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Advances in Anesthesia for Cardiac Surgery
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Advances in Anesthesia for Cardiac Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (30 October 2025) | Viewed by 12564

Special Issue Editors

Dr. Christopher M. Munch

E-Mail Website
Guest Editor
Cardiac Anaesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria delle Marche, 60121 Ancona, Italy
Interests: cardiac anaesthesia; minimal invasive cardiac surgery; postoperative cognitive dysfunction; delirium prevention; hemodynamic monitoring
Dr. Pietro Giorgio Malvindi

E-Mail Website
Guest Editor
Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
Interests: mitral valve surgery; minimally invasive cardiac surgery; aortic surgery; ERAS

Special Issue Information

Dear Colleagues,

Traditionally, anesthesia for cardiac surgery has been a rather standardized approach inside the operating room, consisting of narcosis with high-dose opioid-induced analgesia, muscle relaxation and mechanical ventilation for up to several hours after the end of surgery in the intensive care unit (ICU).

More recently, cardiac surgery and cardiac anesthesia have both rapidly evolved after the introduction of minimally invasive cardiac surgery (MICS) and percutaneous and hybrid cardiothoracic procedures (the latter performed mostly outside the operating theatre), involving a multitude of health care professionals. In 2019, the first guidelines on early recovery in cardiac surgery were published, and since that time, numerous studies highlighted the advantages of earlier extubation (fast-track) in terms of reduction in postoperative complications such as stroke, respiratory insufficiency and acute kidney injury. Some centers even favor an on-table extubation (ultra-fast-track), which appears to further reduce intensive care unit and hospital stay. Interestingly, clinical research is now also focusing on the patient’s own experience and their perceived quality of life after surgery.

Preoperative patient evaluation and pre- and posthabilitation are important issues from the anesthesiologist’s point of view, because patients physical ‘fitness’ is pivotal for early postoperative recovery. Providing optimal postoperative care, including early respiratory physiotherapy and early mobilization, is of the utmost importance to reduce complications, especially postoperative cognitive dysfunction. Although the overall mortality associated with cardiac surgery has significantly decreased over time, improving the quality of perioperative care in a progressively older and sicker population remains an important issue.

Optimal perioperative hemodynamic management, ischemic preconditioning, transfusion strategies and neurological outcomes are some of the more extensively debated topics in the literature.

Minimally invasive cardiac surgery and fast-track cardiac anesthesia are here to stay and will, together with a quickly developing interventional cardiology, promote a new multidisciplinary and hybrid approach.

The aim of this Special Issue is to focus on the most relevant and interesting innovations in cardiac anesthesia in the last 5 years and to provide readers with an updated overview of the state of the art in the field of cardiac anesthesia.

We therefore welcome the submission of original articles or review articles focused on recent scientific evidence in the following fields:

  1. Minimally invasive cardiac surgery and fast-track anesthesia.
  2. Ultra-fast-track anesthesia (on-table extubation) and chest wall blocks.
  3. Opioid-free anesthesia and alternative drug approaches.
  4. Anesthesia and transcatheter therapies.
  5. Transesophageal ultrasound in minimally invasive cardiac surgery.
  6. Recent developments regarding perioperative acute kidney injury.
  7. Neurologic monitoring and outcomes after cardiac surgery.
  8. Risk assessment, complications and the impact of pre- and posthabilitation.
  9. Cardiac anesthesia and patient satisfaction.
  10. Cardiac anesthesia and machine learning.

Authors are encouraged to emphasize the impact of novel findings on anesthesia management for cardiac surgery patients.

Dr. Christopher M. Munch
Dr. Pietro Giorgio Malvindi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • enhanced recovery after cardiac surgery (ERACS)
  • minimally invasive cardiac surgery (MICS)
  • ultra-fast-track an-esthesia
  • chest wall blocks in cardiac anesthesia
  • opioid-free anesthesia in cardiac surgery
  • neurologic dysfunction and cardiac surgery
  • pre- and posthabilitation in cardiac surgery

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Published Papers (9 papers)

