Despite the possibility of a modest reduction in the risk of massive bleeding, the strong and consistent negative mortality trend associated with aprotinin, as compared with the lysine analogues, precludes its use in high-risk cardiac surgery. (Current Controlled Trials number, ISRCTN15166455 [controlled-trials.com].).

Monitoring cerebral rSO2 in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.

Continuous real-time monitoring of the adequacy of cerebral perfusion can provide important therapeutic information in a variety of clinical settings. The current clinical availability of several non-invasive near-infrared spectroscopy (NIRS)-based cerebral oximetry devices represents a potentially important development for the detection of cerebral ischaemia. In addition, a number of preliminary studies have reported on the application of cerebral oximetry sensors to other tissue beds including splanchnic, renal, and spinal cord. This review provides a synopsis of the mode of operation, current limitations and confounders, clinical applications, and potential future uses of such NIRS devices.

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Our results suggest that use of high-dose TXA in older patients in conjunction with cardiopulmonary bypass and open-chamber cardiac surgery is associated with clinical seizures in susceptible patients.

PLT transfusion in the perioperative period of CABG was associated with increased risk for serious adverse events. PLT transfusion may be a surrogate marker for sicker patients and have no causal role in the outcomes observed. However, a direct contribution to outcomes remains possible.

Near-infrared spectroscopy (NIRS) is a technique that can be used as a noninvasive and continuous monitor of the balance between cerebral oxygen delivery and consumption. The authors develop and propose an algorithm for the use of NIRS based on optimizing factors that can affect cerebral oxygen supply/demand. These factors are the position of the vascular cannula, perfusion pressure, arterial oxygen content, partial pressure of carbon dioxide, haemoglobin, cardiac output, and the cerebral metabolic rate of oxygen. Dissemination of a useful treatment algorithm is the primary purpose of this article. Further multicenter studies are necessary to confirm the benefits and cost-effectiveness of this promising monitoring modality.

No abstract