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Haji-Jafari S, Rezaei M, Azizi-Fini I, Tafti SHA, Atoof F. The effect of rewarming on hemodynamic parameters and arterial blood gases of patients after open-heart surgery: A randomized controlled trial. JOURNAL OF VASCULAR NURSING 2023; 41:29-35. [PMID: 36898803 DOI: 10.1016/j.jvn.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/12/2021] [Accepted: 01/16/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Hypothermia after open-heart surgery can have potential side effects for patients. AIM This study aimed to examine the effects of rewarming on patients' hemodynamic and arterial blood gases parameters after open-heart surgery. METHODS This randomized controlled trial was performed in 2019 on 80 patients undergoing open-heart surgery at Tehran Heart Center, Iran. The subjects were consecutively recruited and randomly assigned to an intervention group (n=40) and a control group (n=40). After the surgery, the intervention group was warmed with an electric warming mattress while the control group warmed using a simple hospital blanket. The hemodynamic parameters of the two groups were measured 6 times and arterial blood gas was measured 3 times. Data were analyzed by independent samples t and Chi-squared tests, and repeated measures analysis. RESULTS Before the intervention, the two groups did not significantly differ in terms of hemodynamic and blood gas parameters. However, the two groups were significantly different in the mean heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, temperature, right and left lung drainage in the first half-hour, and the first to fourth hours after the intervention (p < 0.05). Furthermore, there was a significant difference between the mean arterial oxygen pressure of the two groups during and after rewarming (P <0.05). CONCLUSION Rewarming of patients after open-heart surgery can significantly affect hemodynamic and arterial blood gas parameters. Therefore, rewarming methods can be used safely to improve the patients' hemodynamic parameters after open-heart surgery.
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Affiliation(s)
- Somayeh Haji-Jafari
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboubeh Rezaei
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ismail Azizi-Fini
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Iran
| | - Fatemeh Atoof
- Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran.
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Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair. JTCVS Tech 2022; 16:1-7. [PMID: 36510530 PMCID: PMC9737039 DOI: 10.1016/j.xjtc.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair. Methods We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods. Incremental effect of cooling time was assessed in the context of other perfusion time variables using multiple logistic regression analysis. Results Median age was 61 years (interquartile range, 49-70 years) and 34.1% of patients were women. The procedure was emergent in 33.5% of patients, 22.9% had a previous sternotomy. The median circulatory arrest time was 22 minutes, with retrograde cerebral perfusion used in 94% of cases. Median cardiopulmonary bypass time was 149 minutes, with an aortic crossclamp time of 90 minutes. Patients were cooled to deep hypothermia. The first quartile had cooling times ranging from 5 to 13 minutes, second 14 to 18 minutes, third 19-23 minutes, and fourth 24-81 minutes. Overall, 30-day mortality was 9.4%, and was not significantly different across quartiles. There was a statistically significant trend toward lower rates of postoperative encephalopathy, gastrointestinal complications, and respiratory failure with shorter cooling times (P < .001, .006, and < .001, respectively). There was no significant difference in rates of postoperative stroke or dialysis. Conclusions Rapid cooling can be performed safely in patients undergoing aortic surgery requiring circulatory arrest without increasing mortality or stroke. There were significantly lower rates of coagulopathy, respiratory failure, and postoperative encephalopathy with shorter cooling times.
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Lapergola G, Graziosi A, D'Adamo E, Brindisino P, Ferrari M, Romanelli A, Strozzi M, Libener R, Gavilanes DAW, Maconi A, Satriano A, Varrica A, Gazzolo D. S100B in cardiac surgery brain monitoring: friend or foe? Clin Chem Lab Med 2022; 60:317-331. [PMID: 35001583 DOI: 10.1515/cclm-2021-1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
Abstract
Recent advances in perioperative management of adult and pediatric patients requiring open heart surgery (OHS) and cardiopulmonary bypass (CPB) for cardiac and/or congenital heart diseases repair allowed a significant reduction in the mortality rate. Conversely morbidity rate pattern has a flat trend. Perioperative period is crucial since OHS and CPB are widely accepted as a deliberate hypoxic-ischemic reperfusion damage representing the cost to pay at a time when standard of care monitoring procedures can be silent or unavailable. In this respect, the measurement of neuro-biomarkers (NB), able to detect at early stage perioperative brain damage could be especially useful. In the last decade, among a series of NB, S100B protein has been investigated. After the first promising results, supporting the usefulness of the protein as predictor of short/long term adverse neurological outcome, the protein has been progressively abandoned due to a series of limitations. In the present review we offer an up-dated overview of the main S100B pros and cons in the peri-operative monitoring of adult and pediatric patients.
