Cardiac Anesthesiology - Paving the Way across Multiple Subspecialties.

Abstract

Specialists in cardiothoracic and abdominal transplant anesthesia offer unique expertise and a vast breadth of knowledge that contribute to the management of these notably complex patients. Furthermore, these contributions extend beyond intraoperative management, to include leadership throughout the perioperative period, critical care medicine, and even global health. This issue of Seminars in Cardiothoracic and Vascular Anesthesia highlights this broad spectrum of expertise through original research, review articles, and case reports, spanning topics as diverse as airway management, coagulopathy, pediatric heart failure, echocardiography, and educational milestones for fellowship training for abdominal transplant. In the first article of the Original Research section, Auci et al present a retrospective, single-center, observational trial evaluating the optimal time to assess platelet dysfunction during cardiac surgery through the use of platelet aggregometry. In this trial of 63 patients, they utilized an adenosine-50-diphosphate (ADP)-test to compare platelet function at four separate time periods (baseline, aortic declamping, 10 minutes after protamine administration, and end of surgery). There were statistically significant differences in ADP-test results between almost all time periods, with one notable exception: aortic de-clamping vs 10 minutes following protamine. Clinically, this study demonstrates potential value in early identification of platelet dysfunction through assessment at the time of aortic de-clamping, thus allowing timely recognition and thus more effective treatment of platelet impairment following cardiopulmonary bypass (CPB). Anesthesiologists play an essential role for teams performing congenital cardiac surgery in resource-poor conditions throughout the world. To better characterize this work with the goal of improving participation and directing resources, Hubbard et al surveyed members of the Congenital Cardiac Anesthesia Society (CCAS). Survey participants (n = 108) reported 115 total trips to 41 countries spanning 5 continents. The survey covered a broad range of topics, including the nature of the work, trends in geographic locations, and factors that may influence an anesthesiologist’s participation in these efforts. Notably, many of the barriers that interested individuals reported facing stemmed from a lack of institutional support. Not surprisingly, there was also a sharp decline in participation for the year 2020 due to pandemicrelated factors, generating a backlog of cases and further expanding the need for participation in this work in the years to come. With the understanding of dexamethasone’s benefits in treating severe COVID-19 infections, Douin et al performed a multicenter retrospective cohort study to investigate the association between corticosteroid administration and impaired glycemic control in critically ill COVID-19 patients. The study included 292 patients from 12 centers in the United States who required mechanical ventilation and/or venovenous extracorporeal membrane oxygenation. They generated a regression model to assess the association between steroid administration (≥320 mg methylprednisolone, which is equivalent to 60 mg of dexamethasone) and impaired glycemic control (defined as days spent with at least one blood glucose of either >180 mg/dL or <80 mg/dL). After adjusting for multiple confounding variables (gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on ICU day 1, and length of stay), the authors found that these patients demonstrated four additional days of impaired glycemic control (B = 4.00, 95% CI = 2.155.85, P < .001). The authors cite prior work demonstrating the adverse effects on critically ill patients of both hyperglycemia and hypoglycemia, the latter of which is often an iatrogenic consequence of insulin administration. Thus, while corticosteroids have become an important therapeutic intervention for severe cases of COVID-19, this work brings awareness to