODS Using data from a 5% random sample of Medicare patients who underwent their first (within 2 years) coronary artery bypass graft requiring cardiopulmonary bypass procedure in 2005 or 2006, this study estimated associations (hazard ratios and regression coefficients) between transfusion status (received or not) and complications after surgery, serious adverse events, death, and costs using Cox proportional hazard and generalised linear models adjusting for patients' demographic and clinical characteristics. RESULTS Adjusted hazard ratios were statistically significant (P<0.05) for risks of complications (1.20), serious adverse events (1.58), and death (1.49). There was also a statistically significantly (P≤0.01) and strong relationship between receiving transfused blood and Medicare payments over the subsequent 45 months following discharge ($5,778 per calendar quarter for those receiving transfusion vs $5,197; all costs are measured in 2011 USD). CONCLUSION Blood transfusion during hospitalisation for coronary artery bypass graft requiring cardiopulmonary bypass was significantly associated with increased long-term post-operative morbidity, mortality, and overall healthcare costs. This study contributes to the evidence demonstrating an association between transfusion and adverse clinical and economic outcomes by using a nationally representative longitudinal cost and utilisation database.
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7455
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Aghakhani N, Azami M, Jasemi M, Khoshsima M, Eghtedar S, Rahbar N. Epidemiology of traumatic brain injury in urmia, iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:173-4. [PMID: 23682332 PMCID: PMC3652507 DOI: 10.5812/ircmj.2090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 02/16/2012] [Accepted: 03/10/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Nader Aghakhani
- Department of Nursing, Urmia University of Medical Sciences, Urmia, IR Iran
- Corresponding author: Nader Aghakhani, Department of Nursing, Urmia University of Medical Sciences, Urmia, IR Iran. Tel: +98-4412752378, Fax: +98-4412752378, E-mail:
| | - Mehdi Azami
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Madine Jasemi
- Health Policy Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Khoshsima
- Department of Nursing, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Samereh Eghtedar
- Department of Nursing, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Narghes Rahbar
- Department of Nursing, Urmia University of Medical Sciences, Urmia, IR Iran
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7456
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Naik B, Matsumoto AH. Acute cor pulmonale and right heat failure complicating ethanol ablative therapy: anesthetic and radiologic considerations and management. Cardiovasc Intervent Radiol 2013; 36:1213-20. [PMID: 23377237 DOI: 10.1007/s00270-013-0549-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/13/2012] [Indexed: 11/28/2022]
Abstract
Ethanol is an effective ablative agent used for the treatment of certain solid organ tumors and vascular malformations (VMs). The egress of ethanol beyond the target tissue can be associated with significant changes to the cardiopulmonary system that can lead to cardiac arrest. This article reviews the contemporary role of ethanol in tumor and VM treatment and discusses the physiological mechanisms of acute pulmonary hypertension and cardiovascular collapse. The importance of periprocedural recognition of the hemodynamic changes that can occur with the use of ethanol and the treatment of this condition are discussed.
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Affiliation(s)
- Bhiken Naik
- Department of Anesthesiology, University of Virginia, PO Box 800710, Charlottesville, VA, 22008-0710, USA,
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7457
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Transfusion of cell saver salvaged blood in neonates and infants undergoing open heart surgery significantly reduces RBC and coagulant product transfusions and donor exposures: results of a prospective, randomized, clinical trial. Pediatr Crit Care Med 2013; 14:137-47. [PMID: 23287903 PMCID: PMC3671922 DOI: 10.1097/pcc.0b013e31826e741c] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hrs, would decrease the number of postoperative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes. DESIGN Prospective, randomized, controlled, clinical trial. SETTING Pediatric cardiac intensive care unit. PATIENTS Infants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Subjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hrs after collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups. MEASUREMENTS AND MAIN RESULTS Children randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 vs. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hrs post-op (cell saver: 0.09 ± 0.45 vs. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 vs. control: 2.3 ± 4.8; p = 0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 vs. control: 1.1 ± 1.4; p = 0.07). There were no significant clinical outcome differences. CONCLUSION Cell saver blood can be safely stored at the bedside for immediate transfusion for 24 hrs after collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate postoperative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease postoperative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.