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Affiliation(s)
| | | | - Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | | | | - Anna Romanelli
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Mariachiara Strozzi
- Department of Maternal, Fetal and Neonatal Medicine, ASO SS Antonio, Biagio and C. Arrigo, Alessandria, Italy
| | - Roberta Libener
- Department of Maternal, Fetal and Neonatal Medicine, ASO SS Antonio, Biagio and C. Arrigo, Alessandria, Italy
| | - Danilo A W Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | - Antonio Maconi
- Department of Maternal, Fetal and Neonatal Medicine, ASO SS Antonio, Biagio and C. Arrigo, Alessandria, Italy
| | - Angela Satriano
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, Milan, Italy
| | - Alessandro Varrica
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, Milan, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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Augoustides JG. Protecting the Central Nervous System During Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes. Br J Anaesth 2021; 128:11-25. [PMID: 34862000 DOI: 10.1016/j.bja.2021.09.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Postoperative cognitive decline occurs commonly after cardiac surgery. The available literature is inconclusive on the role of intraoperative causal or protective factors. METHODS We systematically reviewed studies evaluating delayed neurocognitive recovery (DNR), postoperative neurocognitive disorder (NCD), stroke, and the mortality rates among patients undergoing hypothermic or normothermic cardiopulmonary bypass (CPB). We further performed a subgroup analysis for age, surgery type (coronary artery bypass grafting [CABG], valve surgery, or combined), and the mean arterial blood pressure (MAP) during CPB, and conducted a proportion meta-analysis after calculation of single proportions and confidence intervals (CIs). RESULTS We included a total of 58 studies with 9609 patients in our analysis. Among these, 1906 of 4010 patients (47.5%) had DNR, and 2071 of 7160 (28.9%) had postoperative NCD. Ninety of 4625 patients (2.0%) had a stroke, and 174 of 7589 (2.3%) died. There was no statistically significant relationship between the considered variables and DNR, NCD, stroke, and mortality. In the subgroup analysis comparing hypothermic with normothermic CPB, we found higher NCD rates after combined surgery; for normothermic CPB cases only, the rates of DNR and NCD were lower after combined surgery compared with CABG surgery. A MAP >70 mm Hg compared with MAP=50-70 mm Hg during CPB was associated with a lower rate of DNR. CONCLUSIONS Temperature, MAP during cardiopulmonary bypass age, and surgery type were not associated with neurocognitive disorders, stroke, and mortality in cardiac surgery. Normothermic cardiopulmonary bypass, particularly when performed with MAP >70 mm Hg, may reduce the risk of postoperative neurocognitive decline after cardiac surgery. PROSPERO REGISTRATION NUMBER CRD42019140844.
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Qu JZ, Kao LW, Smith JE, Kuo A, Xue A, Iyer MH, Essandoh MK, Dalia AA. Brain Protection in Aortic Arch Surgery: An Evolving Field. J Cardiothorac Vasc Anesth 2020; 35:1176-1188. [PMID: 33309497 DOI: 10.1053/j.jvca.2020.11.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Despite advances in cardiac surgery and anesthesia, the rates of brain injury remain high in aortic arch surgery requiring circulatory arrest. The mechanisms of brain injury, including permanent and temporary neurologic dysfunction, are multifactorial, but intraoperative brain ischemia is likely a major contributor. Maintaining optimal cerebral perfusion during cardiopulmonary bypass and circulatory arrest is the key component of intraoperative management for aortic arch surgery. Various brain monitoring modalities provide different information to improve cerebral protection. Electroencephalography gives crucial data to ensure minimal cerebral metabolism during deep hypothermic circulatory arrest, transcranial Doppler directly measures cerebral arterial blood flow, and near-infrared spectroscopy monitors regional cerebral oxygen saturation. Various brain protection techniques, including hypothermia, cerebral perfusion, pharmacologic protection, and blood gas management, have been used during interruption of systemic circulation, but the optimal strategy remains elusive. Although deep hypothermic circulatory arrest and retrograde cerebral perfusion have their merits, there have been increasing reports about the use of antegrade cerebral perfusion, obviating the need for deep hypothermia. With controversy and variability of surgical practices, moderate hypothermia, when combined with unilateral antegrade cerebral perfusion, is considered safe for brain protection in aortic arch surgery performed with circulatory arrest. The neurologic outcomes of brain protection in aortic arch surgery largely depend on the following three major components: cerebral temperature, circulatory arrest time, and cerebral perfusion during circulatory arrest. The optimal brain protection strategy should be individualized based on comprehensive monitoring and stems from well-executed techniques that balance the major components contributing to brain injury.
