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Seminars in Cardiothoracic and Vascular Anesthesia

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https://www.readbyqxmd.com/read/29338605/noteworthy-articles-in-2017-for-cardiothoracic-critical-care
#1
Natalia S Ivascu, Liang Shen, Edward Noguera, Brigid C Flynn
In 2017, many high-impact articles appeared in the literature. This is the third edition of an annual review of articles related to postoperative cardiac critical care that may affect the cardiac anesthesiologist. This year explores vasopressor and inotropic support, timing of renal replacement therapy, management of postoperative respiratory insufficiency, and targeted temperature therapy.
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29332544/the-possible-use-of-preoperative-natriuretic-peptides-for-discriminating-low-versus-moderate-high-surgical-risk-patient
#2
Luigi Vetrugno, Daniele Orso, Carola Matellon, Marilù Giaccalone, Tiziana Bove, Elena Bignami
Perioperative risk scores for patients undergoing noncardiac surgery are generally considered inaccurate, poor, or, at best, modest. We propose estimating a patient's pretest and posttest probability of cardiac morbidity and death using the preoperative scoring system plus the negative likelihood ratio from brain natriuretic peptide (BNP) or N-terminal proB-type natriuretic peptide (NT-proBNP) plasma levels. Our clinical challenge scenario showed a pretest probability of postoperative major cardiac complications with the patient risk factor as 6...
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29320927/benefits-of-using-high-volume-low-pressure-tracheal-tube-in-children-undergoing-congenital-cardiac-surgery-evidence-from-a-prospective-randomized-study
#3
Rakesh Chand, Saibal Roy Chowdhury, Emmanuel Rupert, Chandan Kumar Mandal, Pradeep Narayan
BACKGROUND: In the past 2 decades, usage of high-volume-low-pressure microcuffed tracheal tubes in smaller children has increased. However, there is paucity of evidence of its usage in smaller children undergoing congenital cardiac surgery. The aim of this study was to assess if microcuff endotracheal tubes in neonates and younger children undergoing congenital cardiac surgery is associated with better outcomes than uncuffed tubes. METHODS: We carried out this single-center, prospective, randomized study between June and November 2016...
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29310520/noteworthy-literature-published-in-2017-for-thoracic-transplantation-anesthesiologists
#4
J Mauricio Del Rio, David Maerz, Kathirvel Subramaniam
Thoracic organ transplantation constitutes a significant proportion of all transplant procedures. Thoracic solid organ transplantation continues to be a burgeoning field of research. This article presents a review of remarkable literature published in 2017 regarding perioperative issues pertinent to the thoracic transplant anesthesiologists.
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29303422/use-training-and-opinions-about-effectiveness-of-transesophageal-echocardiography-in-adult-liver-transplantation-among-anesthesiologists-in-the-united-states
#5
Jeron Zerillo, Bryan Hill, Sang Kim, Samuel DeMaria, M Susan Mandell
STUDY OBJECTIVE: Describe transesophageal echocardiography (TEE) use, preparatory training and opinions about clinical importance, and future training pathways in a sample of liver transplant anesthesiologists. DESIGN: Online survey questionnaire. SETTING: Liver Transplant Centers in the United States. PARTICIPANTS: Director of Liver Transplant Anesthesia or designated alternate respondent. RESULTS: A total of 79 Directors or alternates from 111 (71%) centers were identified...
