Late pharmacologic conditioning with volatile anesthetics after cardiac surgery.

Introduction: The aim of this randomized controlled trial was to investigate whether volatile anesthetics used for postoperative sedation have any beneficial effects on myocardial injury in cardiac surgery patients after on-pump valve replacement.

Methods: Anesthesia was performed with propofol. After arrival in the intensive care unit (ICU), 117 patients were randomized to be sedated for at least 4 hours with either propofol or sevoflurane.

The impact of infections on critically ill acute heart failure patients: an observational study.

Background: Hospitalised patients with acute heart failure (AHF) suffer from a high morbidity and mortality, which might, at least partly, be influenced by concomitant infections. The aim of this observational study was to investigate the impact of infections on the clinical course of critically ill patients with AHF, both present on intensive care unit (ICU) admission and acquired during the ICU stay.

Methods: From 178 consecutive AHF patients, 76 were treated medically and 21 required emergency cardiac surgery.

The revised digital transcutaneous PCO2/SpO2 ear sensor is a reliable noninvasive monitoring tool in patients after cardiac surgery.

Objective: The aim of this study was to validate the revised SenTec V-Sign 2 sensor (SenTec AG, Therwil, Switzerland) for combined noninvasive continuous assessment of pulse rate, pulse oximetry (SpO(2)), and transcutaneous carbon dioxide tension (PtcCO(2)) in adults after cardiac surgery.

Design: A prospective clinical study.

Setting: A single-center university hospital.

Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery.

Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery.

A novel operator-independent algorithm for cardiac output measurements based on three-dimensional transoesophageal colour Doppler echocardiography.

Aims: Cardiac output (CO) measurements from three-dimensional (3D) trans-mitral Doppler echocardiography are prone to error as manual selection of the region of interest (i.e. the site of measurement) is required.

Comparison of spectral entropy and bispectral index electroencephalography in coronary artery bypass graft surgery.

Objective: The study's aim was to compare response entropy (RE) and state entropy (SE) with bispectral index (BIS) electroencephalography (EEG) as an alternative cerebral monitoring tool in patients scheduled for coronary artery bypass graft surgery.

Design: Prospective, observational single-center study.

Setting: University hospital.

Presentation and outcome of critically ill medical and cardiac-surgery patients with acute heart failure.

Background: The aim of the study was to investigate presentation and outcome of consecutive acute heart failure (AHF) patients admitted to the intensive care unit (ICU) including also patients undergoing cardiac surgery, thereby providing comparative information on all critically ill AHF subgroups.

Methods: The prospective observational study with 6-month follow up was performed in the cardio-thoracic and the medical ICU of a university hospital. AHF was defined according to the European Society of Cardiology guidelines.

Accuracy of continuous central venous oxygen saturation monitoring in patients undergoing cardiac surgery.

Objective: Continuous assessment of central venous oxygen saturation (S(cevox)O(2)) with the CeVOX device (Pulsion Medical Systems, Munich, Germany) was evaluated against central venous oxygen saturation (S(cv)O(2)) determined by co-oximetry.

Methods: In 20 cardiac surgical patients, a CeVOX fiberoptic probe was introduced into a standard central venous catheter placed in the right internal jugular vein and advanced 2-3 cm beyond the catheter tip. After in vivo calibration of the probe, S(cevox)O(2), S(cv)O(2), mixed venous oxygen saturation (S(mv)O(2)) haemoglobin (Hb), body temperature, heart rate, central venous and mean arterial pressure, and cardiac index were assessed simultaneously at 30 min intervals during surgery and at 60 min intervals during recovery in the intensive care unit.

Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure?

Objective: Traditional cutoff values of serum creatinine considered to define postoperative acute renal failure have been challenged recently. In a previous investigation we demonstrated that minimal changes in serum creatinine concentration were associated with a substantial decrease in survival after cardiac surgery. In this investigation, we assessed the impact of minimal absolute increases in serum creatinine in a second institution, and we analyzed whether relative changes, as in the RIFLE classification and, partially, in Acute Kidney Injury Network (AKIN) classification, confer a different prognostic potential.

Continuous extrapleural infusion of ropivacaine 0.2% after cardiovascular surgery via the lateral thoracotomy approach.

Objective: The pharmacokinetics of ropivacaine 0.2% were evaluated during a 48-hour continuous extrapleural infusion with 2 different infusion rates in patients undergoing cardiovascular surgery. The hypotheses that no toxic plasma concentrations of ropivacaine would be reached and that proportionality exists among plasma concentrations and dosage used were tested.

Clinical validation of a digital transcutaneous PCO2/SpO2 ear sensor in adult patients after cardiac surgery.

Objective: The aim of this study was to validate the V-Sign digital sensor (SenTec AG, Therweil, Switzerland) for combined noninvasive assessment of pulse oxymetric oxygen saturation (SpO(2)) and transcutaneous carbon dioxide tension (PtcCO(2)) in adults after cardiac surgery.