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7458
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Ahn JH, Park JR, Min JH, Sohn JT, Hwang SJ, Park Y, Koh JS, Jeong YH, Kwak CH, Hwang JY. Risk Stratification Using Computed Tomography Coronary Angiography in Patients Undergoing Intermediate-Risk Noncardiac Surgery. J Am Coll Cardiol 2013; 61:661-8. [DOI: 10.1016/j.jacc.2012.09.060] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/12/2012] [Accepted: 09/16/2012] [Indexed: 11/15/2022]
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7459
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Solanki SL, Kishore K, Goyal VK, Yadav R. Electrocautery induced artifactual ST segment depression in leads II, III and aVF on intra-operative 5-lead electrocardiogram. J Clin Monit Comput 2013; 27:97-8. [PMID: 22914912 DOI: 10.1007/s10877-012-9392-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 08/15/2012] [Indexed: 02/07/2023]
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7460
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Mets B. Management of Hypotension Associated With Angiotensin-Axis Blockade and General Anesthesia Administration. J Cardiothorac Vasc Anesth 2013; 27:156-67. [DOI: 10.1053/j.jvca.2012.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Indexed: 11/11/2022]
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7461
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Krivchenya DU, Rudenko EO, Dubrovin AG. Congenital emphysema in children: segmental lung resection as an alternative to lobectomy. J Pediatr Surg 2013; 48:309-14. [PMID: 23414857 DOI: 10.1016/j.jpedsurg.2012.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/12/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital emphysema is a rare lung malformation characterized by overinflation of lung segments or lobe, together with ventilation and lung perfusion disorders. The lesion frequently causes respiratory distress in infants and may require urgent surgery. The pathogenesis is still controversial, and the usual treatment recommended is a lobectomy. AIM The aims of the study were to clarify the pathogenesis and relationship to vascular abnormalities and to assess the safety and efficacy of lung-sparing segmental resections. MATERIALS AND METHODS Retrospective review of hospital records, chest radiograph, digital subtraction angiography, and contrast-enhanced chest CT were used for diagnosis. RESULTS Forty-three (median age 4 months, range 10 days to 10 years) children were diagnosed with congenital emphysema. Most were <1 year of age at presentation (n=33; 77%). The predominant side affected was the left (n=24; 56%), and of these all but one had segmental (not lobar) lesions. Most of these then underwent segmental lung resection (S(1)-S(3)) with preservation of the uninvolved lingual (S(4-5)) segments preserved. A standard lobectomy was used in right-sided lesions. There was a high incidence of vascular abnormalities in association with the emphysematous segments, which may be important in its etiology. One child, referred in extremis and died before surgery could be undertaken. Otherwise, early and late results of surgery were rated as good or excellent in all patients. Longer-term follow-up of the preserved left lingual segments did not suggest any recurrence of emphysema. CONCLUSION Segmental resection in cases of left-sided congenital emphysema appears effective and merits further use as a lung-sparing operation.
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Affiliation(s)
- Daniil U Krivchenya
- Department of Paediatric Surgery, Bogomolets National Medical University, National Children Specialized Hospital OHMATDYT, Kyiv 01135, Ukraine
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7462
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Park M, Costa ELV, Maciel AT, Silva DPE, Friedrich N, Barbosa EVS, Hirota AS, Schettino G, Azevedo LCP. Determinants of oxygen and carbon dioxide transfer during extracorporeal membrane oxygenation in an experimental model of multiple organ dysfunction syndrome. PLoS One 2013; 8:e54954. [PMID: 23383011 PMCID: PMC3558498 DOI: 10.1371/journal.pone.0054954] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/18/2012] [Indexed: 01/19/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has gained renewed interest in the treatment of respiratory failure since the advent of the modern polymethylpentene membranes. Limited information exists, however, on the performance of these membranes in terms of gas transfers during multiple organ failure (MOF). We investigated determinants of oxygen and carbon dioxide transfer as well as biochemical alterations after the circulation of blood through the circuit in a pig model under ECMO support before and after induction of MOF. A predefined sequence of blood and sweep flows was tested before and after the induction of MOF with fecal peritonitis and saline lavage lung injury. In the multivariate analysis, oxygen transfer had a positive association with blood flow (slope = 66, P<0.001) and a negative association with pre-membrane PaCO2 (slope = −0.96, P = 0.001) and SatO2 (slope = −1.7, P<0.001). Carbon dioxide transfer had a positive association with blood flow (slope = 17, P<0.001), gas flow (slope = 33, P<0.001), pre-membrane PaCO2 (slope = 1.2, P<0.001) and a negative association with the hemoglobin (slope = −3.478, P = 0.042). We found an increase in pH in the baseline from 7.50[7.46,7.54] to 7.60[7.55,7.65] (P<0.001), and during the MOF from 7.19[6.92,7.32] to 7.41[7.13,7.5] (P<0.001). Likewise, the PCO2 fell in the baseline from 35 [32,39] to 25 [22,27] mmHg (P<0.001), and during the MOF from 59 [47,91] to 34 [28,45] mmHg (P<0.001). In conclusion, both oxygen and carbon dioxide transfers were significantly determined by blood flow. Oxygen transfer was modulated by the pre-membrane SatO2 and CO2, while carbon dioxide transfer was affected by the gas flow, pre-membrane CO2 and hemoglobin.
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Affiliation(s)
- Marcelo Park
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
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7463
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[Modified rapid sequence induction for Caesarian sections : case series on the use of rocuronium and sugammadex]. Anaesthesist 2013; 61:691-5. [PMID: 22875060 DOI: 10.1007/s00101-012-2065-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Aspiration is a feared complication of anesthesia and is accompanied by increased morbidity and mortality. Rapid sequence induction (RSI) describes the preferred procedure to perform endotracheal placement of the tubus in emergency cases of patients with an increased risk of aspiration of gastric contents. For more than 50 years RSI has consisted of the application of suxamethonium for neuromuscular blockade because of its fast onset and ultra short duration. Due to the serious side effects of suxamethonium attempts were made to find better alternative neuromuscular blocking drugs, e.g. rocuronium, to perform RSI. MATERIALS AND METHODS In this small clinical series RSI was performed for general anesthesia of ten pregnant women for Caesarean sections using 1.0 mg/kgBW rocuronium for induction and maintaining deep relaxation until the end of surgery. For rapid reversal of the neuromuscular blockade to a train-of-four (TOF) ratio of 0.9, the µ-cyclodextrin sugammadex was administered at the end of surgery. Major and minor side effects, such as cardiac dysrhythmia, anaphylactic reactions, hoarseness and postoperative nausea and vomiting were documented. CONCLUSIONS The combination of rocuronium and sugammadex for RSI combines rapid onset and rapid reversal of neuromuscular blockades with avoidance of serious side effects and very comfortable conditions for intubation in all cases. Minor side effects such as hoarseness, throat discomfort (in up to 30%) and myalgia (10%) for up to 48 h were documented.