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14 pages, 901 KB  
Article
Perioperative Care and Clinical Outcomes of Patients with Left Ventricular Assist Devices Undergoing Noncardiac Surgery in Korea: A Retrospective Study
by Yeonji Noh, Dahee Hyun, Dong-Jae Kim, Jong-Hwan Lee, Yang Hyun Cho and Jeong-Jin Min
J. Clin. Med. 2026, 15(5), 1748; https://doi.org/10.3390/jcm15051748 - 25 Feb 2026
Viewed by 341
Abstract
Background: Since 2018, the number of left ventricular assist devices (LVAD) implantations in Korea has been steadily increasing. Consequently, an increasing number of LVAD patients are presenting for non-cardiac surgery (NCS) of varying complexity. However, recent data on the perioperative management and [...] Read more.
Background: Since 2018, the number of left ventricular assist devices (LVAD) implantations in Korea has been steadily increasing. Consequently, an increasing number of LVAD patients are presenting for non-cardiac surgery (NCS) of varying complexity. However, recent data on the perioperative management and clinical course of these patients remain limited. We share our investigation on patient and perioperative risk factors, as well as perioperative adverse outcomes, including mortality, in LVAD patients undergoing NCS. Methods: We retrospectively reviewed medical records of 36 LVAD patients who underwent NCS at our tertiary care center between 2018 and 2024. Patients requiring VA-ECMO were excluded. The primary end point was in-hospital mortality. The secondary end point was a composite of complications, including postoperative pulmonary complications, acute kidney injury, cerebrovascular accident, postoperative bleeding or thrombosis, and hemodynamic instability. Using univariable and multivariable logistic regression analysis, we examined the correlation between perioperative factors and adverse outcomes. Results: A total of 53 NCS index cases across 40 hospitalizations were analyzed. General surgery was the most common specialty (n = 19, 35.8%), followed by thoracic surgery (n = 13, 24.5%), plastic surgery (n = 7, 13.2%), and neurosurgery (n = 4, 7.5%). Thirteen procedures (24.5%) were classified as major surgeries. Postoperative complications occurred in 24 patients (66.7%), and 8 patients (20%) experienced mortality. Multivariable regression analysis identified major surgery (adjusted odds ratio [aOR] 1.44; 95% CI 1.11–1.86; p = 0.010), and intraoperative transfusion of ≥3 units of packed red blood cells (aOR 1.47; 95% CI 1.05–2.04; p = 0.029) as significant predictors of in-hospital mortality. Undergoing NCS within 180 days after LVAD implantation was associated with an increased risk of composite complications (aOR 1.86; 95% CI 1.53–2.27; p < 0.001). Conclusions: LVAD patients undergoing non-cardiac surgery frequently experience postoperative complications. Major surgeries, significant intraoperative transfusions, and early surgery following LVAD implantation are key predictors of poor outcomes. Careful risk assessment and tailored perioperative management are essential in this population. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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10 pages, 727 KB  
Article
A Single Preoperative Dose of Pregabalin and Chronic Postsurgical Pain Following Elective Coronary Artery Bypass Graft Surgery: A Secondary Analysis from a Randomized, Double-Blind, Placebo-Controlled Trial
by Aikaterini Bouzia, Konstantinos Tassoudis, Vasilis Tassoudis, Maria P. Ntalouka, Anastasia Michou, Metaxia Bareka and Eleni Arnaoutoglou
J. Clin. Med. 2026, 15(4), 1648; https://doi.org/10.3390/jcm15041648 - 22 Feb 2026
Viewed by 466
Abstract
Background/Objectives: Chronic persistent postoperative pain after cardiac surgery, first described as Post CABG Pain Syndrome (PCPS), has been a well-recognized problem since 1989. This study investigated the effect of a single preoperatively administrated pregabalin dose on chronic persistent postoperative pain, in terms [...] Read more.
Background/Objectives: Chronic persistent postoperative pain after cardiac surgery, first described as Post CABG Pain Syndrome (PCPS), has been a well-recognized problem since 1989. This study investigated the effect of a single preoperatively administrated pregabalin dose on chronic persistent postoperative pain, in terms of pain intensity, rescue analgesia, and sleep disturbances, after elective cardiac surgery. Methods: This is a secondary analysis of a prospective double-blind single center study that took place in a tertiary/referral center (NCT01701921). Consecutive adult patients who underwent elective cardiac surgery with median sternotomy and extracorporeal circulation under general anesthesia were included. Patients were randomly assigned into three groups {placebo (group 1), oral pregabalin 75 mg (group 2), oral pregabalin 150 mg (group 3)}. Placebo or either dose of pregabalin were administered 1 h preoperatively. Postoperatively at 12 and 24 months, the presence of persistent chronic pain (Numeric Rating Scale, NRS), the need of daily intake of analgesics, and any potential sleep disturbances were assessed. Results: In total, 93 out of 108 patients completed this secondary analysis (86,1%). Patients from all three groups reported persistent postoperative pain at 12 and 24 months, respectively. The mean NRS scores at 12 months were 1.71 (0.588) group 1, 1.23 (0.560) group 2, and 1.19 (0.402) group 3. At 24 months, the mean NRS scores were 1.19 (0.543) Group 1, 0.84 (0.454) Group 2, and 0.84 (0.374) Group 3. No statistically important difference was detected between the two different pregabalin groups. Regarding the use of analgesics, Pearson Chi-Square showed p-values p = 0.027 in 12 months and p = 0.01 in 24 months and lower scores were detected in the high pregabalin dose group. As far as the sleep disturbances are concerned, there was no significant difference between groups. The number of patients who reported persistent postoperative pain at 12 and 24 months was significantly lower in the pregabalin groups (75 mg and 150 mg) than in the placebo group. Regarding the NRS score, Kruskal–Wallis showed a value of p = 0.001 and p = 0.005 in 12 and 24 months respectively. Regarding the use of analgesics, Pearson Chi-Square showed p-values p = 0.027 in 12 months and p = 0.01 in 24 months. Referring to sleep disturbances, there was no significant difference between groups. Conclusions: Based on the results of this study, it seems that oral administration of a single preoperative dose of pregabalin may exhibit a significant preventive effect on chronic persistent postoperative pain after elective cardiac surgery. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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17 pages, 810 KB  