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Affiliation(s)
- Jason Z Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lee-Wei Kao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer E Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alexander Kuo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Albert Xue
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH
| | - Adam A Dalia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Denault A, Shaaban Ali M, Couture EJ, Beaubien-Souligny W, Bouabdallaoui N, Brassard P, Mailhot T, Jacquet-Lagrèze M, Lamarche Y, Deschamps A. A Practical Approach to Cerebro-Somatic Near-Infrared Spectroscopy and Whole-Body Ultrasound. J Cardiothorac Vasc Anesth 2019; 33 Suppl 1:S11-S37. [DOI: 10.1053/j.jvca.2019.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kamenskaya O, Klinkova A, Loginova I, Chernyavskiy A, Sirota D, Lomivorotov VV, Karaskov A. Health-related quality of life one year after surgical treatment of the type I chronic aortic dissection. INT ANGIOL 2019; 38:46-53. [PMID: 30860340 DOI: 10.23736/s0392-9590.18.04009-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The purpose of our study was to assess the health-related quality of life (HRQoL) in patients with type I chronic aortic dissection before and one year after prosthetics of the aorta, and to test the hypothesis that long-term postoperative parameters of HRQoL are affected by clinical determinants related to the underlying disease, intraoperative characteristics, and complications of the early postoperative period. METHODS This prospective cohort study included 82 patients with type I chronic aortic dissection. HRQoL parameters were examined using the Short-Form 36 Health Survey Questionnaire before and one year after surgery. RESULTS Patients with aortic dissection one year after surgery demonstrated an improvement in many HRQoL parameters, including two summary measures of the questionnaire - Physical component summary (PCS) and Mental component summary (MCS). A lower level of PCS and MCS at the preoperative stage significantly predicted lower values of these indices for a long time after aortic prosthetics. The neurological complications in the early postoperative period were the factor affecting the MCS after surgery. Moreover, the neurological complications and the presence of coronary artery disease increased the risk of the adverse outcomes, including aortic related death and significant decrease of MCS or aortic related death and significant decrease of PCS one year after the operation, respectively. CONCLUSIONS Surgical treatment in patients with type I chronic aortic dissection leads to an increase of many HRQoL parameters. Factors affecting MCS and PCS one year after surgery included the neurological complications and lower level of the MCS and PCS at the preoperative stage. Furthermore, the neurological complications and the presence of coronary artery disease increased the risk of the combined endpoints - aortic related death and significant decrease of MCS or aortic related death and significant decrease of PCS one year after the operation, respectively.
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Affiliation(s)
- Oksana Kamenskaya
- Department of Physiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Asya Klinkova
- Department of Physiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia -
| | - Irina Loginova
- Department of Physiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Alexander Chernyavskiy
- Department of Cardiac Surgery, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Dmitry Sirota
- Department of Cardiac Surgery, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Vladimir V Lomivorotov
- Department of Anesthesia and Intensive Care, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Alexander Karaskov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
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Short-Term Postoperative Cognitive Dysfunction and Inflammatory Response in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Pilot Study. Mediators Inflamm 2017; 2017:3605350. [PMID: 29249869 PMCID: PMC5700480 DOI: 10.1155/2017/3605350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/09/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To assess the association between short-term postoperative cognitive dysfuction (POCD) and inflammtory response in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Design A prospective cohort study. Setting University medical centre. Participants Fifty-one adult patients who had undergone CRS-HIPEC and twenty control participants. Measurements The inflammatory marker levels in plasma and cognitive function were measured. Results Twenty (39.2%, 20/51) patients developed POCD at 1 w after CRS-HIPEC. The patients with POCD had higher serum interleukin 1β (IL-1β), serum amyloid A (SAA), S100 calcium-binding protein β (S-100β), and high mobility group box-1 protein (HMGB-1) levels at 1 and 24 h postoperatively than patients without POCD. There was an association between POCD and the maximum IL-1β and S-100β concentrations in serum, which remained following adjustment for age and FBS. Conclusion In this pilot study, perioperative inflammatory marker levels increase significantly after CRS-HIPEC in adult patients, and such elevations are associated with the development of short-term cognitive dysfunction after this complex surgery. These results suggested the need for a larger RCT to replicate and confirm these findings.