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7464
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Wang J, Zheng H, Chen CL, Lu W, Zhang YQ. Sevoflurane at 1 MAC provides optimal myocardial protection during off-pump CABG. SCAND CARDIOVASC J 2013; 47:175-84. [DOI: 10.3109/14017431.2012.760749] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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7465
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Dehghani E, Trenfield S. Tranexamic acid in open cardiac surgery with cardiopulmonary bypass, convulsive seizures, and in-hospital mortality. Br J Anaesth 2013; 110:313-4. [PMID: 23319673 DOI: 10.1093/bja/aes484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7466
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Dorantes Mendez G, Aletti F, Toschi N, Canichella A, Dauri M, Coniglione F, Guerrisi M, Signorini MG, Cerutti S, Ferrario M. Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients. J Clin Monit Comput 2013; 27:417-26. [PMID: 23314842 DOI: 10.1007/s10877-012-9426-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 12/27/2012] [Indexed: 11/24/2022]
Abstract
The aim of this paper is to compare baroreflex sensitivity (BRS) following anesthesia induction via propofol to pre-induction baseline values through a systematic and mathematically robust analysis. Several mathematical methods for BRS quantification were applied to pre-operative and intra-operative data collected from patients undergoing major surgery, in order to track the trend in BRS variations following anesthesia induction, as well as following the onset of mechanical ventilation. Finally, a comparison of BRS trends in chronic hypertensive patients (CH) with respect to non hypertensive (NH) patients was performed. 10 NH and 7 CH patients undergoing major surgery with American Society of Anesthesiologists classification score 2.5 ± 0.5 and 2.6 ± 0.5 respectively, were enrolled in the study. A Granger causality test was carried out to verify the causal relationship between RR interval duration and systolic blood pressure (SBP), and four different mathematical methods were used to estimate the BRS: (1) ratio between autospectra of RR and SBP, (2) transfer function, (3) sequence method and (4) bivariate closed loop model. Three different surgical epochs were considered: baseline, anesthetic procedure and post-intubation. In NH patients, propofol administration caused a decrease in arterial blood pressure (ABP), due to its vasodilatory effects, and a reduction of BRS, while heart rate (HR) remained unaltered with respect to baseline values before induction. A larger decrease in ABP was observed in CH patients when compared to NH patients, whereas HR remained unaltered and BRS was found to be lower than in the NH group at baseline, with no significant changes in the following epochs when compared to baseline. To our knowledge, this is the first study in which the autonomic response to propofol induction in CH and NH patients was compared. The analysis of BRS through a mathematically rigorous procedure in the perioperative period could result in the availability of additional information to guide therapy and anesthesia in uncontrolled hypertensive patients, which are prone to a higher rate of hypotension events occurring during general anesthesia induction.
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Affiliation(s)
- Guadalupe Dorantes Mendez
- Department of Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, MI, Italy
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7467
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Kumar S, Debata PK, Gupta R. Congenital lobar emphysema and intercostal drainage tube insertion: the common fate of an uncommon disease. J Clin Diagn Res 2013; 6:1568-70. [PMID: 23285462 DOI: 10.7860/jcdr/2012/4449.2565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022]
Abstract
Congenital Lobar Emphysema (CLE) is one of the rare cystic malformations of the lung. This malformation is generally confused with pneumothorax of the lung and most often, the placement of an intercostal drainage tube is entertained in an emergency situation, but the non- improvement of the distress and non-expansion of the lung are eye openers for a treating paediatrician. We are describing a case of a 26 days old baby who presented with respiratory distress in the Emergency Department. On the basis of the chest X-ray (CXR), we suspected it to be a case of pneumothorax and an intercostal drainage tube was inserted. But as he did not improve, CT of the chest was done and the baby was diagnosed to have congenital lobar emphysema. In spite of the advanced diagnostic techniques, the diagnosis of CLE may present a diagnostic challenge and a high index of suspicion is needed if the diagnosis has to be made promptly.
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Affiliation(s)
- Saurabh Kumar
- Senior Resident at Department of Pediatrics, Safdarjung Hospital and VMMC , New Delhi, India
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7468
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Gharaei B, Jafari A, Aghamohammadi H, Kamranmanesh M, Poorzamani M, Elyassi H, Rostamian B, Salimi A. Opioid-Sparing Effect of Preemptive Bolus Low-Dose Ketamine for Moderate Sedation in Opioid Abusers Undergoing Extracorporeal Shock Wave Lithotripsy. Anesth Analg 2013; 116:75-80. [DOI: 10.1213/ane.0b013e31826f0622] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7469
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7470
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Hamid M, Irfan Akhtar M, Nasim Minai F, Gangwani AL. Errors during Paediatric Cardiac Anaesthesia: Reporting and Learning. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojanes.2013.39086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7471
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Mao H, Giuliani A, Blanca-Martos L, Kim JC, Nayak A, Virzi G, Brocca A, Scalzotto E, Neri M, Katz N, Ronco C. Effect of Percutaneous Ventricular Assist Devices on Renal Function. Blood Purif 2013; 35:119-26. [DOI: 10.1159/000346096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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7472
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Lee C, Kim YD, Seo DH, Lee JH, Song YK. Conversion of supraventricular tachycardia to normal sinus rhythm by dexmedetomidine treatment. Korean J Anesthesiol 2013; 65:S123-4. [PMID: 24478841 PMCID: PMC3903829 DOI: 10.4097/kjae.2013.65.6s.s123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cheol Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yeon-Dong Kim
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Dong-Hyuk Seo
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Hun Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yoon-Kang Song
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea
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7473
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Extracorporeal Membrane Oxygenation in Children with Heart Disease and Genetic Syndromes. ASAIO J 2013; 59:52-6. [DOI: 10.1097/mat.0b013e31827b5a45] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7474
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7475
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Abstract
The natriuretic system consists of the atrial natriuretic peptide (ANP) and four other similar peptides including the wrongly named brain natriuretic peptide (BNP). Chemically they are small peptide hormones predominantly secreted by the cardiac myocytes in response to stretching forces. The peptide hormones have multiple renal, hemodynamic, and antiproliferative effects through three different kinds of natriuretic receptors. Clinical interest in these peptide hormones was initially stimulated by the use of these peptides as markers to differentiate cardiac versus noncardiac causes of breathlessness. Subsequently work has been done on using these peptides to prognosticate patients with acute and chronic heart failure and those with acute myocardial infraction. Synthetic forms of both atrial- and brain-natriuretic peptides have been studied and approved for use in acute heart failure with mixed results. This review focuses on the biochemistry and physiology of this fascinating hormone system and the clinical application of these hormones.