Methods: In twenty one patients, aged 51-86 years, simultaneous measurements of blood gases with the V-Sign Sensor and with two Nellcor Durasensors (model DS-100A), one at the opposite earlobe and one with a finger clip, were compared first during hyper-, normo- and hypocapnia and at different pulse rates using a pacemaker, and then at 2-h intervals up to 8 h. Agreement was assessed by Bland-Altman analysis.

Cerebral near-infrared spectroscopy in adult patients after cardiac surgery is not useful for monitoring absolute values but may reflect trends in venous oxygenation under clinical conditions.

Objective: Cerebral near-infrared spectroscopy (NIRS) was evaluated for use in monitoring global oxygenation in adult patients after cardiac surgery.

Design: Prospective, randomized clinical monitoring study.

Setting: Intensive care unit for cardiac surgery; university hospital.

Accuracy of a novel approach to measuring arterial thermodilution cardiac output during intra-aortic counterpulsation.

Objective: To assess the agreement between a novel approach of arterial and the pulmonary artery bolus thermodilution for measuring cardiac output in critically ill patients during aortic counterpulsation.

Methods: Eighteen male patients aged 37-80 years, undergoing preoperative insertion of an intra-aortic balloon pump (IABP) and elective coronary artery bypass grafting. A thin 1.

Electroencephalographic changes after pediatric cardiac surgery with cardiopulmonary bypass: is slow wave activity unfavorable?

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is frequently associated with neurologic deficits. We describe the postoperative EEG changes, assess their possible causes, and evaluate their relevance to neurologic outcome. Thirty-one children and five neonates with congenital heart disease were included.

Oxidative stress precedes peak systemic inflammatory response in pediatric patients undergoing cardiopulmonary bypass operation.

Oxidative stress seems to contribute to cardiopulmonary bypass (CPB)-related postoperative complications. Pediatric patients are particularly prone to these complications. With this in mind, we measured oxidative stress markers in blood plasma of 20 children undergoing elective heart surgery before, during, and up to 48 h after cessation of CPB, along with inflammatory parameters and full analysis of iron status.

Cost-effectiveness of routine intraoperative transesophageal echocardiography in pediatric cardiac surgery: a 10-year experience.

The beneficial effect of transesophageal echocardiography (TEE) on medical and surgical treatment of children with congenital heart disease has been established. Its cost-effectiveness, however, has not been extensively studied. We analyzed reports of 580 routine TEE examinations performed in our institution between January 1994 and December 2003 in patients younger than 17 yr who required congenital cardiac surgery.

Intraoperative transesophageal echocardiography in pediatric congenital cardiac surgery: a two-center observational study.

Unlabelled: Transesophageal echocardiography (TEE) is a monitoring and diagnostic tool for the care of children undergoing cardiac surgery. We analyzed reports from 865 routine TEE examinations performed between January 1994 and March 2002 in patients younger than 17-yr-old who were undergoing surgery for congenital heart disease. Patients' median age was 36 mo (range, 1 day-16 yr).

Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study.

Background: Preconditioning by volatile anesthetics is a promising therapeutic strategy to render myocardial tissue resistant to perioperative ischemia. It was hypothesized that sevoflurane preconditioning would decrease postoperative release of brain natriuretic peptide, a biochemical marker for myocardial dysfunction. In addition, several variables associated with the protective effects of preconditioning were evaluated.

Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study.

Objective: Ibutilide, a class III antiarrhythmic drug, has been shown to convert atrial fibrillation to sinus rhythm more rapidly than procainamide or sotalol. Our objective was to compare the efficacy and safety of ibutilide and amiodarone in patients after cardiac surgery.

Design: Prospective, randomized, double-blinded study.

Spindle activity in children during cardiac surgery and hypothermic cardiopulmonary bypass.

Hypothermia has marked effects on the electrical activity of the brain, which has been shown in animals as well as in humans. The aim of this study was to investigate EEG spindle activity in children during cardiac surgery and hypothermic cardiopulmonary bypass. The authors obtained intraoperative 21-channel EEG recordings in 36 children (mean age, 22 months; range, 6 days to 69 months) with congenital heart disease.

Early postoperative arrhythmias after cardiac operation in children.

Background: Arrhythmias are a recognized complication of cardiac operations. However, little is known about the incidence, treatment, and risk factors for early postoperative arrhythmias in children after cardiac operations.

Methods: Diagnosis and treatment of early postoperative arrhythmias were prospectively analyzed in an intensive care unit in 100 consecutive children with a median age of 17 months (range, 1 day to 191 months) who had undergone cardiac operation.

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fast-track cardiac surgery.

Purpose: To compare the effect of combined intrathecal morphine and sufentanil with low-dose iv sufentanil during propofol anesthesia for fast-track cardiac surgery.

Methods: Twenty-four consecutive patients with normal cardiopulmonary function who were scheduled for elective cardiac surgery were randomized to receive either a continuous iv infusion of sufentanil 0.9 to 1.