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Reed H, Berg KB, Janelle GM. Aortic Surgery and Deep-Hypothermic Circulatory Arrest: Anesthetic Update. Semin Cardiothorac Vasc Anesth 2017; 18:137-45. [PMID: 24876229 DOI: 10.1177/1089253214525278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortic arch surgery has become increasingly complex, and novel surgical approaches have been utilized. Efforts aimed at improving neurological outcomes in this patient population have been numerous, with varying degrees of success. This article summarizes the anesthetic considerations for procedures on the aortic arch, including evidence-based outcomes with respect to temperature management, perfusion strategies, hemodynamic goals, adjunct agents, and neuromonitoring.
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Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review. Cardiovasc Psychiatry Neurol 2015; 2015:370612. [PMID: 26491558 PMCID: PMC4605208 DOI: 10.1155/2015/370612] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/15/2015] [Indexed: 12/20/2022] Open
Abstract
Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery.
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Ramakrishna H, Gutsche JT, Evans AS, Patel PA, Weiner M, Morozowich ST, Gordon EK, Riha H, Shah R, Ghadimi K, Zhou E, Fernadno R, Yoon J, Wakim M, Atchley L, Weiss SJ, Stein E, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2015. J Cardiothorac Vasc Anesth 2015; 30:1-9. [PMID: 26847747 DOI: 10.1053/j.jvca.2015.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Indexed: 12/14/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Menachem Weiner
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ronak Shah
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Elizabeth Zhou
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rohesh Fernadno
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeongae Yoon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mathew Wakim
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lance Atchley
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica Stein
- Department of Anesthesiology, Ohio State University, Columbus, OH
| | - George Silvay
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Engelman R, Baker RA, Likosky DS, Grigore A, Dickinson TA, Shore-Lesserson L, Hammon JW. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management During Cardiopulmonary Bypass. Ann Thorac Surg 2015; 100:748-57. [DOI: 10.1016/j.athoracsur.2015.03.126] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
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Engelman R, Baker RA, Likosky DS, Grigore A, Dickinson TA, Shore-Lesserson L, Hammon JW. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2015; 29:1104-13. [DOI: 10.1053/j.jvca.2015.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jo YH, Kim K, Lee JH, Rim KP, Cho IS. Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis. Clin Exp Emerg Med 2014; 1:120-125. [PMID: 27752563 PMCID: PMC5052836 DOI: 10.15441/ceem.14.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/05/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was performed to investigate the effect of the rewarming rate on survival and acute lung injury in sepsis. METHODS Male Sprague-Dawley rats underwent cecal ligation and incision. After 1 hour of sepsis induction, normothermia (37°C±0.5°C, NT group) or hypothermia (32°C±0.5°C) was induced. Hypothermia was maintained for 4 hours and rats were divided into two groups according to the rewarming rate: RW1 group, 1 hour of rewarming; and RW2 group, 2 hours of rewarming. In the survival study, rats were observed for 12 hours after sepsis induction (n=6 per group). In the second experiment, rats were sacrificed 7 hours after sepsis induction, and lung tissues and plasma were harvested (n=10 per group). RESULTS In the survival study, the RW2 group survived longer than the RW1 group (P<0.05), but the RW1 and NT groups showed no significant difference in survival duration (P>0.05). The histological lung injury score and malondialdehyde concentrations in the lung tissues were significantly higher in the RW1 group than in the RW2 group (P<0.05). Plasma interleukin (IL)-6 concentration and the ratio of IL-6 to IL-10 were higher in the RW1 group than in the RW2 group (P<0.05). CONCLUSION Rapid rewarming after therapeutic hypothermia results in a shorter survival period and acute lung injury in sepsis, which could be associated with the inflammatory responses.