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Affiliation(s)
- Sandeep Chopra
- Department of Cardiology, Christian Medical College, Ludhiana, India
| | - Davis Cherian
- Department of Cardiology, Christian Medical College, Ludhiana, India
| | | | - Jubbin J. Jacob
- Department of Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College, Ludhiana, India
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7476
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Liu XL, Chen GZ. Recent advances in the use of epidural anesthesia for acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2012; 20:3737-3741. [DOI: 10.11569/wcjd.v20.i36.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a common acute disease caused by a number of factors. It can cause a variety of systemic symptoms and multiple organ failure (MOF), having a high mortality rate. Currently, there is still a lack of effective treatment for AP because its pathogenesis has not been elucidated. The positive role of epidural anesthesia for AP was firs described by Browne in 1969. In recent years, it has been found that epidural anesthesia can prevent the progression of AP by inducing analgesia, inhibiting the release of inflammatory factors, promoting acinar cell apoptosis, and improving pancreatic microcirculation. In this paper, we will review recent progress in the use of epidural anesthesia for AP.
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7477
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Raja SG, Raja SM. Treating pulmonary arterial hypertension: current treatments and future prospects. Ther Adv Chronic Dis 2012; 2:359-70. [PMID: 23251761 DOI: 10.1177/2040622311420773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) consists of a group of heterogeneous but distinct disorders characterized by complex proliferation of the pulmonary vascular endothelium and progressive pulmonary vascular remodeling that leads to right ventricular failure and death. Over the past two decades, significant advances in our understanding of the pathobiology of PAH have led to the development of several therapeutic targets in this disease. Besides conservative therapeutic strategies such as anticoagulation and diuretics, the current treatment paradigm for PAH targets the mediators of the three main biologic pathways that are critical for its pathogenesis and progression: endothelin receptor antagonists inhibit the upregulated endothelin pathway by blocking the biologic activity of endothelin-1; phosphodiesterase-5 inhibitors prevent breakdown and increase the endogenous availability of cyclic guanosine monophosphate, which signals the vasorelaxing effects of the downregulated mediator nitric oxide; and prostacyclin derivatives provide an exogenous supply of the deficient mediator prostacyclin. In addition to these established current therapeutic options, a large number of potential therapeutic targets are being investigated. These novel therapeutic targets include soluble guanylyl cyclase, phosphodiesterases, tetrahydrobiopterin, 5-hydroxytryptamine (serotonin) receptor 2B, vasoactive intestinal peptide, receptor tyrosine kinases, adrenomedullin, rho kinase, elastases, endogenous steroids, endothelial progenitor cells, immune cells, bone morphogenetic protein and its receptors, potassium channels, metabolic pathways, and nuclear factor of activated T cells. This review provides an overview of the current therapeutic options and potential therapeutic targets for PAH.
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7478
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Hong SH, Moon YE, Lee SR, Cho SJ, Kwon OK. Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation. Korean J Anesthesiol 2012; 63:569-70. [PMID: 23277823 PMCID: PMC3531541 DOI: 10.4097/kjae.2012.63.6.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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7479
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Shehata N, Forster A, Li L, Rothwell DM, Mazer CD, Naglie G, Fowler R, Tu JV, Rubens FD, Hawken S, Wilson K. Does anemia impact hospital readmissions after coronary artery bypass surgery? Transfusion 2012; 53:1688-97; quiz 1687. [DOI: 10.1111/trf.12007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/27/2012] [Accepted: 09/30/2012] [Indexed: 11/30/2022]
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7480
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Bajwa SJS, Kaur J, Singh A, Parmar S, Singh G, Kulshrestha A, Gupta S, Sharma V, Panda A. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth 2012; 56:123-8. [PMID: 22701201 PMCID: PMC3371485 DOI: 10.4103/0019-5049.96303] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, and the present study was carried out to investigate the ability of intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. Methods: One hundred patients scheduled for elective general surgery were randomized into two groups: D and F (n=50 in each group). Group D were administered 1 μg/kg each of dexmedetomidine and fentanyl while group F received 2 μg/kg of fentanyl pre-operatively. Thiopental was given until eyelash reflex disappeared. Anaesthesia was maintained with 33:66 oxygen: nitrous oxide. Isoflurane concentration was adjusted to maintain systolic blood pressure within 20% of the pre-operative values. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Statistical analysis was carried out using analysis of variance, chi-square test, Student's t test and Mann–Whitney U test. Results: The demographic profile was comparable. The pressor response to laryngoscopy, intubation, surgery and extubation were effectively decreased by dexmedetomidine, and were highly significant on comparison (P<0.001). The mean dose of fentanyl and isoflurane were also decreased significantly (>50%) by the administration of dexmedetomidine. The mean recovery time was also shorter in group D as compared with group F (P=0.014). Conclusions: Dexmedetomidine is an excellent drug as it not only decreased the magnitude of haemodynamic response to intubation, surgery and extubation but also decreased the dose of opioids and isoflurane in achieving adequate analgesia and anaesthesia, respectively.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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7481
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Levosimendan is superior to dobutamine as an inodilator in the treatment of pulmonary hypertension for children undergoing cardiac surgery. J Anesth 2012; 27:334-9. [DOI: 10.1007/s00540-012-1537-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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7482
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Diehl P, Olivier C, Bode C, Moser M. Editorial comment: Reduction of oxidative stress: a new indication for acetylsalicylic acid in coronary artery bypass surgery. Eur J Cardiothorac Surg 2012; 43:1163-4. [PMID: 23220870 DOI: 10.1093/ejcts/ezs614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philipp Diehl
- Heart Center, Cardiology and Angiology I, Freiburg University, Freiburg, Germany.
