The concept of ventricular reserve in heart failure and pulmonary hypertension: an old metric that brings us one step closer in our quest for prediction.

Purpose Of Review: Ventricular reserve is emerging a strong predictor of outcome in heart failure and cardiovascular disease. Ventricular reserve is the term used to describe the extent of increase or change in ventricular function that occurs during exercise or pharmacological stress (typically with dobutamine).

Recent Findings: The interest in ventricular reserve lies in its ability to assess viability in coronary artery disease, to predict clinical outcome and response to therapy in patients with heart failure and to screen patients for early cardiovascular disease.

Pulmonary hypertension in cardiac surgery.

Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented.

Intraoperative hemodynamic instability during and after separation from cardiopulmonary bypass.

Every year, more than 1 million patients worldwide undergo cardiac surgery. Because of the aging of the population, cardiac surgery will increasingly be offered to patients at a higher risk of complications. The consequence is a reduced physiological reserve and hence an increased risk of mortality.

The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery.

Objective: The aim of this study was to evaluate the predictive value of cerebral regional oxygen saturation (rSO(2)) in the occurrence of postoperative cognitive dysfunction (POCD) in elderly patients undergoing coronary artery bypass graft (CABG) surgery.

Design: A prospective study.

Setting: University hospital.

Preliminary experience in the use of preoperative echo-guided left stellate ganglion block in patients undergoing cardiac surgery.

Objective: Pulmonary arterial (PA) vasoconstriction in cardiac surgery can originate from the action of combined humoral, endothelial, and sympathetic tone changes. The consequence of PA vasoconstriction is pulmonary hypertension (PHT) and, when present after cardiopulmonary bypass (CPB), can predispose to right ventricular dysfunction. Right ventricular dysfunction after CPB is a serious complication with high mortality rates.

Toward a new approach for the detection of pain in adult patients undergoing cardiac surgery: near-infrared spectroscopy--a pilot study.

Objective: This pilot study examined the discriminant validity and criterion validity of regional cerebral oxygenation measurement (rSO₂), using the near-infrared spectroscopy (NIRS) technique (INVOS-4100 system, Somanetics, Troy, MI) for measuring pain during nociceptive procedures in adults undergoing cardiac surgery.

Methods: A repeated-measures, within-subjects design was used, and 40 adult patients participated. Data collection was completed during 2 test periods: (1) while patients were awake, before the induction of anesthesia (first test period); and (2) after the induction of anesthesia, while patients remained under the effects of anesthesia (second test period).

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development.

Purpose: The objective of this continuing professional development module is to describe the role of ultrasound for central venous catheterization and to specify its benefits and limitations. Although ultrasound techniques are useful for all central venous access sites, the focus of this module is on the internal jugular vein approach.

Principal Findings: In recent years, several studies were published on the benefits of ultrasound use for central venous catheterization.

Quality at the point of service: profiles of practice in after-school settings.

A unique observational data set was used to explore quality at the point of service in after-school programs. Staff practices in after-school settings were represented on a series of unidimensional scales closely indexed to staff behavior. In order to account for heterogeneity of staff performances, pattern-centered methods were used to construct profiles of common staff practices.

[Evidence-based management of right heart failure: a systematic review of an empiric field].

In recent years, several studies have shown that right ventricular function is an important predictor of survival in patients with congenital heart disease, pulmonary hypertension or left heart failure. Our understanding of right heart failure has improved considerably over the last two decades. In this review article, our objective was to provide a critical summary of the evidence underlying the management of right heart failure.

Effects of phlebotomy and phenylephrine infusion on portal venous pressure and systemic hemodynamics during liver transplantation.

Background: A regimen of fluid restriction, phlebotomy, vasopressors, and strict, protocol-guided product replacement has been associated with low blood product use during orthotopic liver transplantation. However, the physiologic basis of this strategy remains unclear. We hypothesized that a reduction of intravascular volume by phlebotomy would cause a decrease in portal venous pressure (PVP), which would be sustained during subsequent phenylephrine infusion, possibly explaining reduced bleeding.

Perioperative intravenous amiodarone does not reduce the burden of atrial fibrillation in patients undergoing cardiac valvular surgery.

Background: Atrial fibrillation is a common complication after cardiac surgery. Postoperative atrial fibrillation is associated with increased risks of morbidity and mortality, and, therefore, preventive strategies using oral amiodarone have been developed but are often unpractical. Intravenous amiodarone administered after the induction of anesthesia and continued postoperatively for 48 h could represent an effective strategy to prevent postoperative atrial fibrillation in patients undergoing cardiac valvular surgery.

Intensity and breadth of participation in organized activities during the adolescent years: multiple associations with youth outcomes.

The goal of this study was to examine initial levels and rates of change in the intensity and breadth of participation in organized activities during the adolescent years, and how these participation practices were related to youth outcomes in later adolescence. The main objectives were (a) to examine growth curves of intensity and breadth of participation from Grades 7 through 11 and their interrelations, and (b) to test the associations between these dimensions of participation and academic orientation, risky behaviors, internalizing problems, and civic development in Grade 11. A homogenous sample of 299 youth (mean age = 13.

Autonomic nervous system and cardiovascular disease.

Because anesthesia affects the integrity of the autonomic nervous system, anesthesiologists use vital signs to maintain respiratory and circulatory homeostasis. However, patients with genetic predispositions or with autonomic dysfunctions are at risk of severe complications from anesthesia. For these patients, the monitoring of vital signs may not give sufficient warning to avoid complications.

Effects of anesthetic induction in patients with diastolic dysfunction.

Purpose: To evaluate the effects of anesthetic induction on bi-ventricular function in patients with known preoperative left ventricular (LV) diastolic dysfunction undergoing coronary artery bypass grafting surgery (CABG).

Methods: Fifty patients with diastolic dysfunction undergoing CABG were studied. Preoperative transthoracic echocardiographic (TTE) examination was performed on the day before surgery and transesophageal echocardiography (TEE) assessment was undertaken after induction of anesthesia with sufentanil, midazolam, isoflurane, and pancuronium.