Abstract:
OBJECTIVE:In minimally invasive surgical ablation for atrial fibrillation during video-assisted thoracoscopy surgery, one-lung ventilation (OLV) with a double- lumen tube is commonly employed. In contrast with the majority of thoracic procedures, the patient lies supine; thus, the protective effect of gravity is lost and intrapulmonary shunt remains high. To decrease intrapulmonary shunt and to increase oxygenation, many strategies are utilized: high inspiratory fraction of oxygen (FIO2), positive end-expiratory pressure on the ventilated lung, and continuous positive airway pressure (CPAP) on the deflated lung. DESIGN:The authors performed a prospective, single- center, randomized study to evaluate the effect of additional CPAP in the nonventilated lung on oxygen delivery during surgical ablation for atrial fibrillation via video-assisted thoracoscopy in the supine position. SETTING:University hospital Centro Cardiologico Monzino IRCCS, Milano, Italy. PARTICIPANTS:Twenty-two patients scheduled for minimally invasive surgical ablation for atrial fibrillation. INTERVENTIONS:The patients underwent pressure-controlled ventilation, adjusting inspiratory pressure to obtain a tidal volume of 7 mL/kg while keeping FIO2 constantly 1.0, a respiratory rate to maintain arterial partial pressure of carbon dioxide (PaCO2) between 35 and 40 mmHg, and positive end-expiratory pressure of 5 cmH2O. During OLV, inspiratory pressure was reduced to obtain a tidal volume of 5 mL/kg, maintaining FIO2 of 1.0, a respiratory rate to maintain PaCO2 between 35 and 40 mmHg with capnothorax of 10 cmH2O. The patients were then randomized into the CPAP group (CPAP 10 cmH20 on deflated lung) and NO CPAP group. Inotropic agents (dopamine or dobutamine) were used if cardiac index fell below 1.5 L/min/m2. MEASUREMENTS AND MAIN RESULTS:Twenty-two patients were enrolled, randomized, and completed the study. Median age was 62 years. The difference in arterial partial pressure of oxygen between the 2 groups was shy of significance, p = 0.16. Cardiac index progressively increased during OLV until the end of the procedure in both groups (p < 0.01) and was maintained above 1.5 mL/min/m2 during the whole study time. Arterial oxygen content remained stable during the entire procedure in both groups (p = 0.27). Oxygen delivery index (DO2I) increased significantly during the procedure (p < 0.01); nevertheless, the difference in DO2I between the CPAP and NO CPAP group was nonsignificant (p = 0.61). Intrapulmonary shunt (Qs/Qt) increased during OLV (p < 0.01 for the time effect) and remained high until total lung ventilation was reintroduced. No difference in Qs/Qt was observed between the CPAP and NO CPAP groups (p = 0.98). Similarly, mean pulmonary artery pressure increased significantly during OLV and remained high at the end of the procedure in both groups (time effect p < 0.01). CONCLUSIONS:During OLV for atrial fibrillation surgical ablation in the supine position, CPAP on the deflated lung seemed to be ineffective to reduce Qs/Qt or to increase arterial partial pressure of oxygen and DO2I, provided cardiac output was maintained above 1.5 L/min/m2.
