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Clinical Advances in Cardiothoracic Anesthesia
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Clinical Advances in Cardiothoracic Anesthesia

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

Deadline for manuscript submissions: 31 July 2025 | Viewed by 3439

Special Issue Editors

Prof. Dr. Eleni Arnaoutoglou

E-Mail Website
Guest Editor
Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece
Interests: anesthesiology; pain medicine; cardiovascular anesthesia
Dr. Metaxia V. Bareka

E-Mail Website
Guest Editor
Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece
Interests: anesthesiology; regional anesthesia; pain medicine; cardiothoracic anesthesia

Special Issue Information

Dear Colleagues,

The Journal of Clinical Medicine (JCM) is introducing this Special Issue, which intends to update our clinical and scientific community on the recent clinical advances in cardiothoracic anesthesia. We welcome state-of-the-art reviews and original clinical and experimental studies on current topical issues in cardiothoracic anesthesia. The field of cardiothoracic anesthesia has undergone a rapid evolution over the past few years, with advances in the pathophysiology of disease states, pain relief techniques, newer devices, novel pharmacological agents, and evolving advanced technology, including artificial intelligence. Moreover, with minimally invasive surgical methods, minimal opioid anesthesia, and ultrasound-guided regional analgesia, enhanced recovery after cardiac surgery has evolved. Therefore, there is an urgent need to optimally implement novel pharmacological and regional anesthesia techniques, along with newer devices and advanced technology, to provide the best perioperative care and ensure the best possible postoperative outcome for patients undergoing cardiothoracic procedures, increasing patient safety. We sincerely welcome your submissions to this Special Issue of the JCM to address these important questions and promote future research.

Prof. Dr. Eleni Arnaoutoglou
Dr. Metaxia V. Bareka
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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • cardiac anesthesia
  • perioperative medicine
  • outcome
  • regional anesthesia
  • novel pharmacological agents
  • minimally invasive surgical methods
  • enhanced recovery
  • patient safety

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Published Papers (5 papers)

