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Cardiothoracic anaesthesia

Anje J Scarfe, Susanne Schuhmann-Hingel, Joanna K Duncan, Ning Ma, Yasoba N Atukorale, Alun L Cameron
A continuous paravertebral block is used when pain relief is required beyond the duration of a single-injection paravertebral block. Surgical procedures requiring an incision into the pleural cavity are some of the most painful procedures postoperatively and, if not managed appropriately, can lead to chronic pain. The current gold standard for post-cardiothoracic surgery pain management is epidural analgesia, which has contraindications, a failure rate of up to 12% and risk of complications such as epidural abscess and spinal haematoma...
May 30, 2016: European Journal of Cardio-thoracic Surgery
S A Longo, A Echegaray, C M Acosta, L I Rinaldi, M C Cabrera Schulmeyer, I Olavide Goya
Transoesophageal echocardiography (TEE) has become a fundamental tool in modern cardiothoracic anaesthesia. It has an indisputable role in coronary valve surgery and revascularisations with severe impairment of ventricle function. It helps in making diagnoses that can optimise the surgical strategy and to minimal invasively dynamically monitor volaemia and cardiac function during the post-operative period, detecting complications unobservable by other methods. The McConnell sign, visualised using TEE as an akinesis of the right ventricular free wall, with a normal apex motility and enlargement of the right cavities, is characteristic of right ventricular (RV) dysfunction...
April 5, 2016: Revista Española de Anestesiología y Reanimación
Joyce H Y Yeung, Simon Gates, Babu V Naidu, Matthew J A Wilson, Fang Gao Smith
BACKGROUND: Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risks of developing complications such as lung collapse, chest infections and blood clots due to ineffective breathing and clearing of secretions...
2016: Cochrane Database of Systematic Reviews
P J McCall, A Macfie, J Kinsella, B G Shelley
Lung resection is associated with significant perioperative morbidity, and a proportion of patients will require intensive care following surgery. We set out to characterise this population, assess their burden of disease and investigate the influence of anaesthetic and surgical techniques on their admission rate. Over a two-year period, 1169 patients underwent surgery, with 30 patients (2.6%) requiring unplanned intensive care. Patients requiring support had a higher mortality (0.2% vs 26.7%, p < 0.001)...
December 2015: Anaesthesia
Kalpana Vinod Kelkar
Post-operative pulmonary complications (PPCs) occur in 5-10% of patients undergoing non-thoracic surgery and in 22% of high risk patients. PPCs are broadly defined as conditions affecting the respiratory tract that can adversely influence clinical course of the patient after surgery. Prior risk stratification, risk reduction strategies, performing short duration and/or minimally invasive surgery and use of anaesthetic technique of combined regional with general anaesthesia can reduce the incidence of PPCs. Atelectasis is the main cause of PPCs...
September 2015: Indian Journal of Anaesthesia
L de Bruin, W Pasma, D B M van der Werff, T A N J Schouten, F Haas, D C van der Zee, L van Wolfswinkel, J C de Graaff
BACKGROUND: Research in postoperative mortality is scarce. Insight into mortality and cause of death might improve and innovate perioperative care. The objective for this study was to report the 24-hour and 30-day overall, and surgery and anaesthesia-related, in-hospital mortality at a tertiary paediatric hospital. METHODS: All patients <18 yr old who underwent anaesthesia with or without surgery between January 1, 2006, and December 31, 2012, at the Wilhelmina Children's Hospital, Utrecht, The Netherlands, were included in this retrospective cohort study...
October 2015: British Journal of Anaesthesia
Jacob T Gutsche, Hynek Riha, Prakash Pate, Lance Atchley, Elizabeth Valentine, Ronak Shah, Sophia T Cisler, Stuart J Weiss, George Silvay, John G T Augoustides
There has been significant progress throughout 2014 in cardiothoracic and vascular anaesthesia and intensive care. There has been a revolution in the clinical approach to acute and chronic adult aortic diseases. Contemporary management of adult aortic disease is based on etiology, clinical presentation, extent, and integrated intervention with medical, endovascular and/or surgical measures. Further European guidelines have explored in depth the cardiovascular management in non-cardiac surgery with a thematic focus to reduce perioperative mortality from the leading offender, namely myocardial ischemia...
2015: Heart, Lung and Vessels
S Shah, H Gilliland, G Benson
INTRODUCTION: Cardiac surgery involves cardiopulmonary bypass during which the core temperature is generally lowered to hypothermic levels. Patients presenting for cardiac surgery are sometimes reported to have cold or warm autoantibodies at the time of blood screening. It is known that cold agglutinins may cause potentially life-threatening haemolysis, intracoronary haemagglutination leading to inadequate cardioplegia distribution, thrombosis, embolism, ischaemia or infarction. The risk (if any) posed by warm autoantibodies is less clear...
2014: Heart, Lung and Vessels
J Graham, D Sidebotham, D A Story, R Hu, F Parker
A suggested standard examination (SSE) for intraoperative transoesophageal echocardiography for cardiac surgery was developed at the Green Lane Department of Cardiothoracic and Otorhinolaryngology Anaesthesia at the Auckland City Hospital. The examination includes views to be recorded in all patients pre- and post-cardiopulmonary bypass. There are also additional views to be recorded in patients with valvular pathology. Using the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines, we report an audit comparing acquisition ratios before and after introduction of the SSE...