journal_name
J Cardiothorac Vasc Anesthjournal_title
Journal of cardiothoracic and vascular anesthesiaauthors
L'Acqua C,Meli A,Rondello N,Polvani G,Salvi Ldoi
10.1053/j.jvca.2020.03.064subject
Has Abstractpub_date
2020-11-01 00:00:00pages
2931-2936issue
11eissn
1053-0770issn
1532-8422pii
S1053-0770(20)30314-1journal_volume
34pub_type
杂志文章abstract::Complications associated with pulmonary artery catheters (PACs) include interpretation errors, insertion problems, sepsis, thrombosis, and dysrhythmias. Alternatives to the use of PACs include the central venous pressure catheter, measurement of cardiac output by thoracic electrical bioimpedance, gastric tonometry and...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 评论,杂志文章,评审
doi:
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:To compare the hemodynamic effects, efficacy, and safety of intravenous milrinone (M), 50 microg/kg during 10 minutes followed by 0.5 microg/kg/min, with intravenous dobutamine (D), 10 to 20 microg/kg/min, in patients with low cardiac output after cardiac surgery. DESIGN:Randomized, open-label, multicenter s...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/jcan.2001.23274
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the safety and efficacy of ketamine in pediatric patients undergoing interventional cardiac procedures. DESIGN:A retrospective clinical study. SETTING:A single, tertiary referral center. PARTICIPANTS:Patients (n = 107) undergoing interventional cardiac procedures between July 1996 and July 1998...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(00)90053-3
更新日期:2000-02-01 00:00:00
abstract::When transcatheter aortic valve replacement (TAVR) was first approved for use in the United States in 2012, multiple leading surgical and cardiology societies were tasked with creating recommendations and requirements for operators and institutions starting and maintaining TAVR programs. Creation of this consensus doc...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.01.062
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To determine the degree of hemodynamic and airway compromise in infants and children undergoing anesthesia for primary cardiac tumors. DESIGN:Retrospective study. SETTING:Tertiary-care, academic children's hospital. PARTICIPANTS:Patients <18 years old who had undergone anesthesia and surgery for resection ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2002.126952
更新日期:2002-10-01 00:00:00
abstract::The ASA Closed Claims Project has generated a standardized collection of case summaries of adverse anesthetic outcomes, with the objectives of identifying major areas of anesthesiologist liability and the contribution of substandard care to anesthetic injury. Seventy-six (3%) of the files in the project's current data...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(94)90608-4
更新日期:1994-02-01 00:00:00
abstract:DESIGN:A prospective, randomized, open study. The regional technique used was not blinded. SETTING:A university teaching hospital. PARTICIPANTS:Forty-eight patients undergoing video-assisted thoracoscopic surgery (VATS) for tumor resection. INTERVENTIONS:Patients received either continuous extrapleural block or cont...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2011.07.026
更新日期:2011-12-01 00:00:00
abstract::This article is the third of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to conti...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.03.034
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To evaluate whether exogenous surfactant therapy may be useful in adult patients with acute lung injury or acute respiratory distress syndrome, using a meta-analysis of published clinical trials. DESIGN:A comprehensive literature search was performed to identify all randomized clinical trials examining the e...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,meta分析
doi:10.1053/j.jvca.2011.11.006
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:To delineate associations between preoperative risk factors and clinical processes of care and perioperative glucose tolerance in patients managed on a fast-track cardiac surgery clinical pathway with prebypass methylprednisolone administration. DESIGN:Retrospective sequential cohort study. SETTING:Universi...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2000.18298
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:Adequate maintenance of hypnosis during anesthesia throughout surgery using sevoflurane alone was investigated. In addition, sevoflurane pharmacokinetics during cardiopulmonary bypass were analyzed. DESIGN:This was a pilot pharmacokinetic study. SETTING:Tertiary care university hospital. PARTICIPANTS:The s...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2016.12.018
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:The goal of this study was to evaluate the efficacy of 100% oxygen and inhaled nitric oxide (iNO) in decreasing pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG) in dilated cardiomyopathy patients being evaluated for orthotopic heart transplantation (OHT); who, despite maximal intravenous ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章
doi:10.1053/j.jvca.2006.01.028
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:To determine whether access to reimbursement increases anesthesiologists' use of intraoperative transesophageal echocardiography (TEE). DESIGN:Survey. SETTING:United States. PARTICIPANTS:Members of the Society of Cardiovascular Anesthesiologists, local Medicare carriers. INTERVENTIONS:None. MEASUREMENTS ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2002.124137
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:Currently, there are no large-scale studies that compare differences in case duration of aortic valve replacements (AVRs). The primary objective of this study was to determine associations of hospital facility type, geographic location, case volume per year, and time of day with duration of valve replacement ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2017.06.039
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:To evaluate drug costs, time of mechanical ventilation, complications, and hospital length of stay comparing propofol-based with fentanyl-isoflurane-based anesthesia. DESIGN:A prospective, randomized study. SETTING:A university-affiliated, tertiary care community hospital. PARTICIPANTS:Seventy patients und...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1053-0770(98)90328-7