Article
Hormonal and Osmoregulatory Responses in Intraoperative High-Volume Diuresis During Off-Pump Coronary Artery Bypass Grafting: An Exploratory Cohort Study
by Yuxi Hou, Shuwen Li, Fei Cai, Fangyi Luo and Jun Ma
J. Clin. Med. 2025, 14(23), 8395; https://doi.org/10.3390/jcm14238395 - 26 Nov 2025
Cited by 1 | Viewed by 703
Abstract
Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery [...] Read more.
Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery bypass grafting (OPCABG). Methods: For this single-center observational cohort study, 70 patients undergoing OPCABG were enrolled (diuresis: urine output > 5 mL/kg/h, n = 38; normal, n = 32). Hormonal markers and osmolality parameters were measured perioperatively. Logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) curves was used to assess model performance. Results: Intraoperative high-volume diuresis occurred in 54.2% of patients. Logistic regression identified a low Body Mass Index (BMI) (OR 0.72, p = 0.002), reduced albumin (OR 0.75, p = 0.014), and lower copeptin (OR 0.43, p = 0.037) as independent predictors (AUC 0.855). Perioperatively, NT-proBNPT0 rose in both groups, aldosterone increased only in the diuresis group, and copeptin showed a slight nonsignificant rise. Plasma sodium was higher in cases of diuresis at the end of surgery (148.4 vs. 144.9 mmol/L, p < 0.001). Despite greater urine output and fluid infusion, the rates of intensive care unit (ICU) admission and hospital stays were similar. Conclusions: Intraoperative high-volume diuresis in OPCABG is strongly associated with reduced antidiuretic hormone activity, suggesting a partial central diabetes insipidus-like mechanism. Although not affecting short-term outcomes, it posed challenges for intraoperative fluid and electrolyte management. Larger multicenter studies are needed for validation. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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21 pages, 1737 KB  
Article
CO2 Gap Alone Is Not a Prognostic Marker for 28-Day Survival of Patients Undergoing a Transcatheter Aortic Valve Replacement
by Lisa Thiehoff, Julia Alexandra Simons, Steffen B. Wiegand, Gereon Schälte, Jörg W. Schröder and Anna Fischbach
J. Clin. Med. 2025, 14(13), 4612; https://doi.org/10.3390/jcm14134612 - 29 Jun 2025
Cited by 1 | Viewed by 1313
Abstract
Background: The venous-to-arterial difference in partial pressure of carbon dioxide (CO2 gap) has been suggested as a marker of cardiac output and clinical outcomes. This study aimed to evaluate the CO2 gap as a prognostic indicator for 28-day survival in patients [...] Read more.
Background: The venous-to-arterial difference in partial pressure of carbon dioxide (CO2 gap) has been suggested as a marker of cardiac output and clinical outcomes. This study aimed to evaluate the CO2 gap as a prognostic indicator for 28-day survival in patients undergoing transcatheter aortic valve replacement (TAVR) and to explore its relationship with cardiac function and lactate levels. Methods: In this prospective cohort study, 50 TAVR patients were stratified based on their left ventricular ejection fraction (LV-EF) and survival status. Central venous and arterial blood samples were collected at five time points to measure blood gas parameters. The primary endpoint was the prognostic value of the CO2 gap for 28-day survival. Secondary endpoints included group differences in the CO2 gap, its correlation with lactate levels, and CO2 content analysis. Results: ROC analysis indicated limited prognostic value for 28-day survival. The CO2 gap was higher in non-survivors than in survivors (11.1 mmHg vs. 6.8 mmHg, p = 0.039), but showed no significant difference between individual time points. The CO2 gap between cardiac (LV-EF ≤ 50%) and non-cardiac (LV-EF > 50%) groups showed no significant difference. Lactate and CO2 gap showed no correlation, except at T2 in the cardiac group (p = 0.039, r = 0.525). CO2 content showed no significance, except at T5, where it was significantly higher in survivors (5.3 mL/dL vs. 1.1 mL/dL, p = 0.003). Conclusions: The CO2 gap did not emerge as a reliable prognostic marker for 28-day survival in TAVR patients. Further studies are needed to explore its clinical relevance. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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14 pages, 1391 KB  
Article
Optimizing Analgesia After Minimally Invasive Cardiac Surgery: A Randomized Non-Inferiority Trial Comparing Interpectoral Plane Block Plus Serratus Anterior Plane Block to Erector Spinae Plane Block
by Onur Baran, Ayhan Şahin, Selami Gürkan, Özcan Gür and Cavidan Arar
J. Clin. Med. 2025, 14(11), 3786; https://doi.org/10.3390/jcm14113786 - 28 May 2025
Cited by 1 | Viewed by 1530
Abstract
Background: Regional anesthesia techniques are increasingly used for pain management in minimally invasive cardiac surgery (MICS). We aimed to evaluate whether the combination of interpectoral plane block (IPB) and superficial serratus anterior plane block (SAPB) provides non-inferior postoperative analgesia compared to erector spinae [...] Read more.
Background: Regional anesthesia techniques are increasingly used for pain management in minimally invasive cardiac surgery (MICS). We aimed to evaluate whether the combination of interpectoral plane block (IPB) and superficial serratus anterior plane block (SAPB) provides non-inferior postoperative analgesia compared to erector spinae plane block (ESPB) in adult patients undergoing MICS. Methods: In this prospective, single-center, double-blind, randomized, non-inferiority trial, 40 adult patients scheduled for MICS were allocated to receive either ESPB (n = 20) or a combination of IPB + SAPB (n = 20) prior to surgical incision. All patients received standardized anesthesia. Pain was assessed using the Critical-Care Pain Observation Tool (CPOT) during intubation and the Numerical Rating Scale (NRS) at 6–48 h postoperatively, following extubation. The primary outcome was the NRS score at 24 h. A non-inferiority margin of 2 NRS points was pre-specified, and non-inferiority was evaluated using between-group differences with 95% confidence intervals. Opioid consumption was recorded via PCA fentanyl and rescue analgesics, converted to morphine milligram equivalents (MMEs). Secondary outcomes included extubation time and postoperative nausea and vomiting (PONV). Results: Median 24 h NRS was 3.0 (0–5.0) in the ESPB group and 2.5 (0–5.0) in the IPB + SAPB group. The between-group difference remained within the predefined two-point margin (95% CI: −0.8 to 1.2). Opioid consumption (p = 0.394), extubation time, and PONV incidence were comparable (all p > 0.05). No block-related complications occurred. Conclusions: IPB + SAPB was non-inferior to ESPB for postoperative analgesia in MICS. Despite requiring two injections, it remains an effective alternative. Larger trials are needed to confirm these findings. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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12 pages, 623 KB  