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Affiliation(s)
- You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Pil Rim
- Department of Emergency Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - In Soo Cho
- Department of Emergency Medicine, Kepco Medical Center, Seoul, Korea
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Impact of different surgical strategies on perioperative protein S100β release in elderly patients undergoing coronary artery bypass grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 8:230-6. [PMID: 23989819 DOI: 10.1097/imi.0b013e3182a3496a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study was designed to compare neurological injury-associated protein S100β release during three different treatment modalities, minimized closed circuit coronary artery bypass grafting (CABG) (MCABG), off-pump CABG (OPCAB), and conventional CABG (CCABG), comprising high-volume prime and cold crystalloid cardioplegia. Our working hypothesis was that fluid restriction as provided by MCABG may decrease neurological injury-associated protein S100β release. METHODS In this prospective trial, in a tertiary center, 30 surgical patients (aged >70 years, 25 men and 5 women) undergoing first-time elective CABG were enrolled. The inclusion criteria were three-vessel disease and elective surgery. The exclusion criteria were left ventricular ejection fraction of less than 30%, use of clopidogrel, carotid disease, or needing fewer than three distal anastomoses. Protein S100β concentrations, hematocrit (Ht) levels, and PO2 levels were measured after induction of anesthesia, 10 minutes after reperfusion, upon arrival at the intensive care unit, 3 hours postoperatively at the intensive care unit, and the next morning. Statistics consisted of areas under the curve, peak levels, and correlation and variance tests. RESULTS A significant negative correlation was found indicating higher S100β release at lower Ht levels and at lower PO2 levels in all study groups. The lowest S100β variance was measured during MCABG (Wilks Λ P = 0.052). The perioperative Ht was significantly higher in the MCABG group and in the OPCAB group compared with the CCABG group (P = 0.04 vs P < 0.01). At all time points, the S100β protein concentration showed no significant differences between the different surgical techniques. The mean (95% confidence interval) values of S100 area under the curve were the following: CCABG, 2.3 (1.06-3.5); MCABG, 1.44 (0.6-2.21); and OPCAB, 1.87 (1.5-2.19) [independent nonparametric Kruskal-Wallis test (P = 0.13)]. The mean (95% confidence interval) peak S100 values (calculated as the maximum value seen in a patient during the research period) were the following: CCABG, 1.07 (0.4-1.68); MCABG, 0.59 (0.28-0.90); and OPCAB, 0.83 (0.59-1.06) [independent nonparametric Kruskal-Wallis test (P = 0.22)]. CONCLUSIONS Despite similar perioperative S100β protein release for all techniques studied, higher Ht and PO2 levels correlated with lower S100β release within all study groups. The low S100β variance during the fluid restrictive MCABG technique may be due to more efficient oxygen transport to the brain provided by significantly higher perioperative Ht levels. Further prospective data are required to better understand this complex issue.
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Mukherji J, Hood RR, Edelstein SB. Overcoming Challenges in the Management of Critical Events During Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth 2014; 18:190-207. [DOI: 10.1177/1089253214526646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Critical events during cardiopulmonary bypass (CPB) can challenge the most experienced perfusionists, anesthesiologists, and surgeons and can potentially lead to devastating outcomes. Much of the challenge of troubleshooting these events requires a key understanding of these situations and a well-defined strategy for early recognition and treatment. Adverse situations may be anticipated prior to going on CPB. Atherosclerosis is pervasive, and a high plaque burden may have implications in surgical technique modification and planning of CPB. Hematologic abnormalities such as cold agglutinins, antithrombin III deficiency, and hemoglobin S have been discussed with emphasis on managing complications arising from their altered pathophysiology. Jehovah’s witness patients require appropriate techniques for cell salvage to minimize blood loss. During initiation of CPB, devastating situations leading to acute hypoperfusion and multiorgan failure may be encountered in patients undergoing surgery for aortic dissection. Massive air emboli during CPB, though rare, necessitate an urgent diagnosis to detect the source and prompt management to contain catastrophic outcomes. Gaseous microemboli remain ubiquitous and continue to be a major concern for neurocognitive impairment despite our best efforts to improve techniques and refine the CPB circuit. During maintenance of CPB, adverse events reflect inability to provide optimal perfusion and can be ascribed to CPB machine malfunction or physiological aberrations. We also discuss critical events that can occur during perfusion and the need to monitor for organ perfusion in altered physiologic states emanating from hemodilution, hypothermia, and acid–base alterations.