更新日期:1998-04-01 00:00:00
abstract::Patients with abdominal aortic aneurysms (AAA) have a high incidence of associated cardiac disease. If a patient presents with both severe coronary artery disease and a large AAA, a staged procedure of cardiac surgery (CS) followed by AAA resection may present too great a risk of aneurysm rupture and death. A combined...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(94)90163-5
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:To compare methylene blue with hydroxocobalamin as a rescue therapy for vasoplegic syndrome. DESIGN:Retrospective cohort. SETTING:Academic medical center. PARTICIPANTS:Patients undergoing cardiothoracic surgery treated for vasoplegic syndrome. INTERVENTIONS:Thirty-five patients were treated with methylene...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.01.033
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:Two types of material are used to manufacture double-lumen endobronchial tubes (DLTs): Polyvinylchloride (PVC) and silicon. PVC DLTs (Broncho-Cath) and silicon DLTs (Silbroncho) not only differ in material, but also subtly differ in structure. The goal of this study was to determine whether the incidences of ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2014.05.028
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:To investigate the cardioprotective effect of the continuous administration of dexmedetomidine using serum cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) concentrations as biomarkers during off-pump coronary artery bypass grafting (OPCAB) surgery. DESIGN:A prospective, randomized, parallel-group co...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2015.06.026
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVES:Perioperative treatment with angiotensin-converting enzyme (ACE) inhibitors in cardiac surgery with cardiopulmonary bypass is still controversial. Using ACE inhibitors during cardiac surgery might be associated with an increased risk of critical hypotensive episodes. On the other hand, ACE inhibitors could h...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/j.jvca.2003.10.011
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:Over 150,000 carotid endarterectomy (CEA) procedures are performed each year. Perioperative anesthetic management may be complex due to multiple patient and procedure-related risk factors. The authorsaimed to determine whether the use of general anesthesia (GA), when compared with regional anesthesia (RA), wo...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.08.195
更新日期:2019-04-01 00:00:00
abstract::Anesthesia for thoracic surgery requires specialist intervention to provide adequate operating conditions and one-lung ventilation. The pandemic caused by severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) is transmitted by aerosol and droplet spread. Because of its virulence, there is a risk of t...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2020.07.049
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:Two-dimensional speckle tracking echocardiography has advantages over tissue Doppler imaging during isovolumetric relaxation for predicting left-ventricular end-diastolic pressure in non-surgical patients. Considering the direct and indirect effects of general anesthesia on hemodynamics, we examined correlat...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.06.011
更新日期:2019-04-01 00:00:00
abstract::To determine the effect of 1.5 MAC of two volatile anesthetics (halothane and isoflurane) on platelet-induced contraction of canine coronary artery, isolated, denuded coronary rings were suspended between two stirrups, placed into organ chambers filled with an oxygenated Krebs-Ringer solution, and connected to an isom...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(94)90058-2
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVE:To investigate the relationship between applied external positive end-expiratory pressure (PEEP) and auto-PEEP and the resultant total PEEP experienced by the patient during one-lung ventilation (OLV). DESIGN:A prospective clinical study. SETTING:A university hospital. PARTICIPANTS:Ten adult patients under...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(98)90318-4
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:Intraoperative monitoring of myogenic motor evoked potentials to transcranial electrical stimulation (tc MEPs) is a new method to assess the integrity of the motor pathways. The authors studied the effects of 50% nitrous oxide (N2O) and a low-dose propofol infusion on tc MEPs paired electrical stimulation dur...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(99)90169-6
更新日期:1999-02-01 00:00:00
abstract::Middle aortic syndrome (MAS) is a rare vascular disease occurring in pediatric patients. MAS describes narrowing of the abdominal aorta, often referred to as abdominal coarctation. Extra-aortic vessels are commonly involved, including the renal and mesenteric arteries. Pediatric patients with MAS frequently present wi...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.07.130
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the success and complication rates of a single center's multidisciplinary approach to transvenous lead extraction. SETTING:One university hospital. PARTICIPANTS:One hundred ninety-five patients scheduled for transvenous lead extraction. INTERVENTIONS:A multidisciplinary approach to transvenous ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2014.11.010
更新日期:2015-04-01 00:00:00
abstract::This study was designed to compare the cardiovascular effects of pipecuronium bromide (PIP) to vecuronium (V) when combined with sufentanil (SF) in patients undergoing coronary artery bypass surgery. Eighty-two patients were studied; 40 were normotensive and 42 had hypertension currently controlled by pharmacological ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/1053-0770(91)90321-j
更新日期:1991-04-01 00:00:00
abstract:OBJECTIVES:The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. DESIGN:Prospectiv...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2016.04.025
更新日期:2017-02-01 00:00:00