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7483
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Yang W, Dong X, Li B, Zhang XQ, Zeng Y, Wei YP, Zhou JL, Tang YH, Xu JJ. Correlation of angiotensin converting enzyme gene polymorphism with perioperative myocardial protection under extracorporeal circulation. ASIAN PAC J TROP MED 2012. [DOI: 10.1016/s1995-7645(12)60189-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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7484
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Kumar V, Calamaras TD, Haeussler D, Colucci WS, Cohen RA, McComb ME, Pimentel D, Bachschmid MM. Cardiovascular redox and ox stress proteomics. Antioxid Redox Signal 2012; 17:1528-59. [PMID: 22607061 PMCID: PMC3448941 DOI: 10.1089/ars.2012.4706] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SIGNIFICANCE Oxidative post-translational modifications (OPTMs) have been demonstrated as contributing to cardiovascular physiology and pathophysiology. These modifications have been identified using antibodies as well as advanced proteomic methods, and the functional importance of each is beginning to be understood using transgenic and gene deletion animal models. Given that OPTMs are involved in cardiovascular pathology, the use of these modifications as biomarkers and predictors of disease has significant therapeutic potential. Adequate understanding of the chemistry of the OPTMs is necessary to determine what may occur in vivo and which modifications would best serve as biomarkers. RECENT ADVANCES By using mass spectrometry, advanced labeling techniques, and antibody identification, OPTMs have become accessible to a larger proportion of the scientific community. Advancements in instrumentation, database search algorithms, and processing speed have allowed MS to fully expand on the proteome of OPTMs. In addition, the role of enzymatically reversible OPTMs has been further clarified in preclinical models. CRITICAL ISSUES The identification of OPTMs suffers from limitations in analytic detection based on the methodology, instrumentation, sample complexity, and bioinformatics. Currently, each type of OPTM requires a specific strategy for identification, and generalized approaches result in an incomplete assessment. FUTURE DIRECTIONS Novel types of highly sensitive MS instrumentation that allow for improved separation and detection of modified proteins and peptides have been crucial in the discovery of OPTMs and biomarkers. To further advance the identification of relevant OPTMs in advanced search algorithms, standardized methods for sample processing and depository of MS data will be required.
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Affiliation(s)
- Vikas Kumar
- Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA 02118, USA
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7485
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Slankamenac K, Breitenstein S, Beck-Schimmer B, Graf R, Puhan MA, Clavien PA. Does pharmacological conditioning with the volatile anaesthetic sevoflurane offer protection in liver surgery? HPB (Oxford) 2012; 14:854-62. [PMID: 23134188 PMCID: PMC3521915 DOI: 10.1111/j.1477-2574.2012.00570.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/26/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND A recently published randomized control trial (RCT) showed a protection of the remnant liver from ischemia-reperfusion (I/R) injury by pharmacological pre-conditioning with a volatile anaesthetic in patients undergoing hepatic resection. Whether the continuous application of volatile anaesthetics (pharmacological conditioning) also protects against I/R injury is unknown. METHODS Consecutive patients undergoing liver resection with inflow occlusion from 2005-2007 were included in the trial. Two groups of anaesthesia regimens with either continuous application of the volatile anaesthetic sevoflurane (pharmacological conditioning) or continuous infusion of the intravenous (i.v.) anaesthetic propofol (control group) were compared. Endpoints were serum-peak-aspartate aminotransferase (AST)/ alanine aminotranferease (ALT) levels, length of stay (LOS) and intensive care unit (ICU) stays, and the occurrence of post-operative complications. RESULTS Two hundred and twenty-seven patients were included. Pharmacological conditioning did not protect the remnant liver from IR injury (adjusted difference for peak-AST:61.9 U/l, 95% confidence interval (CI): -151.7-275.4 U/l, P = 0.568; peak-ALT:136.1 U/l, 95% CI: -113.7-385.9 U/l, P = 0.284) nor reduce LOS (adjusted difference 0.9 days, 95% CI: -2.6-4.3 days, P = 0.622) or ICU stay (1.6 days, 95% CI: -0.2-3.3 days, P = 0.079), and was not associated with reduced complication rates (adjusted OR 1.12, 95% CI:0.6-2.3, P = 0.761) compared with the control group. CONCLUSION In this retrospective study, continuous volatile anaesthesia in liver resection does not provide protection of the remnant liver from IR injury compared with continuous i.v. anaesthesia.