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Affiliation(s)
| | - Ryan R. Hood
- Loyola University Medical Center, Maywood, IL, USA
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Neurologic recovery from profound accidental hypothermia after 5 hours of cardiopulmonary resuscitation. Crit Care Med 2014; 42:e167-70. [PMID: 24158171 DOI: 10.1097/ccm.0b013e3182a643bc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the successful neurologic recovery from profound accidental hypothermia with cardiac arrest despite the longest reported duration of cardiopulmonary resuscitation. DESIGN Case report. SETTING Mountain. PATIENT A 57-year-old woman experienced profound accidental hypothermia (16.9°C) in a mountainous region of Grenoble. She was unconscious and had extreme bradycardia (6 beats/min) at presentation. A cardiac arrest occurred at the mobilization that was not responsive to electrical shocks or epinephrine. INTERVENTION Cardiopulmonary resuscitation was continued for 307 minutes after rescue until venoarterial extracorporeal membrane oxygenation blood flow had been established at the emergency department. MEASUREMENTS AND MAIN RESULTS At a 3-month follow-up, the patient showed good physical and mental recovery. CONCLUSION With no evidence of trauma or asphyxia, profound accidental hypothermia with cardiac arrest represents a specific condition for which successful neurologic recovery is feasible despite prolonged cardiopulmonary resuscitation.
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Choi SP, Wee JH, Park JH, Park KN, Hong SJ, Lee SH. Therapeutic hypothermia following emergent coronary artery bypass grafting after failed percutaneous coronary intervention in a comatose post-cardiac arrest patient. J Korean Med Sci 2013; 28:1257-9. [PMID: 23960458 PMCID: PMC3744719 DOI: 10.3346/jkms.2013.28.8.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022] Open
Abstract
We report the case of 60-yr-old female in which therapeutic hypothermia (TH) was successfully induced maintaining the target temperature of 34℃ for 12 hr despite a risk of hypothermia-induced coagulation abnormalities following an emergent coronary artery bypass grafting (CABG) due to failed percutaneous coronary intervention, who suffered a cardiac arrest. Emergent CABG may be a relative contraindication for TH in post-cardiac arrest patients because hypothermia may increase the risk of infection and bleeding. However, the possibility of an improved neurologic outcome outweighs the risk of bleeding, although major surgery may be a relative contraindication for TH.
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Affiliation(s)
- Seung Pill Choi
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hee Wee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Jin Hong
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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van Boven WJP, Morariu A, Salzberg SP, Gerritsen WB, Waanders FG, Korse TC, Aarts LP. Impact of Different Surgical Strategies on Perioperative Protein S100β Release in Elderly Patients Undergoing Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Wim Jan P. van Boven
- Department of Cardio Thoracic Surgery, and Leiden University Medical Centre, Leiden, the Netherlands
| | - Aurora Morariu
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sacha P. Salzberg
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Wim B. Gerritsen
- Department of Clinical Chemistry and Haematological Laboratory, Gelre Hospital, Apeldoorn, the Netherlands
| | | | - Tiny C. Korse
- Department of Clinical Chemistry, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Leon P. Aarts
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
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Xu T, Gong Z, Zhu WZ, Wang JF, Li B, Chen F, Deng XM. Remote ischemic preconditioning protects neurocognitive function of rats following cerebral hypoperfusion. Med Sci Monit 2012; 17:BR299-304. [PMID: 22037731 PMCID: PMC3539484 DOI: 10.12659/msm.882038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Protection of remote ischemic preconditioning on neurocognitive function caused by bilateral common carotid artery occlusion has been investigated in rats. MATERIAL/METHODS Thirty-six male Sprague-Dawley rats were divided into 3 groups - control group (Group C, n=12), bilateral carotid arteries occlusion group (Group B, n=12) and remote ischemic precondition group (Group P, n=12). In Group P, remote ischemic preconditioning (RIPC) was performed on the right femoral artery with 3 cycles (10 min) of occlusion/perfusion. After 3 cycles of preconditioning, bilateral carotid arteries were occluded immediately for 60 min. In Group B, ischemic insults were conducted without RIPC. Sham surgeries were performed in Group C. Evaluation of memory and learning capacity was performed on days 5-8 after surgery by Morris water maze testing of spatial learning capacity (n=6 for each group). Apoptosis of cells in the hippocampus region was determined by TUNEL tests and Bcl-2 at this region was determined by ELISA 24 h and 9 days after vessel occlusion (n=6 for each group). RESULTS Neurocognitive tests showed that latency time was significantly longer in Group B than in Group P on day 7 (p=0.016) and day 8 (p=0.036). Moreover, frequency of platform crossings was significant less in group B than in the other 2 groups on day 9. Bcl-2 level was significantly increased in the hippocampal region of rats in Group P on days 1 and 9 after vessel occlusion. TUNEL test showed that apoptosis could be observed at 24 h after occlusion in Group B, but not in Group P and Group C. No apoptosis was observed on day 9. CONCLUSIONS Our results suggest that RIPC can protect neurocognitive function of rats after bilateral carotid occlusions, and that Bcl-2 may play an important role in this protective effect.