Article
Telemedicine/Telerehabilitation to Expand Enhanced Recovery After Surgery Interventions in Minimally Invasive Mitral Valve Surgery
by Pietro Giorgio Malvindi, Maria Gabriella Ceravolo, Marianna Capecci, Stefania Balestra, Emanuela Cinì, Antonia Antoniello, Lucia Pepa, Antonella Carbonetti, Maurizio Ricci, Paolo Berretta, Francesca Mazzocca, Marco Fioretti, Umberto Volpe, Christopher Munch and Marco Di Eusanio
J. Clin. Med. 2025, 14(3), 750; https://doi.org/10.3390/jcm14030750 - 24 Jan 2025
Cited by 4 | Viewed by 2375
Abstract
Objectives: Having achieved a consolidated in-hospital experience with enhanced recovery after cardiac surgery, we explored the feasibility of expanding our protocol to pre-admission and post-discharge periods. Methods: A multidisciplinary team including cardiac surgeons, anaesthetists/intensivists, physiatrists, physiotherapists, perfusionists, nurses, psychiatrists, and engineers, [...] Read more.
Objectives: Having achieved a consolidated in-hospital experience with enhanced recovery after cardiac surgery, we explored the feasibility of expanding our protocol to pre-admission and post-discharge periods. Methods: A multidisciplinary team including cardiac surgeons, anaesthetists/intensivists, physiatrists, physiotherapists, perfusionists, nurses, psychiatrists, and engineers, elaborated a new therapeutic offer, based on current ERAS evidence and using telerehabilitation, to enhance preoperative communication and education and improve pre- and postoperative health and psychological state. Results: An institutional web-based platform for remote rehabilitation will host digital content that covers three main areas, including information and communication, prehabilitation and rehabilitation with the offer of respiratory and muscular exercises and aerobic activities, and psychological and patient experience evaluations. These interventions will be achieved through purposely developed video tutorials that present the hospital environments, the relevant healthcare personnel, and their role during the in-hospital patient’s journey, and illustrate tailored prehabilitation activities. A series of questionnaires will be administered to evaluate and follow the patient’s psychological state and collect patient-reported experience measures. The platform was activated in September 2024 and this service will initially involve 100 patients undergoing minimally invasive mitral valve surgery. A first review of compliance and engagement will be carried out after four months and a complete review of the results after the first year. Conclusions: ERAS is associated with improved surgical outcomes. A person-centred treatment should also address the health and psychological difficulties that patients face before hospitalisation and after discharge. Telemedicine is a valid tool to expand treatment and monitoring outside the hospital. This experience may give new insights into the feasibility and effectiveness of providing home-based remote interventions aimed at a global improvement in results throughout the overall cardiac surgery journey. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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9 pages, 2137 KB  
Article
Fibrinogen and Prothrombin Complex Concentrate: The Importance of the Temporal Sequence—A Post-Hoc Analysis of Two Randomized Controlled Trials
by Marco Ranucci, Tommaso Aloisio, Umberto Di Dedda, Martina Anguissola, Alessandro Barbaria and Ekaterina Baryshnikova
J. Clin. Med. 2024, 13(23), 7137; https://doi.org/10.3390/jcm13237137 - 25 Nov 2024
Cited by 3 | Viewed by 1769
Abstract
Background/Objectives: A low level of soluble coagulation factors after cardiac surgery may cause excessive bleeding and trigger clinical correction using prothrombin complex concentrate (PCC). According to the current guidelines, the trigger values for PCC administration are not defined. In the published algorithms, [...] Read more.
Background/Objectives: A low level of soluble coagulation factors after cardiac surgery may cause excessive bleeding and trigger clinical correction using prothrombin complex concentrate (PCC). According to the current guidelines, the trigger values for PCC administration are not defined. In the published algorithms, when driven by ROTEM®, the triggers vary from 80 s to >100 s of coagulation time (CT) during an EXTEM test. Two randomized controlled trials on fibrinogen (FC) supplementation after cardiac surgery previously pointed out that the patients receiving FC supplementation had a significant decrease in their EXTEM CT. This study investigates the hypothesis that after increasing the availability of a substrate (fibrinogen), thrombin generation induces fibrin network formation faster, and that, before considering PCC administration, the normalization of fibrinogen levels should be sought. Methods: A retrospective study based on a post-hoc analysis of the data collected in two previous RCTs involving 85 patients, all of whom received FC supplementation. Results: The results of this post-hoc analysis demonstrate that there is a significant negative association between FIBTEM maximum clot firmness (MCF) and the EXTEM CTs before and after FC supplementation; FC supplementation decreases the EXTEM CTs both in patients with a low FIBTEM MCF and a normal FIBTEM MCF. After FC supplementation, 45 (53%) of the patients had an EXTEM CT of >80 s, 22 (26%) had an EXTEM CT of >90 s, and 8 (9%) had an EXTEM CT of >100 s. Conclusions: Our study confirms and quantifies the effects of reducing EXTEM CTs through FC supplementation. A stepwise strategy of factors correction with FC supplementation should be used before considering PCC administration as it might reduce the need for PCC. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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Review

