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pulmonary endarterectomy, anesthesia management

Jean Liew, Janelle Stevens, Christopher Slatore
INTRODUCTION: Acute pulmonary embolism is the third leading cause of cardiovascular death. Management options include anticoagulation with or without thrombolysis. Concurrent persistent hypoxemia should be a clue to the existence of an intracardiac shunt. CASE PRESENTATION: A 46-year-old man experienced acute hypoxemic respiratory failure requiring mechanical ventilation after anesthesia induction for elective hip arthroplasty. He was found to have submassive bilateral pulmonary emboli with acute right ventricular dysfunction and a coexisting patent foramen ovale with right-to-left shunt...
March 2, 2018: Permanente Journal
Hüseyin Şaşkın, Cagri Duzyol, Kazım Serhan Ozcan, Rezan Aksoy, Mustafa Idiz
BACKGROUND: Treatment method in patients with coronary artery disease undergoing coronary bypass surgery with accompanying carotid artery disease is still a hot topic among clinicians. This study is designed to investigate if there is an effect on myocardial infarction, cerebrovascular events and mortality during postoperative period of simultaneous carotid endarterectomy with coronary bypass surgery compared to staged carotid artery stenting before coronary bypass surgery. METHODS: 102 patients (79 male, 23 female) who underwent simultaneous carotid endarterectomy with coronary bypass surgery or staged carotid artery stenting with coronary bypass surgery in the same center with the same surgical team were divided into 2 groups and retrospectively reviewed...
October 28, 2015: Heart Surgery Forum
Danny Hoogma, Bart Meyns, Dirk Van Raemdonck, Marc Van de Velde, Carlo Missant, Steffen Rex
We describe a patient who presented with a bilateral pulmonary artery sarcoma, initially treated as pulmonary embolism, that necessitated concomitant pulmonary endarterectomy and pneumonectomy. We reviewed the anesthetic management used for this procedure, which bears many similarities to the management of patients undergoing pulmonary thromboendarterectomy. Right ventricular failure, pulmonary hemorrhage, and cerebral ischemia due to circulatory arrest are life-threatening perioperative complications. The anesthesiologist can play a key role in the prevention (or timely recognition and treatment) of these perioperative complications by establishing adequate hemodynamic, echocardiographic, and neurologic monitoring and by optimizing cardiopulmonary function and coagulation...
August 15, 2015: A & A Case Reports
David Rubes, Andrew A Klein, Michal Lips, Jan Rulisek, Petr Kopecky, Jan Blaha, Frantisek Mlejnsky, Jaroslav Lindner, Alena Dohnalova, Jan Kunstyr
BACKGROUND: Regular endotracheal tube cuff monitoring may prevent silent aspiration. OBJECTIVES: We hypothesised that active management of the cuff of the tracheal tube during deep hypothermic cardiac arrest would reduce silent subglottic aspiration. We also determined to study its effect on postoperative mechanical ventilation and the incidence of postoperative positive tracheal cultures. DESIGN: A randomised clinical trial. SETTING: The study was conducted in a University Teaching Hospital from September 2008 to November 2009...
September 2014: European Journal of Anaesthesiology
Dalia A Banks, Gert Victor D Pretorius, Kim M Kerr, Gerard R Manecke
Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary thromboembolic hypertension remains underdiagnosed. It is imperative that all patients with pulmonary hypertension (PH) be screened for the presence of CTEPH since this form of PH is potentially curable with pulmonary endarterectomy (PEA) surgery...
December 2014: Seminars in Cardiothoracic and Vascular Anesthesia
N Andrade, J Ferreira, J Mourão, J Oliveira, S Gomes, G Afonso
Per-operative management of patients with cardiovascular pathology, has been regarded, since ever, as a challenge for anesthesiologists and vascular surgeons. Vascular disease, often diffuse and asymptomatic, has a high prevalence in the community and is associated to an annual mortality rate of 12%. This requires that anesthetic technique should be concentrated in the preservation of myocardial, renal, pulmonary and cerebral functions, during the hemodynamic alterations related to surgery, in order to lower the per-operative complications and to promote faster and safer post-operative recovery...
October 2008: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Gerard R Manecke
Anesthetic care for patients undergoing pulmonary endarterectomy represents one of the most challenging tasks in cardiac anesthesia. Chronic thromboembolic pulmonary hypertension with its concomitant right ventricular failure may cause hemodynamic instability during anesthetic induction and the precardiopulmonary bypass (CPB) period, and the associated comorbidities (pulmonary, hepatic) may affect the actions and metabolism of anesthetic drugs. During the CPB period, proper perfusion patterns, cerebral oxygenation, and adequate hypothermia for deep hypothermic circulatory arrest must be achieved...
2006: Seminars in Thoracic and Cardiovascular Surgery
Susan Schneider, Tamara Sakert, John Lucke, Peter McKeown, Ajeet Sharma
Cardiopulmonary bypass (CPB) poses great risks for hypercoagulable patients and requires management techniques to ensure an optimal outcome free from thrombotic events. This case report reviews perfusion management techniques that may contribute to a safer CPB experience for a patient deficient in both protein C and protein S. A patient with heterozygous protein C deficiency is at increased risk of thrombosis, especially in the venous circulation. Since it is an essential cofactor for activated protein C, deficiency of free protein S is also linked to a hypercoagulable condition...
March 2006: Perfusion
Thorsten Kramm, Balthasar Eberle, Stefan Guth, Eckhard Mayer
OBJECTIVE: Pulmonary endarterectomy (PEA) is the standard therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In the immediate postoperative period, persistent pulmonary hypertension increases the risk of acute respiratory or right heart failure. In pulmonary arterial hypertension, prostanoid inhalation has been found to improve pulmonary hemodynamics, right ventricular function, gas exchange, and clinical outcome. We report the results of a double-blinded randomized trial with the aerosolized prostacyclin analogue iloprost in patients with residual pulmonary hypertension after PEA...
December 2005: European Journal of Cardio-thoracic Surgery
G D Trachiotis, A J Pfister
BACKGROUND: The occurrence of significant carotid artery disease in patients requiring coronary artery bypass grafting (CABG) results in a dilemma regarding the best surgical management. Our philosophy has been to perform simultaneous carotid endarterectomy and CABG. We reviewed the efficacy of this therapy in patients treated at a large community-based hospital. METHODS: During a 6-year period, from 1990 to 1996, 88 patients underwent simultaneous carotid endarterectomy and CABG...
October 1997: Annals of Thoracic Surgery
D L Brown, A K Bodary, R R Kirby
No abstract text is available yet for this article.
August 1984: Anesthesiology
G C Kaiser
During the past 15 years coronary artery bypass surgery (CABG) has evolved into a procedure with low operative mortality and morbidity resulting in excellent improvement in lifestyle and improved longevity in some instances. Operative risk factors have been identified. Their significance has changed during this time. Currently, clinical congestive heart failure and emergency operation are the most commonly observed adverse results. Since the patients being operated upon, especially those emergent, are sicker, the improvements in mortality and morbidity with CABG are not due to patient selection, but rather to improvement in preoperative, intraoperative, and postoperative management...
December 1985: Circulation
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