The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Pisano, Antonio; Torella, Michele; Yavorovskiy, Andrey; Landoni, Giovanni

doi:10.1053/j.jvca.2020.03.054

Cited by 13 publications

(20 citation statements)

References 202 publications

(215 reference statements)

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“…A benzodiazepine, such as midazolam, has been used in cardiac surgical patients for induction of anesthesia, especially in regions where etomidate is not available [ 5 , 6 ]. Remimazolam is a novel, ultra-short-acting benzodiazepine that recently (August 7, 2020) became available for general anesthesia in Japan and has advantages over midazolam in terms of shorter onset time and faster recovery [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

et al. 2021

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Background Remimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic effects of remimazolam as an induction agent in elderly patients with severe aortic stenosis. Methods This prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65 years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6 mg/kg/h combined with 0.25 μg/kg/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage. Results Twenty patients aged 84 [79–86] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0–4] mg and phenylephrine 0.1 [0–0.1] mg were administered to 14/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69–86] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached < 60 at 120 s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (< 40 bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed. Conclusions Remimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis. Trial registration UMIN Clinical Trials Registry, identifier UMIN000042318.

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Section: Introductionmentioning

confidence: 99%

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

et al. 2021

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“…Table 8 lists the first five articles in each of the last 3 years, which were ranked by the harmonic mean (H) of three different structural variation variables, namely ΔM, ΔCLw, and C KL (Chen, 2012 ). The five highly ranked articles in 2021 focused on the pathophysiologic mechanisms of PNDs, such as anesthetic regimen, cerebral perfusion pressure management, cerebral oximetry monitoring and so on (Akhtar et al, 2021 ; Evered and Goldstein, 2021 ; Pisano et al, 2021 ; Snyder et al, 2021 ; Zugni et al, 2021 ). In 2019 and 2020, there were two valuable articles providing evidence-based recommendations on perioperative delirium care and prevention (White et al, 2019 ; Hughes et al, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

Potential Markers of Neurocognitive Disorders After Cardiac Surgery: A Bibliometric and Visual Analysis

2022

Front. Aging Neurosci.

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BackgroundIdentifying useful markers is essential for diagnosis and prevention of perioperative neurocognitive disorders (PNDs). Here, we attempt to understand the research basis and status, potential hotspots and trends of predictive markers associated with PNDs after cardiac surgery via bibliometric analysis.MethodsA total of 4,609 original research articles and reviews that cited 290 articles between 2001 and 2021 were obtained from the Web of Science Core Collection (WoSCC) as the data source. We used the software CiteSpace to generate and analyze visual networks of bibliographic information, including published years and journals, collaborating institutions, co-cited references, and co-occurring keywords.ResultsThe number of annual and cumulative publications from 2001 to 2021 has been increasing on the whole. The Harvard Medical School was a very prolific and important institution in this field. The journal of Ann Thorac Surg (IF 4.33) had the most publications, while New Engl J Med was the most cited journal. Neuron-specific enolase (NSE), S100b and kynurenic acid (KYNA) were frequently discussed as possible markers of PNDs in many references. Cardiopulmonary bypass (CPB) was a keyword with high frequency (430) and sigma (6.26), and inflammation was the most recent burst keyword.ConclusionPotential markers of PNDs has received growing attention across various disciplines for many years. The research basis mainly focuses on three classic biomarkers of S100b, NSE, and KYNA. The most active frontiers are the inflammation-related biomarkers (e.g., inflammatory cells, cytokines, or mediators) and surgery-related monitoring parameters (e.g., perfusion, oxygen saturation, and the depth of anesthesia).

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“…27,28 All patients with moderate-to-severe (as defined by the ratio of arterial oxygen tension to a fraction of inspired oxygen (PaO 2 /F I O 2 200 mmHg) 22 COVID-19Àrelated ARDS received chest CT at the discretion of attending clinicians. Patients were considered for IMV according to criteria suggested by Pisano et al 29 However, in the case of detection of Macklin-like radiological sign on the first chest CT scan performed in the emergency department in non-intubated patients with severe COVID-19 ARDS, the authors decided to avoid intubation and proceed directly with VV-ECMO implantation. Macklin-like radiological sign effectively predicts the subsequent development of PNX/PMD in mechanically ventilated patients with COVID-19 with ARDS.…”

Section: Ecmo Implantation Algorithmmentioning

confidence: 99%

Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma

Paternoster¹,

Bertini

Belletti

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Cited by 13 publications

References 202 publications

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

Potential Markers of Neurocognitive Disorders After Cardiac Surgery: A Bibliometric and Visual Analysis

Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma

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