Anesthesiology and Intensive Care

Modern Recommendations for Using Glucocorticosteroids in the Perioperative Period in Cardiac Surgery Published on February 22, 2025 Keywords: glucocorticosteroids in cardiac surgery, perioperative steroids, cardiac surgery inflammation, modern steroid guidelines The use of glucocorticosteroids in the perioperative period of cardiac surgery has been a topic of debate for decades. These powerful anti-inflammatory drugs can reduce complications, but their

Moderately Hypothermic Intermittent Global Myocardial Ischemia Intermittent cardiac ischemia with moderate cardiac hypothermia requires performing cardiopulmonary bypass (CPB) with a perfusate temperature between 25°C and 30°C. During this method,

Continuous Normokalemic Coronary Perfusion: Empty Beating Heart Early intracardiac procedures were performed on normothermic, perfused, empty beating hearts. Experimental studies initially suggested that this method maintained "normal left ventricular function" for up to 3 hours of cardiopulmonary bypass (CPB) with the heart empty and

DE-AIRING THE HEART AFTER CARDIAC SURGERY   After completing the repair and as the cardiac chambers are closed or as CABG is being completed, the heart must be freed of as much air as possible before it begins to eject into the systemic circulation. Clinical studies have demonstrated a correlation between the number of gaseous microemboli and the severity of neuropsychological impairment after surgical procedures employing CPB. Thus, special maneuvers are necessary to avoid air embolism, as has clearly been demonstrated by intraoperative echocardiography.  The exact steps and sequences and the time of de-airing may vary, but the principles are well established: 

  Rigid Sternal Fixation in Cardiac Surgery

  Preoperative Carbohydrate Loading

 Consumption of Clear Liquids Before General Anesthesia

    A guide to which regular medications should be continued until the day of surgery. Continue: Statins (decreases in-hospital mortality and need for RRT) β-Blockers (reduced risk of post-CABG AF) Nitrates Calcium antagonists K+ channel openers Corticosteroids Anti-dysrhythmics Bronchodilators

Cardiac protection with phosphocreatine: a meta-analysis Giovanni Landonia, Alberto Zangrilloa, Vladimir V. Lomivorotovc , Valery Likhvantsevd , Jun Mae , Francesco De Simonea and Evgeny Fominskiya Phosphocreatine (PCr) plays an important role in the energy metabolism of the heart and a decrease in its intracellular concentration results in alteration of myocardium energetics and work. We conducted a meta-analysis of all randomized and matched trials that compared PCr with placebo or standard treatment in patients with coronary artery disease or chronic heart failure or in those undergoing cardiac surgery. We systematically searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials and Google Scholar up to 1 November 2015, for pertinent trials. The primary outcome was all-cause mortality. Secondary outcomes included inotrope use, ejection fraction (EF), peak creatinine kinase-myocardial band (CK-MB) release and the incidence of major arrhythmias, as well ...

   Blood conservation measures to reduce perioperative blood loss during cardiac surgery have been a subject of focus in recent years. This is due in part to the high cost of allogeneic blood transfusion, as well as the morbidity and mortality associated with transfusion.One such conservation measure is hemodilution with colloids such as human albumin ( HA ) or hydroxyethyl starch ( HES ). Hemodilution is an inevitable sine qua non condition of cardiopulmonary bypass ( CPB ) because of its circuit-priming requirements. On the other hand, correction of hypovolemia with intravenous ( IV ) fluids is one of the most frequent therapeutic interventions in cardiac surgery.     A variety of IV fluids currently are used for volume expansion in major surgery and in critically ill patients. Crystalloid solutions are inexpensive and widely available,  while colloids have the theoretical advantage of a lower plasma clearance, and stronger and sustained colloid osmotic ...