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Affiliation(s)
- Ksenija Slankamenac
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital of ZurichZurich, Switzerland
| | - Stefan Breitenstein
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital of ZurichZurich, Switzerland
| | | | - Rolf Graf
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital of ZurichZurich, Switzerland
| | - Milo A Puhan
- Horten Centre for Patient-Oriented Research, University Hospital of ZurichZurich, Switzerland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimore, MD, USA
| | - Pierre-Alain Clavien
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital of ZurichZurich, Switzerland
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7486
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Favilli S, Santoro G, Ballo P, Arcangeli C, Bovenzi FM, Chiappa E, Conti U, Monopoli A, Murzi B, Rosini C, Zuppiroli A. Prevalence and clinical characteristics of adult patients with congenital heart disease in Tuscany. J Cardiovasc Med (Hagerstown) 2012; 13:805-9. [DOI: 10.2459/jcm.0b013e3283569b3a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7487
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Abstract
Better understanding of the pathophysiology of acute lung injury (ALI) and the hazards inherent to extremes in volume status has led efforts toward goal-directed, individualized therapies designed to achieve optimal hemodynamic status. The role for colloids both as a volume expander and potential protective agent against ALI is receiving revived interest. The evidence for the impact of fluid therapy is encouraging and supports the undertaking of properly designed perioperative fluid trials in thoracic surgeries. Such work offers hope that optimal fluid strategies can be defined and reduce the adverse events that have affected patients having lung resection.
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Affiliation(s)
- Cait P Searl
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
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7488
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Abstract
Transexamic acid (TXA) is an antifibrinolytic that has been used successfully to prevent blood loss during major surgery. However, as its usage has increased, there have been growing reports of postsurgical seizure events in cardiac surgery patients. In this issue of the JCI, Lecker et al. explore this connection and suggest that TXA-mediated inhibition of glycine receptors may underlie the effect. This finding prompted the authors to explore the preclinical efficacy of common anesthetics that function by reducing the TXA-mediated inhibition to prevent or modify postsurgical seizures.
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Affiliation(s)
- Debra A Schwinn
- Department of Anesthesiology, Pharmacology, and Biochemistry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa 52242-1101, USA.
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7489
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Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA. Tranexamic acid concentrations associated with human seizures inhibit glycine receptors. J Clin Invest 2012. [PMID: 23187124 DOI: 10.1172/jci63375] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antifibrinolytic drugs are widely used to reduce blood loss during surgery. One serious adverse effect of these drugs is convulsive seizures; however, the mechanisms underlying such seizures remain poorly understood. The antifibrinolytic drugs tranexamic acid (TXA) and ε-aminocaproic acid (EACA) are structurally similar to the inhibitory neurotransmitter glycine. Since reduced function of glycine receptors causes seizures, we hypothesized that TXA and EACA inhibit the activity of glycine receptors. Here we demonstrate that TXA and EACA are competitive antagonists of glycine receptors in mice. We also showed that the general anesthetic isoflurane, and to a lesser extent propofol, reverses TXA inhibition of glycine receptor-mediated current, suggesting that these drugs could potentially be used to treat TXA-induced seizures. Finally, we measured the concentration of TXA in the cerebrospinal fluid (CSF) of patients undergoing major cardiovascular surgery. Surprisingly, peak TXA concentration in the CSF occurred after termination of drug infusion and in one patient coincided with the onset of seizures. Collectively, these results show that concentrations of TXA equivalent to those measured in the CSF of patients inhibited glycine receptors. Furthermore, isoflurane or propofol may prevent or reverse TXA-induced seizures.
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Affiliation(s)
- Irene Lecker
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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7490
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Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury. J Neurosurg Anesthesiol 2012; 24:178-84. [PMID: 22504924 DOI: 10.1097/ana.0b013e318254fb70] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. METHODS This is a retrospective cohort study of patients 18 years and above, who underwent emergent craniotomy for TBI at Harborview Medical Center (level 1 trauma center) between October 2007 and January 2010. Demographic, clinical, and radiographic characteristics and hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records. Hypotension was defined as systolic blood pressure <90 mm Hg. Univariate analyses were performed to compare the clinical characteristics of patients with and without IH, and multiple logistic regression analysis was used to determine independent risk factors for IH. RESULTS Data abstracted from 113 eligible patients aged 48±19 years were analyzed. IH was common (n=73, 65%) but not affected by the choice of anesthetic agent. Independent risk factors for IH were multiple computed tomographic (CT) lesions [adjusted odds ratios (AOR) 19.1; 95% confidence interval (CI), 2.08-175.99; P=0.009], subdural hematoma (AOR 17.9; 95% CI, 2.97-108.10; P=0.002), maximum CT lesion thickness (AOR 1.1; 95% CI, 1.01-1.13; P=0.016), and anesthesia duration (AOR 1.1; 95% CI, 1.01-1.30; P=0.009). CONCLUSIONS IH was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion, and longer duration of anesthesia increase the risk for IH.
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7491
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Möller Petrun A, Kamenik M. Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial. Br J Anaesth 2012; 110:388-96. [PMID: 23166149 DOI: 10.1093/bja/aes416] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a double-blind, randomized trial, we compared the haemodynamic effects of a bispectral index (BIS)-guided etomidate and propofol infusion for anaesthesia induction in patients undergoing major abdominal surgery. METHODS Forty-six patients were randomly assigned to two groups based on the induction of anaesthesia, performed with a BIS value of 60 titrated infusion of etomidate (E group) or propofol (P group). Mean arterial pressure (MAP), cardiac index (CI), heart rate, and systemic vascular resistance index (SVRI) measurements were taken 1 min before induction and recorded at 1-min intervals for 20 min. P<0.05 was considered statistically significant. RESULTS Before intubation, no significant differences between the two groups regarding the haemodynamics were noticed. At intubation and up to 7 min after intubation MAP (P=0.019) was significantly higher in the E group. CI was significantly higher in the E group with respect to the P group 2, 6, and 7 min after intubation. Twenty-three patients developed complications. The incidence of hypotension was higher in the P group than that in the E group (8 vs 3; P=0.08), and the incidence of hypertension was significantly higher in the E group than that in the P group (10 vs 2; P=0.007). CONCLUSIONS Our study showed that the use of propofol resulted in less hypertension and tachycardia at and after intubation than etomidate. But even with the reduced doses given with the BIS-guided protocol, it often caused significant hypotension.
