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Cardiac Anesthesia: A Problem-Based Learning Approach最新文献

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Aortic Stenosis in Noncardiac Surgery 非心脏手术中的主动脉瓣狭窄
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0014
B. Perkins, F. Dupont
{"title":"Aortic Stenosis in Noncardiac Surgery","authors":"B. Perkins, F. Dupont","doi":"10.1093/MED/9780190884512.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0014","url":null,"abstract":"Aortic stenosis is the most common valvular lesion in patients older than 65 years, occurring in 2%–9% of patients. It is estimated that the number of patients with aortic stenosis who will need surgery will increase dramatically as the world’s population ages. Treatment of aortic stenosis includes surgical aortic valve replacement, transcatheter aortic valve replacement, balloon valvuloplasty, or medical management. Aortic stenosis is associated with significant perioperative risk in noncardiac surgery. Hemodynamic changes from anesthesia medications and the surgical procedure can result in decreased coronary perfusion, myocardial ischemia, arrhythmias, heart failure, or even death. General or regional anesthesia can be administered safely to asymptomatic patients with significant aortic stenosis if hemodynamics are maintained in the perioperative period.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127479450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Disruptive Provider 颠覆性供应商
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0034
M. Minhaj
{"title":"The Disruptive Provider","authors":"M. Minhaj","doi":"10.1093/MED/9780190884512.003.0034","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0034","url":null,"abstract":"It is estimated that less than 5% of physicians can be labeled as “disruptive providers” who demonstrate behaviors such as verbal or physical abuse. Passive-aggressive behaviors are also commonly manifested by these providers. Proceduralists are more often labeled as disruptive providers as compared to primary care physicians, which means that anesthesiologists will likely encounter these individuals during their career. Disruptive behaviors have been associated with decreased communication, worse patient outcomes, and increased staff turnover, and they present a danger to patient safety. Organizations need to clearly define policies aimed at engaging disruptive providers and modifying poor behaviors and have a culture that does not promote these behaviors or individuals who demonstrate them.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115691647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aortic Arch Repair (Circulatory Arrest) 主动脉弓修复(循环停止)
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0027
Shyamal Asher
{"title":"Aortic Arch Repair (Circulatory Arrest)","authors":"Shyamal Asher","doi":"10.1093/MED/9780190884512.003.0027","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0027","url":null,"abstract":"Aortic arch repair is a technically challenging surgery that requires collaboration between the anesthesiology, cardiac surgery, and perfusion teams. To accomplish a total aortic arch repair, blood flow to the brain and the rest of the body has to be interrupted. The most common aortic arch pathologies encountered for surgery are aortic arch aneurysms followed by aortic dissections. The need for hypothermia and circulatory arrest during aortic arch surgeries leads to unique implications for anesthetic management. Therefore, adequate knowledge of the planned surgery and specific surgical and nonsurgical cerebral protection techniques are necessary. Furthermore, an understanding of intraoperative neurophysiologic and temperature monitoring at deep hypothermia as well as postbypass coagulopathy management are needed in these challenging cases.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117216637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Air Embolism on Cardiopulmonary Bypass 体外循环的空气栓塞
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0017
Aaron Hudson, R. Hood
{"title":"Air Embolism on Cardiopulmonary Bypass","authors":"Aaron Hudson, R. Hood","doi":"10.1093/MED/9780190884512.003.0017","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0017","url":null,"abstract":"The danger associated with air embolism in cardiac surgery has been well established for over 125 years. In the first volume of Annals of Surgery, published in 1885, long preceding the era of cardiac surgery and the use of extracorporeal circulatory techniques, Dr. Nicholas Senn alluded to the ensuing calamity caused by air embolism: “I intend on this occasion to call your attention to one of the most dreaded and, I may add, one of the most uncontrollable causes of sudden death—I allude to air-embolism.”1,2 Since the advent of modern cardiac surgery, much attention has been focused on the prevention of air embolism by cardiac surgeons, anesthesiologists, and perfusionists alike. Indeed, all three team members are critically responsible for the safe conduct of thousands of cardiac surgical procedures occurring on a daily basis worldwide. While the morbidity and mortality of massive air embolism is exceedingly high, most believe that with appropriate training and unwavering vigilance during clinical practice, almost all massive air emboli can be prevented.3\u0000","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127349137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation and Anesthetic Management for Patients With Cardiac Trauma 心脏创伤患者的评估与麻醉管理
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0035
Daniel A Smith, E. Ness, A. Kleiman
{"title":"Evaluation and Anesthetic Management for Patients With Cardiac Trauma","authors":"Daniel A Smith, E. Ness, A. Kleiman","doi":"10.1093/MED/9780190884512.003.0035","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0035","url":null,"abstract":"Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134213125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mediastinal Mass Excision 纵隔肿块切除术
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0030
Alan Schurle, Junaid Nizamuddin
