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

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The Obstetric Patient for Cardiac Surgery 心脏外科的产科病人
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0033
Lauren Powlovich, A. Kleiman
{"title":"The Obstetric Patient for Cardiac Surgery","authors":"Lauren Powlovich, A. Kleiman","doi":"10.1093/MED/9780190884512.003.0033","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0033","url":null,"abstract":"Cardiac disease is the second leading cause of morbidity and mortality in pregnancy behind peripartum hemorrhage. In developed countries, a majority of cardiac disease in pregnancy is secondary to congenital heart defects, whereas in developing countries, mitral stenosis secondary to rheumatic fever prevails as the leading cause of cardiac disease during pregnancy. There is added workload on the heart during pregnancy due to the increased blood volume and cardiac output of the parturient. In patients with preexisting cardiac disease, this added workload may lead to decompensated congestive heart failure. Alternatively, such physiologic changes may unmask an unknown cardiac lesion in an unsuspecting patient. Medical management is always the first-line treatment of the pregnant patient with decompensated heart failure. However, if medical management has failed, cardiac surgery with cardiopulmonary bypass may be necessary. Due to the unique maternal physiology and the presence of not only one but also two patients, anesthesia, cardiac surgery, and cardiopulmonary bypass come with specific challenges, hemodynamic goals, and ethical dilemmas.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"25 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":"124052163","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
ICU Management of the Cardiac Patient 心脏病人的ICU管理
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0036
V. Patel, Junaid Nizamuddin
{"title":"ICU Management of the Cardiac Patient","authors":"V. Patel, Junaid Nizamuddin","doi":"10.1093/MED/9780190884512.003.0036","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0036","url":null,"abstract":"Management of the cardiac surgery patient continues in the intensive care unit, necessitating an understanding of the underlying disease process, operative procedure, and potential complications. Complications in cardiac surgery patients span virtually every organ system and manifest at different times in the postoperative period. As such, successful outcomes in cardiac surgery require a multidisciplinary approach, with postoperative care tailored to the pathophysiology present. This chapter discusses the commonly encountered postoperative concerns and overarching management pearls, beginning from intensive care unit handoff to weaning circulatory support and extubation. Also discussed are the postoperative implications of specific interventions utilized in cardiac surgery.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"84 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":"124691092","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
Adult Congenital Heart Disease 成人先天性心脏病
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0011
C. Peterson, D. Joffe
{"title":"Adult Congenital Heart Disease","authors":"C. Peterson, D. Joffe","doi":"10.1093/MED/9780190884512.003.0011","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0011","url":null,"abstract":"The incidence of congenital heart disease is about 1 in 150 live births. In the United States, there are comprehensive healthcare programs that care for the pediatric patient with congenital heart disease; however, there are far fewer resources available for the adult patient. In fact, the majority of adult congenital heart disease patients are cared for in centers without specific expertise in congenital heart disease, which often results in worse outcomes for many of these complex patients. Therefore, it is preferable for patients with anything more than simple congenital heart disease to be treated in centers with specialized programs that have a full spectrum of providers. This chapter will review some of the medical, anesthetic and surgical challenges in caring for these patients.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"18 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":"116444107","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
Cardiac Implantable Electronic Device Lead Extractions 心脏植入式电子装置引线提取
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0022
Kevin Fitzmartin, A. Kacha
{"title":"Cardiac Implantable Electronic Device Lead Extractions","authors":"Kevin Fitzmartin, A. Kacha","doi":"10.1093/MED/9780190884512.003.0022","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0022","url":null,"abstract":"Cardiac implantable electronic devices (CIEDs) are used for an increasing range of indications. With a broader range of indications, CIEDs are being implanted in increasing numbers. They are being used in older patients as well as patients with more comorbidities. As expected with these trends, the need for device extraction for a variety of reasons has steadily grown as well. These leads can often be removed via simple traction, but other techniques have been developed for circumstances where removal is more complex. To perform this procedure safely, a team-based approach is required, as is the ability to anticipate consequences of complications for each of the different methods of removal. A gold standard method has not been identified for transvenous lead extraction, but rather one has a toolbox of methods at their disposal. In this chapter, indications for lead removal, extraction techniques and devices, as well as potential complications are reviewed.","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":"131923201","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
Off-Pump Coronary Artery Bypass (OPCAB) Surgery 非体外循环冠状动脉搭桥(OPCAB)手术
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0012
Andrew J. Feider
{"title":"Off-Pump Coronary Artery Bypass (OPCAB) Surgery","authors":"Andrew J. Feider","doi":"10.1093/MED/9780190884512.003.0012","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0012","url":null,"abstract":"Off-pump coronary artery bypass grafting is a type of open-heart surgery whereby coronary grafts are performed without the use of cardiopulmonary bypass (CPB) and cardioplegia. Although not performed as frequently as on-pump coronary artery bypass grafting, it is still utilized in certain situations. Because CPB is not used, anesthetic management has many unique considerations, including temperature management and anticoagulation. Proper monitoring of cardiac output, mixed venous oxygen saturation, and wall motion abnormalities via transesophageal echocardiography are very important during intraoperative management, and there are many anesthetic and surgical techniques that are utilized to limit the degree of myocardial ischemia during surgical construction of the coronary anastomoses.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"55 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":"121959025","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 Valve Surgery 主动脉瓣手术
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0003
Heather Reed, Stefan A. Lombaard, Samantha Arzillo