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Affiliation(s)
- A Möller Petrun
- Department of Anaesthesiology, Intensive Care and Pain Management University Medical Centre Maribor, Ljubljanska ulica 5, SI-2000 Maribor, Slovenia
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7492
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Grocott MPW, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev 2012; 11:CD004082. [PMID: 23152223 PMCID: PMC6477700 DOI: 10.1002/14651858.cd004082.pub5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Studies have suggested that increasing whole body blood flow and oxygen delivery around the time of surgery reduces mortality, morbidity and the expense of major operations. OBJECTIVES To describe the effects of increasing perioperative blood flow using fluids with or without inotropes or vasoactive drugs. Outcomes were mortality, morbidity, resource utilization and health status. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2012, Issue 1), MEDLINE (1966 to March 2012) and EMBASE (1982 to March 2012). We manually searched the proceedings of major conferences and personal reference databases up to December 2011. We contacted experts in the field and pharmaceutical companies for published and unpublished data. SELECTION CRITERIA We included randomized controlled trials with or without blinding. We included studies involving adult patients (aged 16 years or older) undergoing surgery (patients having a procedure in an operating room). The intervention met the following criteria. 'Perioperative' was defined as starting up to 24 hours before surgery and stopping up to six hours after surgery. 'Targeted to increase global blood flow' was defined by explicit measured goals that were greater than in controls, specifically one or more of cardiac index, oxygen delivery, oxygen consumption, stroke volume (and the respective derived indices), mixed venous oxygen saturation (SVO(2)), oxygen extraction ratio (0(2)ER) or lactate. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data. We contacted study authors for additional data. We used Review Manager software. MAIN RESULTS We included 31 studies of 5292 participants. There was no difference in mortality: 282/2615 (10.8%) died in the control group and 238/2677 (8.9%) in the treatment group, RR of 0.89 (95% CI 0.76 to 1.05, P = 0.18). However, the results were sensitive to analytical methods and the intervention was better than control when inverse variance or Mantel-Haenszel random-effects models were used, RR of 0.72 (95% CI 0.55 to 0.95, P = 0.02). The results were also sensitive to withdrawal of studies with methodological limitations. The rates of three morbidities were reduced by increasing global blood flow: renal failure, RR of 0.71 (95% CI 0.57 to 0.90); respiratory failure, RR of 0.51 (95% CI 0.28 to 0.93); and wound infections, RR of 0.65 (95% CI 0.51 to 0.84). There were no differences in the rates of nine other morbidities: arrhythmia, pneumonia, sepsis, abdominal infection, urinary tract infection, myocardial infarction, congestive cardiac failure or pulmonary oedema, or venous thrombosis. The number of patients with complications was reduced by the intervention, RR of 0.68 (95% CI 0.58 to 0.80). Hospital length of stay was reduced in the treatment group by a mean of 1.16 days (95% CI 0.43 to 1.89, P = 0.002). There was no difference in critical care length of stay. There were insufficient data to comment on quality of life and cost effectiveness. AUTHORS' CONCLUSIONS It remains uncertain whether increasing blood flow using fluids, with or without inotropes or vasoactive drugs, reduces mortality in adults undergoing surgery. The primary analysis in this review (mortality at longest follow-up) showed no difference between the intervention and control, but this result was sensitive to the method of analysis, the withdrawal of studies with methodological limitations, and is dominated by a single large RCT. Overall, for every 100 patients in whom blood flow is increased perioperatively to defined goals, one can expect 13 in 100 patients (from 40/100 to 27/100) to avoid a complication, 2/100 to avoid renal impairment (from 8/100 to 6/100), 5/100 to avoid respiratory failure (from 10/100 to 5/100), and 4/100 to avoid postoperative wound infection (from 10/100 to 6/100). On average, patients receiving the intervention stay in hospital one day less. It is unlikely that the intervention causes harm. The balance of current evidence does not support widespread implementation of this approach to reduce mortality but does suggest that complications and duration of hospital stay are reduced.