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15 pages, 2284 KB  
Review
Cardiovascular Anesthesia and Critical Care in the French West Indies: Historical Evolution and Current Prospects
by Christian Isetta, François Barbotin-Larrieu, Sylvain Massias, Diae El Manser, Adrien Koeltz, Patricia Shri Balram Christophe, Mohamed Soualhi and Marc Licker
J. Clin. Med. 2025, 14(2), 459; https://doi.org/10.3390/jcm14020459 - 13 Jan 2025
Viewed by 2310
Abstract
Anesthesiology, the medical specialty that deals with the management of vital functions in patients undergoing surgery, has played an important role in the successful development of cardiac interventions worldwide. Tracing the historical roots of cardiac anesthesia and critical care from its inception in [...] Read more.
Anesthesiology, the medical specialty that deals with the management of vital functions in patients undergoing surgery, has played an important role in the successful development of cardiac interventions worldwide. Tracing the historical roots of cardiac anesthesia and critical care from its inception in the late 1950s, a paradigm shift in perioperative care has been driven by a better understanding of the mechanisms of organ dysfunction in stressful conditions and technological advances regarding surgical approach, patient monitoring, and organ protection. Although progress in cardiac anesthesia and critical care lagged a little behind in Caribbean territories, successful achievements have been accomplished over the last forty years. Compared with Western countries, the greater prevalence of obesity, diabetes mellitus, and hypertension as well as specific diseases such as cardiac amyloidosis, sickle cell anemia, rheumatic heart disease, and tropical infections may reduce a patient’s physiologic reserve and increase the operative risk among the multi-ethnic population living in the French West Indies and Guiana. So far, cardiac anesthesiologists at the University Hospital of Martinique have demonstrated their abilities in implementing evidence-based clinical care processes and adaptating to efficiently working in a complex environment interacting with multiple partners. Attracting specialized physicians in dedicated cardiac surgical centers and the creation of a regional health network supported by governmental authorities, insurance companies, and charitable organizations are necessary to solve the unmet needs for invasive cardiac treatments in the Caribbean region. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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Other