{"title":"Aortic Valve Surgery","authors":"Heather Reed, Stefan A. Lombaard, Samantha Arzillo","doi":"10.1093/MED/9780190884512.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0003","url":null,"abstract":"Aortic valve stenosis is the most common primary valvular disease today. The natural history of aortic valve stenosis is most commonly described as a long latent period without symptoms as the disease progresses from mild to severe, followed by a shorter period with symptoms; ultimately, death will result if the stenosis is left untreated. Today, severe aortic stenosis is a class 1 indication for surgery. Classic symptoms include dyspnea, syncope, and angina. Diagnostic options include echocardiography, cardiac catheterization, computed tomography, and magnetic resonance imaging. Perioperative transesophageal echocardiography is necessary for preoperative and postoperative assessment of the patient who has severe aortic stenosis.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"8 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":"114391388","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
Chronic Pain After Cardiac Surgery 心脏手术后的慢性疼痛
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0018
J. D. Hansen, M. Chaney
{"title":"Chronic Pain After Cardiac Surgery","authors":"J. D. Hansen, M. Chaney","doi":"10.1093/MED/9780190884512.003.0018","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0018","url":null,"abstract":"Chronic pain after cardiac surgery can impair quality of life and rehabilitation. Chronic pain is difficult to study, and depending on how patients are questioned, the incidence of chronic pain after sternotomy is between 17% and 56%, and chronic pain after thoracotomy is between 15% and 80%. Several risk factors are independent predictors for the development of chronic pain. In recent years, minimally invasive techniques have been utilized in cardiac surgery patients to potentially minimize pain and to decrease length of stay in the hospital. At this point in time, no single regimen has been proven superior at preventing chronic pain. An aim to treat acute pain without delaying extubation has been the recent focus of pain management, with research in neuraxial and peripheral nerve blocks. In addition, multimodal analgesia is key for treatment of acute pain to allow patients to deep breathe, cough, and ambulate comfortably without respiratory depression. Some believe treatment of acute pain leads to less development of chronic pain; however, this has not yet been definitively proven.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"40 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114020110","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
Anesthesia for Lung Transplantation 肺移植的麻醉
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0032
J. Roberts
{"title":"Anesthesia for Lung Transplantation","authors":"J. Roberts","doi":"10.1093/MED/9780190884512.003.0032","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0032","url":null,"abstract":"Since the first human procedure in 1963, lung transplantation has become the gold standard treatment of a variety of end-stage lung diseases. With over 4000 lung transplants performed in 2015 and steadily improving survival rates over the past three decades, anesthetic management of patients undergoing lung transplant can significantly contribute to patient outcomes. Anesthesia care for lung transplantation can be both complex and clinically challenging. Anesthesiologists taking part in these procedures need to have specific skills regarding thoracic and cardiac anesthesia. There are both technical and physiological challenges, such as achieving adequate lung isolation and oxygenation, interpretation and use of transesophageal echocardiography, and the management of respiratory and myocardial impairments. This chapter provides an overview of these perioperative anesthetic management considerations utilizing a problem-based format.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"43 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":"129661558","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
Robotic Mitral Valve Surgery 机器人二尖瓣手术
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0007
S. Ghia
{"title":"Robotic Mitral Valve Surgery","authors":"S. Ghia","doi":"10.1093/MED/9780190884512.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0007","url":null,"abstract":"Robotic mitral valve surgery is the most commonly performed robotic cardiac surgery. The first robotic mitral valve surgery took place in 1998. Differences from traditional mitral valve surgery include thoracic access via ports and peripheral cannulation for cardiopulmonary bypass (CPB). Although new techniques result in new complications, the robotic approach has many benefits: no need for sternotomy, reduced postoperative pain, and decreased hospital length of stay. The advent of robotic mitral valve surgery has resulted in drastic implications for anesthetic management: incorporation of regional techniques to address analgesia, need for lung isolation to optimize surgical exposure, and placement of catheters to assist in CPB or cardiac arrest. After a case presentation, this chapter details the surgical technique for robotic mitral valve surgery and the anesthetic implications.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"27 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":"131707230","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 Dreaded Bring Backs 可怕的回归
Cardiac Anesthesia: A Problem-Based Learning Approach Pub Date : 2019-04-01 DOI: 10.1093/MED/9780190884512.003.0016
A. Zaky
{"title":"The Dreaded Bring Backs","authors":"A. Zaky","doi":"10.1093/MED/9780190884512.003.0016","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0016","url":null,"abstract":"The postoperative care of the cardiac surgical patient continues to be an ongoing challenge. An aging population coupled with increasing comorbidities results in sicker patients now undergoing open-heart surgery. Moreover, those patients with high operative risk are undergoing minimally invasive cardiac procedures that are associated with their own newly recognized inherent risks. Anesthesiologists and intensivists caring for cardiac surgical patients should be aware of the challenges imposed by the population and by the procedures. Their scope of skills should expand to encompass fluency in bedside echocardiography, electrophysiology, and bedside extracorporeal and balloon pump insertion techniques. In so doing, cardiac anesthesiologists/intensivists not only will be able to make critical abstract plans that are implemented by other personnel, but also will be able to pursue lifesaving prompt diagnostic and therapeutic procedures frequently needed in this acutely critically ill patient population. This chapter discusses some of the frequently encountered life-threatening complications that occur in the postoperative cardiac surgical patient that may lead to surgical reexploration. The chapter focus is on the definitive and supportive management of these complications and their underlying mechanisms with more specific attention on postoperative bleeding and coagulopathy.","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":"130147207","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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