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Research

Jump to: Review, Other

17 pages, 1004 KiB  
Article
Is a Perioperative Opioid-Sparing Anesthesia-Analgesia Strategy Feasible in Open Thoracotomies? Findings from a Retrospective Matched Cohort Study
by Vasileia Nyktari, Georgios Stefanakis, Georgios Papastratigakis, Eleni Diamantaki, Emmanouela Koutoulaki, Periklis Vasilos, Giorgos Giannakakis, Metaxia Bareka and Alexandra Papaioannou
J. Clin. Med. 2025, 14(6), 1820; https://doi.org/10.3390/jcm14061820 - 8 Mar 2025
Viewed by 476
Abstract
Background/Objectives: To assess the feasibility and effectiveness of a perioperative opioid-sparing anesthesia-analgesia (OSA-A) technique without regional nerve blocks compared to standard opioid-based technique (OBA-A) in open thoracotomies. Methods: This retrospective, matched cohort study was conducted at a university hospital from September [...] Read more.
Background/Objectives: To assess the feasibility and effectiveness of a perioperative opioid-sparing anesthesia-analgesia (OSA-A) technique without regional nerve blocks compared to standard opioid-based technique (OBA-A) in open thoracotomies. Methods: This retrospective, matched cohort study was conducted at a university hospital from September 2019 to February 2021, including adult patients undergoing open thoracotomy for lung or pleura pathology. Sixty patients in the OSA-A group were matched with 40 in the OBA-A group. Outcomes included postoperative pain scores on days 0, 1, and 2; 24-h postoperative morphine consumption; PACU and hospital length of stay; time to bowel movement; and rates of nausea and vomiting. Results: Of 125 eligible patients, 100 had complete records (60 OSA-A, 40 OBA-A). Demographics were similar, but ASA status scores were higher in the OBA-A group. The OSA-A group reported significantly lower pain levels at rest, during cough, and on movement on the first two postoperative days, shorter PACU stay, and required fewer opioids. They also had better gastrointestinal motility (p < 0.0001) and lower rates of nausea and vomiting on postoperative days 1 and 2. A follow-up study with 68 patients (46 OSA-A, 22 OBA-A) assessing chronic pain prevalence found no significant differences between the groups. Conclusions: OSA-A without regional nerve blocks for open thoracotomies is feasible and safe, improving postoperative pain management, reducing opioid consumption, shortening PACU stay, and enhancing early gastrointestinal recovery compared to OBA-A. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesia)
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15 pages, 847 KiB  
Article
Enhanced Recovery After Surgery (ERAS) Protocols in Cardiac Surgery: Impact on Opioid Consumption
by Alexandra Othenin-Girard, Zied Ltaief, Mario Verdugo-Marchese, Luc Lavanchy, Patrice Vuadens, Anna Nowacka, Ziyad Gunga, Valentine Melly, Tamila Abdurashidova, Caroline Botteau, Marius Hennemann, Jérôme Graf, Patrick Schoettker, Matthias Kirsch and Valentina Rancati
J. Clin. Med. 2025, 14(5), 1768; https://doi.org/10.3390/jcm14051768 - 6 Mar 2025
Viewed by 699
Abstract
Background: Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical specialties to improve patient outcomes and reduce opioid consumption. In cardiac surgery, the traditionally high-dose opioid use is associated with prolonged ventilation, intensive care unit (ICU) stays, and opioid-related [...] Read more.
Background: Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical specialties to improve patient outcomes and reduce opioid consumption. In cardiac surgery, the traditionally high-dose opioid use is associated with prolonged ventilation, intensive care unit (ICU) stays, and opioid-related adverse drug events (ORADEs). This study evaluates the impact of an ERAS® Society-certified program on opioid consumption in patients undergoing elective cardiac surgery at Lausanne University Hospital. Methods: A retrospective, monocentric observational study was conducted comparing two patient cohorts: one treated with ERAS protocols (2023–2024) and a retrospective control group from 2019. Data were collected from the hospital’s electronic medical records and the ERAS program database. The primary outcome was total opioid consumption, measured intraoperatively and postoperatively (postoperative day (POD) 0–3). Secondary outcomes included pain control, length of stay, complications, and recovery parameters. Statistical analyses included multivariate logistic regression to identify factors associated with reduced opioid consumption. Results: Patients in the ERAS group demonstrated significantly lower total opioid consumption, whether intraoperatively (median sufentanil: 40 mcg vs. 51 mcg, p < 0.0001) or postoperatively (POD 0–3: p < 0.001). The ERAS group had faster extubation times, earlier mobilization and pain control with non-opioid analgesics, fewer complications, and shorter hospital stays (9 vs. 12 days, p < 0.001). Logistic regression identified fast-track extubation and absence of complications as strong predictors of reduced opioid use. Conclusions: The implementation of an ERAS protocol in cardiac surgery significantly reduces opioid consumption while enhancing recovery. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesia)
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13 pages, 932 KiB  
Article
Risk Factors for Postoperative Pulmonary Complications in Patients Undergoing Thoracotomy for Indications Other than Primary Lung Cancer Resection: A Multicenter Retrospective Cohort Study from the German Thorax Registry
by Wolfgang Baar, Axel Semmelmann, Florian Anselm, Torsten Loop, Sebastian Heinrich and for the Working Group of the German Thorax Registry
J. Clin. Med. 2025, 14(5), 1565; https://doi.org/10.3390/jcm14051565 - 26 Feb 2025
Viewed by 385
Abstract
Background: Postoperative pulmonary complications (PPCs) are the most common complications following lung surgery and can lead to increased postoperative mortality. In this study, we examined the incidence of PPCs, the in-hospital mortality rate, and the risk factors associated with PPCs in patients undergoing [...] Read more.
Background: Postoperative pulmonary complications (PPCs) are the most common complications following lung surgery and can lead to increased postoperative mortality. In this study, we examined the incidence of PPCs, the in-hospital mortality rate, and the risk factors associated with PPCs in patients undergoing open thoracotomy lung resection (OTLR) for reasons other than primary lung cancer. Methods: Data from this multicenter, retrospective study involving 1.368 patients were extracted from the German Thorax Registry and analyzed using univariate and multivariable statistical methods. Results: In total, 278 patients showed at least one PPC. The presence of PPCs was associated with a significantly higher in-hospital mortality rate (7.2% vs. 1.5%; p = 0.000). Multivariable stepwise logistic regression analysis showed absolute age (OR 1.02) and BMI ≤ 19 (OR 2.6) as independent patient-specific risk factors. Significant preoperative risk factors included re-thoracotomy (OR 4.0) and FEV1 < 60% (OR 2.5). Procedure-related independent risk factors for PPCs included a surgical duration surpassing 195 min (OR 2.7), the continuation of invasive ventilation post-surgery (OR 3.8), and an intraoperative infusion of crystalloids greater than 6 mL/kg/h (OR 1.8). Conclusions: Optimizing intraoperative fluid therapy and on-table extubation when possible may reduce the incidence of PPCs and associated mortality. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesia)
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Review