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Affiliation(s)
- Michael PW Grocott
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise HealthUniversity College London Centre for Altitude Space and Extreme Environment (CASE) MedicineLondonUK
| | | | - Mark A Hamilton
- St. George's HospitalGeneral Intensive Care Unit1st Floor St. James wingBlackshaw RoadLondonUKSW17 0QT
| | - Michael G Mythen
- University College LondonDepartment Anaesthesia and Critical Care1st Floor Maple House149 Tottenham Court RoadLondonUKWC1E 6DB
| | - David Harrison
- Intensive Care National Audit & Research CentreNapier House24 High HolbornLondonUKWC1V 6AZ
| | - Kathy Rowan
- Intensive Care National Audit & Research CentreNapier House24 High HolbornLondonUKWC1V 6AZ
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7493
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Successful coronary artery bypass grafting with the aid of a portable minimized extracorporeal life support system. ASAIO J 2012; 58:337-42. [PMID: 22717590 DOI: 10.1097/mat.0b013e31825fdfcb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extracorporeal life support system has been successfully used in patients with cardiac failure after open heart surgery, as a bridge to transplantation, and in patients with prolonged cardiogenic shock or cardiopulmonary arrest. This report presents our early experience with the new system Cardiohelp in coronary artery bypass grafting (CABG). Between August 2010 and June 2011, 50 patients underwent CABG with the aid of Cardiohelp. This subgroup was matched for sex and logistic EuroSCORE with 100 patients, who underwent CABG using two different extracorporeal circulation systems, a minimized (MECC) (n = 50) and a conventional (CECC) (n = 50) during the same period. Because of less hemodilution, the intraoperative blood transfusion was significantly lower in the Cardiohelp group (36%) and MECC group (40%) compared with the CECC group (64%). Postoperative release of creatinine kinase and lactate was lower in the Cardiohelp and MECC groups (p < 0.001). Furthermore, these patients had shorter duration of ventilation and lengths of stay at the intensive care unit (p < 0.05). Device-related complications were not observed. A conversion to CECC was not necessary. In conclusion, the Cardiohelp is a safe alternative for CABG surgery. Valid technical innovations and limited number of side effects support its employment as a highly effective device for coronary surgery.
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7494
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Nielsen K, Dahl B, Johansson PI, Henneberg SW, Rasmussen LS. Intraoperative transfusion threshold and tissue oxygenation: a randomised trial. Transfus Med 2012; 22:418-25. [PMID: 23121563 DOI: 10.1111/j.1365-3148.2012.01196.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 09/16/2012] [Accepted: 09/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Transfusion with allogeneic red blood cells (RBCs) may be needed to maintain oxygen delivery during major surgery, but the appropriate haemoglobin (Hb) concentration threshold has not been well established. We hypothesised that a higher level of Hb would be associated with improved subcutaneous oxygen tension during major spinal surgery. MATERIALS AND METHODS Fifty patients aged 18 years or older scheduled for spinal fusion with instrumentation were included and randomised to receive RBCs at either a Hb concentration of 7·3 g dL(-1) (restrictive group) or a Hb concentration of 8·9 g dL(-1) (liberal group) (Registration no.: H-C-2009-072). Oxygen tension was measured with a polarographic electrode placed subcutaneously over the left deltoid muscle. The primary endpoint was subcutaneous oxygen tension at the time most patients were still undergoing surgery. RESULTS Forty-eight patients were included in the intention-to-treat analysis; 25 patients in the restrictive group and 23 patients in the liberal group. The median change in subcutaneous oxygen tension 60 min after surgical incision was -0·79 and -0·75 kPa in the restrictive and the liberal groups, respectively (P = 0·78). No significant difference was found in the lowest subcutaneous oxygen tension; -2·07 vs. -1·95 kPa in the restrictive and the liberal groups, respectively (P = 0·85). CONCLUSION A Hb concentration transfusion threshold of 8·9 g dL(-1) was not associated with a higher subcutaneous oxygen tension during major spinal surgery than a threshold of 7·3 g dL(-1), but the trial was compromised by methodological difficulties.
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Affiliation(s)
- K Nielsen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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7495
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Corrección de tetralogía de Fallot: papel del ecocardiograma transesofágico intraoperatorio. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rca.2012.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7496
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Abstract
This paper focuses on the problem of high and/or imbalanced electrode-skin impedances changing electrocardiogram (ECG) morphology. After reproducing ECG interference in a controlled laboratory setting-similar to what was observed during cardiopulmonary bypass surgery- and then understanding the cause, this knowledge was applied to clinical settings. Most interference was reduced by using electrode impedance meters and consistent skin prep.
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7497
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Hameed AB, Shrivastava VK, Blair L, Wing DA. Intracranial hemorrhage in pregnancy. AJP Rep 2012; 2:47-50. [PMID: 23946906 PMCID: PMC3653512 DOI: 10.1055/s-0032-1316463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 03/03/2012] [Indexed: 11/17/2022] Open
Abstract
A pregnant woman with a mechanical prosthetic mitral valve was anticoagulated with low-molecular-weight heparin in the first trimester followed by warfarin until 36 weeks' gestation. She was then switched to intravenous unfractionated heparin infusion to allow for regional anesthesia in anticipation of vaginal delivery. She developed severe headache on hospital day 2 that was refractory to pain medications. Cranial imaging demonstrated a large subdural hematoma with midline shift. She delivered a healthy baby girl by cesarean section. Eventually, symptoms and intracranial abnormalities resolved over time. In conclusion, subdural hematoma is a relatively rare complication that requires multidisciplinary management plan.
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Affiliation(s)
- Afshan B Hameed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange, California
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7498
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Kaneko S, Khoo NS, Smallhorn JF, Tham EB. Single Right Ventricles Have Impaired Systolic and Diastolic Function Compared to Those of Left Ventricular Morphology. J Am Soc Echocardiogr 2012; 25:1222-30. [DOI: 10.1016/j.echo.2012.08.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Indexed: 11/16/2022]
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7499
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Clivatti J, Smith RL, Sermer M, Silversides C, Carvalho JCA. Cardiac output monitoring during Cesarean delivery in a patient with palliated tetralogy of Fallot. Can J Anaesth 2012; 59:1119-24. [DOI: 10.1007/s12630-012-9793-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/14/2012] [Indexed: 11/25/2022] Open
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7500
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Ferraris VA. Facts, opinions, and conclusions: aprotinin brings out all of these. J Thorac Cardiovasc Surg 2012; 145:240-2. [PMID: 23062411 DOI: 10.1016/j.jtcvs.2012.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/07/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
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