Adverse renal effects associated with cardiopulmonary bypass.

Cardiac surgery on cardiopulmonary bypass (CPB) is associated with postoperative renal dysfunction, one of the most common complications of this surgical cohort. Acute kidney injury (AKI) is associated with increased short-term morbidity and mortality and has been the focus of much research. There is increasing recognition of the role of AKI as the key pathophysiological state leading to the disease entities acute and chronic kidney disease (AKD and CKD).

Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury.

Acute kidney injury (AKI) is one of the most common major complications of cardiac surgery, and is associated with increased morbidity and mortality. Cardiac surgery-associated AKI has a complex, multifactorial etiology, including numerous factors such as primary cardiac dysfunction, hemodynamic derangements of cardiac surgery and cardiopulmonary bypass, and the possibility of a large volume of blood transfusion. There are no truly effective pharmacologic therapies for the management of AKI, and, therefore, anesthesiologists, intensivists, and cardiac surgeons must remain vigilant and attempt to minimize the risk of developing renal dysfunction.

Neurologic complications after cardiopulmonary bypass - A narrative review.

Neurologic complications, associated with cardiac surgery and cardiopulmonary bypass (CPB) in adults, are common and can be devastating in some cases. This comprehensive review will not only consider the broad categories of stroke and neurocognitive dysfunction, but it also summarises other neurological complications associated with CPB, and it provides an update about risks, prevention and treatment. Where appropriate, we consider the impact of off-pump techniques upon our understanding of the contribution of CPB to adverse outcomes.

Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study.

Background: Preoperative frailty may predispose patients to poorer outcomes in cardiac surgery; however, there are limited data concerning how preoperative frailty predicts patient-centred outcomes, such as patient-reported disability. Our objective was to evaluate the association between preoperative frailty and postoperative disability.

Methods: Patients were prospectively evaluated using the Comprehensive Assessment of Frailty score, separating patients into frail and non-frail cohorts.

Developing guidance for the management of intraoperative anaesthetic machine failure.

Intraoperative anaesthetic machine failure represents an immediate risk to patient safety, as well as risking long-term harm in the form of accidental awareness under general anaesthesia. Currently, there is no widely accepted consensus guidance for the management of such an event. Based upon institutional experiences of anaesthetic machine failure and the principles of delivering good-quality care under emergency scenarios, we devised a single-sheet guideline for management of this event.

Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review.

Neurocognitive dysfunction after cardiac surgery can present with diverse clinical phenotypes, which include postoperative delirium, postoperative cognitive dysfunction, and stroke, and it presents a significant healthcare burden for both patients and providers. Neurologic monitoring during cardiac surgery includes several modalities assessing cerebral perfusion and oxygenation (near-infrared spectroscopy, transcranial Doppler and jugular venous bulb saturation monitoring) and those that measure cerebral function (processed and unprocessed electroencephalogram), reflecting an absence of a single, definitive neuromonitor. This narrative review briefly describes the technologic basis of these neuromonitoring modalities, before exploring their use in clinical practice, both as tools to predict neurocognitive dysfunction, and with a bundle of interventions designed to optimize cerebral oxygen supply, with the aim of reducing postoperative delirium and cognitive dysfunction following cardiac surgery.

Digital calcinosis circumscripta: case series and review of the literature.

A series of three paediatric cases of digital calcinosis circumscripta is presented. Digital calcinosis circumscripta is an unusual form of calcinosis circumscripta occurring specifically in the digits. The condition is rare among the paediatric population.