September 2014: Anaesthesia and Intensive Care
K E O'Sullivan, J C Kelly, J P Hurley
INTRODUCTION: This study is a citation analysis of the top 100 most cited papers in adult cardiac surgery. Bibliometric analyses are viewed as a proxy marker of a paper's influence and, therefore, an analysis of the most influential papers published in recent decades. METHODS: Impact factor ranking as of 2012 was used to decide which journals to include in our searches. The Thompson Reuters Web of Knowledge was used to search for citations of all papers relevant to cardiac surgery within selected journals...
March 2015: Irish Journal of Medical Science
J T Gutsche, H Riha, P Patel, G S Sahota, E Valentine, K Ghadimi, G Silvay, J G T Augoustides
There has been significant progress throughout 2013 in cardiothoracic and vascular anaesthesia and intensive care. There has been a revolution in the medical and interventional management of atrial fibrillation. The medical advances include robust clinical risk scoring systems, novel oral anticoagulants, and growing clinical experience with a new antiarrhythmic agent. The interventional advances include left atrial appendage occlusion for stroke reduction, generalization of ablation techniques in cardiac surgery, thoracoscopic ablation techniques, and the emergence of the hybrid ablation procedure...
2014: Heart, Lung and Vessels
Tom Pedersen, Amanda Nicholson, Karen Hovhannisyan, Ann Merete Møller, Andrew F Smith, Sharon R Lewis
BACKGROUND: This is an update of a review last published in Issue 9, 2009, of The Cochrane Library. Pulse oximetry is used extensively in the perioperative period and might improve patient outcomes by enabling early diagnosis and, consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomized clinical trials of pulse oximetry during anaesthesia and in the recovery room have been performed that describe perioperative hypoxaemic events, postoperative cardiopulmonary complications and cognitive dysfunction...
2014: Cochrane Database of Systematic Reviews
Kamal H Sharma, Bhavik S Shah, Nikhil D Jadhav
Intra-aortic balloon pump (IABP) is used in cardiogenic shock of different etiologies. Routinely, it is inserted through the transfemoral access, but in the patients with severe peripheral artery obstruction disease (PAOD), use of alternative approach is needed. In this case report, IABP insertion through the right subclavian artery with the help of cardiothoracic surgeon in a patient of anterior wall myocardial infarction (AWMI) with severe PAOD has been described. A 60-years-old male patient, with the history of chronic smoking, presented with progressing chest pain for last 3 days...
September 2016: Catheterization and Cardiovascular Interventions
R González-Rodríguez, A Muñoz Martínez, J Galan Serrano, M V Moral García
INTRODUCTION AND OBJECTIVE: Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa(®)) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit...
March 2014: Revista Española de Anestesiología y Reanimación
Nnamdi Nwaejike, Ehab Elbur, Kandadai S Rammohan, Rajesh Shah
A 29-year old woman at 26 weeks gestation (gravida 3 and para 0) presented with an acute left-sided pneumothorax. She had a 10 pack-year smoking history and no other relevant medical history. Over the next 3 weeks, she had three recurrences of her left-sided pneumothorax, each of which was managed by intercostal drain insertion. During the fourth episode of pneumothorax, after chest drain insertion there was a continued air-leak for 4 days. She was referred to the cardiothoracic service for further management of this problem...
December 2013: Interactive Cardiovascular and Thoracic Surgery
Piera Polidori, Concetta Di Giorgio, Alessio Provenzani
BACKGROUND: Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs. OBJECTIVE: The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed...
2012: Informatics in Primary Care
Wen Sheng Chen, Bing Ren Gao, Wen Qin Chen, Zhen Zhen Li, Zhi Yi Xu, Yan Hua Zhang, Kun Yang, Xin Qiang Guan
OBJECTIVE: To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation (AF). METHODS: Patients with permanent AF who had undergone prosthetic cardiac valve replacement, who had a cardiothoracic ratio ≤ 0.5 and a left atrial diameter ≤ 50 mm for ≥ 6 months after surgery were randomly divided to receive either electrical or pharmacological cardioversion...
August 2013: Journal of International Medical Research
Saina Attaran, Gentjan Jakaj, Metesh Acharya, Jon R Anderson
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Are frozen sections of mediastinoscopy samples as effective as formal paraffin assessment of mediastinoscopy samples for a decision on a same-day lobectomy?'. Five papers were found using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
June 2013: Interactive Cardiovascular and Thoracic Surgery
João F Viterbo, André P Lourenço, Adelino F Leite-Moreira, Paulo Pinho, Fernanda Barros
CONTEXT: Haemodynamic stability during induction is a cornerstone of cardiac anaesthesia. The evaluation of pharmacokinetic models for propofol during induction is lacking. OBJECTIVE: To compare haemodynamics during cardiac anaesthesia induction with two pharmacokinetic models. DESIGN: Randomised controlled trial. SETTING: Department of Cardiothoracic Surgery, São João Hospital; July to December 2010. PATIENTS: Ninety consecutive elective adult cardiac surgical patients...
October 2012: European Journal of Anaesthesiology
Klaudia Adler, Barbara Pullmann, Christian Byhahn
Further development of surgical techniques and instruments provide complex endoscopic or transcatheter guided interventions in thoracic organs. However, minimalinvasive surgery does not mean minimalinvasive anaesthesia. Particularly concerning cardiothoracic surgery, complex endoscopic procedures represent a challenge to the anaesthesiological management. These interventions require a close interdisciplinary cooperation. Considering the surgical procedures, this review describes the anaesthesiological management for transcatheter aortic valve implantation (TAVI) and percutaneous mitral valve repair...
July 2012: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
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