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Affiliation(s)
- Tao Xu
- Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, 2nd Military Medical University, Shanghai, P R China
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Camp-Rogers T, Murphy G, Dean A, Gunnerson K, Rossler D, Kurz MC. Therapeutic hypothermia after profound accidental hypothermia and cardiac arrest. Am J Emerg Med 2011; 30:387.e5-7. [PMID: 21295432 DOI: 10.1016/j.ajem.2010.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 11/23/2010] [Indexed: 11/28/2022] Open
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Engelen S, Himpe D, Borms S, Berghmans J, Van Cauwelaert P, Dalton JE, Sessler DI. An evaluation of underbody forced-air and resistive heating during hypothermic, on-pump cardiac surgery*. Anaesthesia 2011; 66:104-10. [DOI: 10.1111/j.1365-2044.2010.06609.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Grigore AM, Murray CF, Ramakrishna H, Djaiani G. A Core Review of Temperature Regimens and Neuroprotection During Cardiopulmonary Bypass: Does Rewarming Rate Matter? Anesth Analg 2009; 109:1741-51. [DOI: 10.1213/ane.0b013e3181c04fea] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Heard KJ, Peberdy MA, Sayre MR, Sanders A, Geocadin RG, Dixon SR, Larabee TM, Hiller K, Fiorello A, Paradis NA, O'Neil BJ. A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest. Resuscitation 2009; 81:9-14. [PMID: 19854555 DOI: 10.1016/j.resuscitation.2009.09.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/31/2009] [Accepted: 09/09/2009] [Indexed: 11/17/2022]
Abstract
CONTEXT Hypothermia improves neurological outcome for comatose survivors of out-of-hospital cardiac arrest. Use of computer controlled high surface area devices for cooling may lead to faster cooling rates and potentially improve patient outcome. OBJECTIVE To compare the effectiveness of surface cooling with the standard blankets and ice packs to the Arctic Sun, a mechanical device used for temperature management. DESIGN, SETTING, AND PATIENTS Multi-center randomized trial of hemodynamically stable comatose survivors of out-of-hospital cardiac arrest. INTERVENTION Standard post-resuscitative care inducing hypothermia using cooling blankets and ice (n=30) or the Arctic Sun (n=34). MAIN OUTCOME MEASURES The primary end point was the proportion of subjects who reached a target temperature within 4h of beginning cooling. The secondary end points were time interval to achieve target temperature (34 degrees C) and survival to 3 months. RESULTS The proportion of subjects cooled below the 34 degrees C target at 4h was 71% for the Arctic Sun group and 50% for the standard cooling group (p=0.12). The median time to target was 54 min faster for cooled patients in the Arctic Sun group than the standard cooling group (p<0.01). Survival rates with good neurological outcome were similar; 46% of Arctic Sun patients and 38% of standard patients had a cerebral performance category of 1 or 2 at 30 days (p=0.6). CONCLUSIONS While the proportion of subjects reaching target temperature within 4h was not significantly different, the Arctic Sun cooled patients to a temperature of 34 degrees C more rapidly than standard cooling blankets.
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Affiliation(s)
- Kennon J Heard
- University of Colorado Denver School of Medicine and the Colorado Emergency Medicine Research Center, Denver, CO, United States.
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Kurusz M. Temperature management during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2009; 24:385-6. [PMID: 19716712 DOI: 10.1053/j.jvca.2009.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Indexed: 11/11/2022]
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Erdoes G, Basciani R. Assessment of neurocognitive function and neuroprotective strategies in cardiac surgery. J Cardiothorac Vasc Anesth 2009; 24:536-7. [PMID: 19716713 DOI: 10.1053/j.jvca.2009.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Indexed: 11/11/2022]
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Chauhan S. Brain, cardiopulmonary bypass and temperature: What should we be doing? Ann Card Anaesth 2009; 12:104-6. [DOI: 10.4103/0971-9784.53427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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