Off-Pump Versus On-Pump: Long-Term Outcomes After Coronary Artery Bypass in a Veteran Population.

Objectives: The authors sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass and hypothesized that off-pump would be comparable with on-pump. The primary outcome of interest was survival, and secondary outcomes were need for reintervention for revascularization or new diagnosis of myocardial infarction occurring any time after surgery during the 8- to 12-year follow-up period.

Design: Retrospective cohort analysis.

A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy.

Background: The Acute Pain Service (APS) was initially introduced to optimize multimodal postoperative pain control. The aim of this study was to evaluate the association between the implementation of an APS and postoperative pain management and outcomes for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Methods: In this propensity-matched retrospective cohort study, we performed a before-after study without a concurrent control group.

Propofol and diabetes insipidus.

A case in which the intraoperative administration of propofol was strongly associated with an acute episode of diabetes insipidus is presented.

Tackling the economic burden of postsurgical complications: would perioperative goal-directed fluid therapy help?

Introduction: Pay-for-performance programs and economic constraints call for solutions to improve the quality of health care without increasing costs. Many studies have shown decreased morbidity in major surgery when perioperative goal directed fluid therapy (GDFT) is used. We assessed the clinical and economic burden of postsurgical complications in the University HealthSystem Consortium (UHC) in order to predict potential savings with GDFT.

Pulmonary endarterectomy: Part II. Operation, anesthetic management, and postoperative care.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary thromboembolic hypertension remains underdiagnosed.

Pulmonary endarterectomy: part I. Pathophysiology, clinical manifestations, and diagnostic evaluation of chronic thromboembolic pulmonary hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary hypertension (PH) remains underdiagnosed.

Plasma vasopressin levels in patients with right-sided heart dysfunction and chronic thromboembolic pulmonary hypertension (CTEPH).

Objectives: Patients with left-sided heart dysfunction and volume overload often have associated elevations in vasopressin from neuroendocrine activation. The authors investigated perioperative levels of vasopressin in patients with isolated right-sided heart dysfunction from chronic thromboembolic pulmonary hypertension.

Design: Prospective, observational study.

Pulse wave transit time measurements of cardiac output in patients undergoing partial hepatectomy: a comparison of the esCCO system with thermodilution.

Background: Measuring cardiac output accurately during anesthesia is thought to be helpful for safely controlling hemodynamics. Several minimally invasive methods to measure cardiac output have been developed as alternatives to thermodilution with pulmonary artery catheterization. We evaluated the reliability of a novel pulse wave transit time method of cardiac output assessment to trend with thermodilution cardiac output in patients undergoing partial hepatectomy.

Efficacy of methylprednisolone in preventing lung injury following pulmonary thromboendarterectomy.

Background: We sought to determine the efficacy and safety of perioperative treatment with methylprednisolone on the development of lung injury after pulmonary thromboendarterectomy.

Methods: This was a randomized, prospective, double-blind, placebo-controlled study of 98 adult patients with chronic thromboembolic pulmonary hypertension who were undergoing pulmonary thromboendarterectomy at a single institution. The patients received either placebo (n = 47) or methylprednisolone (n = 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the final circulatory arrest, and 250 mg IV bolus 36 h after surgery).

Cardiac output determination from endotracheally measured impedance cardiography: clinical evaluation of endotracheal cardiac output monitor.

Objectives: To evaluate the accuracy, precision, and trending of a new endotracheally sourced impedance cardiography-based cardiac output (CO) monitor (ECOM; ConMed Corp, Irvine, CA).

Setting: Two university hospitals.

Participants: Thirty patients scheduled for elective coronary artery bypass graft (CABG) surgery.