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7 pages, 193 KB  
Brief Report
Impact of Intraoperative Albumin Use During Lung Transplantation on Primary Graft Dysfunction
by Yoshio Tatsuoka, Krzysztof J. Zembrzuski, Jake G. Natalini, Stephanie H. Chang and Jennie Y. Ngai
J. Clin. Med. 2025, 14(21), 7843; https://doi.org/10.3390/jcm14217843 - 5 Nov 2025
Viewed by 675
Abstract
Background: Primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. Albumin is commonly used during lung transplantation to maintain intravascular volume while minimizing total intravenous fluid administration, given the established association between larger intravenous fluid and PGD. However, [...] Read more.
Background: Primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. Albumin is commonly used during lung transplantation to maintain intravascular volume while minimizing total intravenous fluid administration, given the established association between larger intravenous fluid and PGD. However, the direct impact of albumin on PGD remains unclear. Methods: We conducted a single-center retrospective cohort study of lung transplant recipients between 2018 and 2023. We calculated the corrected albumin proportion (cAP), representing the ratio of albumin to total intravenous fluid administered. We analyzed associations between cAP and PGD at 24, 48, and 72 h, as well as secondary outcomes including total fluid administration, 30-day acute kidney injury, mortality, and ICU length of stay. Results: A total of 190 patients were included in this study. A higher cAP was associated with lower total intravenous fluid administration (r = −0.15, p = 0.03), whereas a higher total intravenous fluid administration was associated with higher PGD at 72 h (OR 1.02, 95% CI 1.00–1.03, p = 0.04). However, cAP was not independently associated with PGD or other short-term outcomes. Conclusions: Intraoperative albumin use modestly reduced total intravenous fluid administration but was not independently associated with significant reductions in PGD or improvements in other short-term outcomes. Full article
(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)
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