{"title":"Mediastinal Mass Excision","authors":"Alan Schurle, Junaid Nizamuddin","doi":"10.1093/MED/9780190884512.003.0030","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0030","url":null,"abstract":"Mediastinal masses are rare tumors of the thoracic cavity. Although not all types require surgical intervention, resection of these masses provides a clinical challenge for the anesthesiologist due to both local mass effects, such as airway and vascular compression, and systemic effects, including paraneoplastic syndromes. A common example includes myasthenia gravis associated with thymoma. Preoperative assessment includes viewing imaging, obtaining a thorough history, performing a focused physical examination, and reviewing laboratory values. Medically optimizing comorbid conditions prior to excision, if possible, may reduce perioperative morbidity and mortality. Intraoperative considerations include planning for postoperative analgesia, establishing an airway, selection of invasive and noninvasive monitors, choosing intravenous access sites commensurate with tumor size and location, judicious fluid administration, and ventilator management. Postoperative considerations include intensive care unit transport, analgesia, and airway maintenance.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124276151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0019
Melanie Liu, G. Mackensen
{"title":"Transcatheter Aortic Valve Replacement","authors":"Melanie Liu, G. Mackensen","doi":"10.1093/MED/9780190884512.003.0019","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0019","url":null,"abstract":"Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with severe symptomatic aortic stenosis deemed high risk for surgery or inoperable, and its use has recently expanded to the treatment of intermediate-risk patients with severe symptomatic aortic stenosis as well as high-risk patients with a failing aortic valve bioprosthesis. As a key member of the interdisciplinary heart valve team involved in the care of the TAVR patient, the anesthesiologist must be familiar with the currently available devices, procedural steps, and intraoperative imaging requirements in order not only to provide the appropriate level of anesthesia and analgesia for any given patient and procedure but also to anticipate and treat the hemodynamic changes and possible complications that accompany it.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"189 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116458775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ventricular Assist Devices 心室辅助装置
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0023
K. Togashi
{"title":"Ventricular Assist Devices","authors":"K. Togashi","doi":"10.1093/MED/9780190884512.003.0023","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0023","url":null,"abstract":"Left ventricular assist devices (LVADs) have found increasing use since their initial approval in 1994. They can be used as bridge therapy to heart transplantation or as destination therapy for patients in whom transplants are not possible. The increasing number of LVAD implants, combined with longer life expectancies, has resulted in growth in this patient population. This has also resulted in the development of additional complications, and these patients often present for noncardiac interventions. Anesthesiologists must be familiar with currently available devices, LVAD physiology, common perioperative complications, and effects of anesthesia on LVAD physiology when they manage these patients intraoperatively.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127035351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Extracorporeal Membrane Oxygenation 体外膜氧合
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/med/9780190884512.003.0024
Michael E Lowe, J. D. Roberts, M. Chaney
{"title":"Extracorporeal Membrane Oxygenation","authors":"Michael E Lowe, J. D. Roberts, M. Chaney","doi":"10.1093/med/9780190884512.003.0024","DOIUrl":"https://doi.org/10.1093/med/9780190884512.003.0024","url":null,"abstract":"Percutaneous mechanical devices are used in the treatment of severe cardiac or respiratory disease. These devices include extracorporeal membrane oxygenation, intra-aortic balloon pump, TandemHeart™, and Impella®. The use of these devices has increased over time as their clinical efficacy has been established and technological advancements have made their use more practical and accessible. Technological advancements have helped improve the morbidity of ECMO. Two of the major improvements have been to the oxygenator and to the pump system. As these devices become more commonplace, it is important to have a thorough understanding of how each device works, their indications, and potential complications.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129049125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative Evaluation of the Cardiac Surgical Patient 心脏手术患者的术前评估
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0001
Rebecca M. Gerlach
{"title":"Preoperative Evaluation of the Cardiac Surgical Patient","authors":"Rebecca M. Gerlach","doi":"10.1093/MED/9780190884512.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0001","url":null,"abstract":"Patients undergoing cardiac surgery are at elevated risk for perioperative complications; however, certain risk factors may be modifiable. Preoperative evaluation performed in advance of surgery provides an opportunity for the perioperative anesthesiologist to intervene to reduce risk. Performing a focused history and physical examination informs the selection of appropriate preoperative tests. Risk assessment via tools specific to cardiac surgery provide a detailed risk profile. Certain diseases common to cardiac surgical patients deserve particular focus during assessment. Poorly controlled diabetes mellitus and resultant hyperglycemia are modifiable risk factors. Undiagnosed obstructive sleep apnea is common and associated with postoperative complications. Concurrent carotid artery disease presents a management conundrum requiring multidisciplinary planning. Preoperative anemia is common; when due to iron deficiency, it is easily treated to improve outcomes. In addition to gathering information about the patient, the goal of preoperative evaluation is to identify ways to reduce risk and improve outcome from surgery in a resource-efficient manner.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132778785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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