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15 pages, 5311 KiB  
Review
Local Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report
by Felix Berger, Lennart Peters, Sebastian Reindl, Felix Girrbach, Philipp Simon and Christian Dumps
J. Clin. Med. 2025, 14(1), 165; https://doi.org/10.3390/jcm14010165 - 30 Dec 2024
Viewed by 1020
Abstract
Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This [...] Read more.
Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland. Results: We identified numerous risk stratification grading systems and only a few case reports of regional anesthesia techniques for extracorporeal membrane oxygenation patients. Clinical Case: After consultation with his general physician because of exertional dyspnea and stridor, a 78-year-old patient with no history of heart failure was advised to present to a cardiology department under the suspicion of decompensated heart failure. Computed tomography imaging showed a large mediastinal mass that most likely originated from the left thyroid lobe, with subtotal obstruction of the trachea. Prior medical history included the implantation of a dual-chamber pacemaker because of a complete heart block in 2022, non-insulin-dependent diabetes mellitus type II, preterminal chronic renal failure with normal diuresis, arterial hypertension, and low-grade aortic insufficiency. After referral to our hospital, an interdisciplinary consultation including experienced cardiac anesthesiologists, thoracic surgeons, general surgeons, and cardiac surgeons decided on completing the resection via median sternotomy after awake cannulation for veno-venous extracorporeal membrane oxygenation via the right internal jugular and the femoral vein under regional anesthesia. An intermediate cervical plexus block and a suprainguinal fascia iliaca compartment block were performed, followed by anesthesia induction with bronchoscopy-guided placement of the endotracheal tube over the stenosed part of the trachea. The resection was performed with minimal blood loss. After the resection, an exit blockade of the dual chamber pacemaker prompted emergency surgical revision. The veno-venous extracorporeal membrane oxygenation was explanted after the operation in the operating room. The postoperative course was uneventful, and the patient was released home in stable condition. Conclusions: Awake veno-venous extracorporeal membrane oxygenation placed under local anesthetic infiltration with regional anesthesia techniques is a feasible individualized approach for patients with high risk of airway collapse, especially if the mediastinal mass critically alters tracheal anatomy. Compressible cysts may represent a subgroup with easy passage of an endotracheal tube. Interdisciplinary collaboration during the planning stage is essential for maximum patient safety. Prospective data regarding risk stratification for veno-venous extracorporeal membrane oxygenation cannulation and effectiveness of regional anesthesia is needed. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesia)
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Other

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14 pages, 1442 KiB  
Systematic Review
Comparative Analysis of Perioperative Analgesia Methods in Thoracic Surgery: A Literature Systemic Review
by Fahim Kanani, Rijini Nugzar, Mordechai Shimonov and Firas Abu Akar
J. Clin. Med. 2025, 14(7), 2484; https://doi.org/10.3390/jcm14072484 - 5 Apr 2025
Viewed by 331
Abstract
Background/Objectives: Effective pain management following thoracic surgery remains challenging yet crucial for optimal patient outcomes. This literature review compares the efficacy, safety, and clinical outcomes of different perioperative analgesia methods in thoracic surgery patients, focusing on paravertebral block (PVB), intercostal nerve block (ICNB), [...] Read more.
Background/Objectives: Effective pain management following thoracic surgery remains challenging yet crucial for optimal patient outcomes. This literature review compares the efficacy, safety, and clinical outcomes of different perioperative analgesia methods in thoracic surgery patients, focusing on paravertebral block (PVB), intercostal nerve block (ICNB), epidural analgesia (EPI), erector spinae plane block (ESPB), and patient-controlled analgesia (PCA). Methods: A systematic search was conducted across medical databases, yielding ten relevant randomized controlled trials and meta-analyses. Results: The evidence indicates that paravertebral block provides superior pain control with lower opioid requirements, fewer adverse events, and higher patient satisfaction compared to other methods. While epidural analgesia offers pain control comparable to PVB, it is associated with higher technical failure rates and side effects, including urinary retention, nausea/vomiting, and hypotension. ICNB and ESPB demonstrate efficacy superior to systemic analgesia but generally inferior to PVB in terms of pain scores and opioid consumption. Conclusions: This review highlights the need for individualized approaches to perioperative pain management in thoracic surgery, with paravertebral block emerging as a preferred option due to its favorable efficacy and safety profile. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesia)
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