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29291344/diagnosis-and-management-of-ischemic-mitral-regurgitation-evidence-based-clinical-decision-making-at-the-point-of-care
#6
Ajay Kumar Jha, Vishwas Malik
Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older and ubiquitous cutoff of EROA (effective regurgitant orifice area) and Rvol (regurgitant volume) for IMR has been reinstated in the new guideline after a brief hiatus. There had always been a lack of good-quality evidence for its introduction for guiding IMR severity in the previous guideline, and we still do not have quality evidences that could justify its reintroduction...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29284365/echocardiographic-guidance-for-surgical-excision-of-the-intracardiac-component-of-a-pheochromocytoma
#7
Dinesh J Kurian, Angela X Li, Srikar Rao, Agathoklis Konstantinidis, Sanziana A Roman, Miklos D Kertai
Pheochromocytomas are rare neuroendocrine tumors, with published incidence of 2 to 8 cases per million patients per year. The extension of these tumors into the vena cava and right atrium is rarely seen. Transesophageal echocardiography may be invaluable to delineate tumor extent and characteristics, which in turn may provide a useful tool to guide intraoperative surgical approach to these uncommon masses. In the case presented in this article, we describe the role of transesophageal echocardiography in guiding a safe and complete, excision of an invasive pheochromocytoma without embolization of tumor components...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29277148/prostacyclins-in-cardiac-surgery-coming-of-age
#8
Seema P Deshpande, Michael A Mazzeffi, Erik Strauss, Allison Hollis, Kenichi A Tanaka
Prostacyclin (prostaglandin I2 [PGI2]) is an eicosanoid lipid mediator produced by the endothelial cells. It plays pivotal roles in vascular homeostasis by virtue of its potent vasodilatory and antithrombotic effects. Stable pharmacological analogues of PGI2 are used for treatment of pulmonary hypertension and right ventricular failure. PGI2 dose dependently inhibits platelet activation induced by adenosine-5'-diphosphate, arachidonic acid, collagen, and low-dose thrombin. This property has led to its use as an alternative to direct thrombin inhibitors in patients with type II heparin-induced thrombocytopenia (HIT) undergoing cardiac surgery...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29276852/organ-donor-management-part-1-toward-a-consensus-to-guide-anesthesia-services-during-donation-after-brain-death
#9
Michael J Souter, E Eidbo, James Y Findlay, Daniel J Lebovitz, Marina Moguilevitch, Nikole A Neidlinger, Gerhard Wagener, Anil S Paramesh, Claus U Niemann, Pamela R Roberts, Ernesto A Pretto
Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage. The majority of organs are from deceased donors; however, some are not suitable for transplantation. Some of this loss is due to management of the donor...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29231093/the-utility-of-simulation-in-the-management-of-patients-with-congenital-heart-disease-past-present-and-future
#10
Ali Subat, Andrew Goldberg, Samuel Demaria, Daniel Katz
Significant advancements have been made in the diagnosis and management of congenital heart disease (CHD). As a result, a higher percentage of these patients are surviving to adulthood. Despite this improvement in management, these patients remain at higher risk of morbidity and mortality, particularly in the perioperative setting. One new area of interest in these patients is the implementation of simulation-based medical education. Simulation has demonstrated various benefits across high-acuity scenarios encountered in the hospital...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29188763/prothrombotic-state-in-a-patient-with-acute-liver-failure-the-question-of-anticoagulation
#11
Ecaterina Scărlă Tescu, Dana Rodica Tomescu
A 35-year-old male with acute liver failure due to acute hepatitis B virus infection was admitted to the intensive care unit with significant hepatocellular injury, cholestasis, abnormal standard coagulation tests, normal rotational thromboelastometry indices, and without signs of bleeding. He underwent emergency liver transplantation without requiring blood product transfusions or procoagulant treatments. The postoperative course was complicated by deep vein thrombosis and impending hepatic artery thrombosis treated with unfractionated heparin, aspirin, and intravenous prostacyclin...
November 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29144180/intraoperative-hemodynamic-instability-and-diagnosis-of-pheochromocytoma-during-excision-of-adrenal-incidentaloma-with-incomplete-workup-a-case-report
#12
Anthony Chang, George Silvay, Andrew Goldberg
Preoperative evaluation of incidentalomas for pheochromocytoma is imperative. This case report describes a scheduled adrenalectomy in an asymptomatic patient with what was eventually determined to be an incomplete biochemical workup. The intraoperative course was complicated by labile and rapid increases in blood pressure and heart rate, suggesting the missed diagnosis of pheochromocytoma. It is important for anesthesiologists to ensure adequate preoperative biochemical workup before excluding the possibility of coexisting pheochromocytoma...
November 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29099345/coagulation-management-during-liver-transplantation-use-of-fibrinogen-concentrate-recombinant-activated-factor-vii-prothrombin-complex-concentrate-and-antifibrinolytics
#13
Jonathan H Chow, Khang Lee, Ezeldeen Abuelkasem, Obi R Udekwu, Kenichi A Tanaka
Coagulation management, and transfusion practice in liver transplantation (LT) have been evolving in the recent years due to better understanding of coagulation abnormalities in end-stage liver disease, and clinical management of LT patients. Avoidance of allogeneic blood components is feasible in some patients, but multi-modal coagulation therapies may be necessary in others who develop complex coagulopathy due to hemorrhage, hemodilution, hypothermia, and acid-base disturbances. Transfusions of plasma and cryoprecipitate remain to be the mainstay therapy for procoagulant factor replacement during LT...
November 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29099334/viscoelastic-monitoring-to-guide-hemostatic-resuscitation-in-liver-transplantation-surgery
#14
Kevin P Blaine, Tetsuro Sakai
Coagulopathic bleeding must be anticipated during liver transplantation (LT) surgery. Patients with end-stage liver disease (ESLD) often present with disease-related hematologic disturbances, including the loss of hepatic procoagulant and anticoagulant clotting factors and thrombocytopenia. Transplantation surgery itself presents additional hemostatic changes, including hyperfibrinolysis. Viscoelastic monitoring (VEM) is often used to provide targeted, personalized hemostatic therapies for complex bleeding states including cardiac surgery and major trauma...
November 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29098956/advancing-the-scientific-and-educational-basis-of-perioperative-cardiothoracic-and-transplant-care
#15
Nathaen S Weitzel, Mark D Twite, Tetsuro Sakai, Miklos D Kertai
No abstract text is available yet for this article.
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29098955/perioperative-takotsubo-cardiomyopathy-a-systematic-review-of-published-cases
#16
Shvetank Agarwal, Matthew G Bean, J Steven Hata, Manuel R Castresana
Takotsubo cardiomyopathy (TCM) is a condition that is characterized as a transient ventricular dysfunction in the absence of obstructive coronary artery disease (CAD) and is usually triggered by an acute medical illness or intense physical or emotional stress. Multiple cases of perioperative TCM (pTCM) have been reported from around the world, but a qualitative analysis of these cases has not yet been done. For this systematic review, we searched PubMed for case reports and case series of pTCM published from 1966 to April 2015 with the objective being to evaluate whether differences in demographics, clinical features and outcomes exist between pTCM and nonperioperative (npTCM), as well as to attempt to identify any predictors of the severe form of pTCM, which requires mechanical circulatory support (MCS) devices or leads to death...
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29029588/society-for-the-advancement-of-transplant-anesthesia-liver-transplant-anesthesia-fellowship-white-paper-advocating-measurable-proficiency-in-transplant-specialties-training
#17
Ryan M Chadha, Cara Crouch, Jeron Zerillo, Ernesto A Pretto, Raymond Planinsic, Sang Kim, Ramona Nicolau-Raducu, Dieter Adelmann, Elia Elia, Christopher L Wray, Coimbatore Srinivas, M Susan Mandell
The anesthesia community has openly debated if the care of transplant patients was generalist or specialist care ever since the publication of an opinion paper in 1999 recommended subspecialty training in the field of liver transplantation anesthesia. In the past decade, liver transplant anesthesia has become more complex with a sicker patient population and evolving evidence-based practices. Transplant training is currently not required for accreditation or certification in anesthesiology, and not all anesthesia residency programs are associated with transplant centers...
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28933249/anesthetic-management-of-laser-lead-extraction-for-cardiovascular-implantable-electronic-devices
#18
Meena Bhatia, Payam Safavi-Naeini, Mehdi Razavi, Charles D Collard, Daniel A Tolpin, James M Anton
Cardiovascular implantable electronic devices (CIEDs) play a significant role in the modern management of cardiovascular disease. CIEDs include implantable pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. These devices improve the quality of life of their recipients and help reduce the incidence of sudden cardiac death. Traditionally, CIEDs have been reliant on the use of transvenous endocardial leads to directly connect with the heart. Over time, these endovascular leads may become endothelialized rendering removal extremely difficult...
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28388863/perioperative-coagulation-management-of-a-hemophilia-a-patient-during-cardiac-surgery
#19
Patrick Odonkor, Archana Srinivas, Erik Strauss, Brittney Williams, Michael Mazzeffi, Kenichi A Tanaka
Perioperative management of cardiovascular surgical procedures requiring cardiopulmonary bypass (CPB) in patients with hemophilia A poses a clinical challenge in coagulation management. Use of CPB requires the administration of an anticoagulant, usually unfractionated heparin, and also causes dilutional coagulopathy, platelet dysfunction or platelet consumption coagulopathy. Hypothermia and activation of the inflammatory cascade also affect coagulation. The effects of CPB on circulating levels of factor VIII have not been clearly defined...
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29327650/transesophageal-echocardiography-use-in-diagnosis-and-management-of-embolized-intravascular-foreign-bodies
#20
James Taylor Herbert, Miklos David Kertai
The increasing use of endovascular interventions coupled with the large number of published case series detailing complications attest to the likelihood that anesthesiologists will encounter a case of intravascular foreign body embolization during their careers. Transesophageal echocardiography is essential to the diagnosis and management of traumatic and intravascular foreign bodies embolized to the heart because it can identify not only the foreign body but also hemodynamically significant lesions to radiolucent anatomic structures prior to and during surgical exploration...
October 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
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