Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Effect of Regional Analgesia Techniques on Opioid Consumption and Length of Stay After Thoracic Surgery.","authors":"Wills C Dunham,&nbsp;Frederick W Lombard,&nbsp;David A Edwards,&nbsp;Yaping Shi,&nbsp;Matthew S Shotwell,&nbsp;Kara Siegrist,&nbsp;Susan S Eagle,&nbsp;Mias Pretorius,&nbsp;Matthew D McEvoy,&nbsp;Erin A Gillaspie,&nbsp;Jonathan C Nesbitt,&nbsp;Jonathan P Wanderer,&nbsp;Miklos D Kertai","doi":"10.1177/1089253220949434","DOIUrl":"https://doi.org/10.1177/1089253220949434","url":null,"abstract":"<p><strong>Background: </strong>We examined how intercostal nerve block (ICNB) with standard bupivacaine and ICNB with extended-release liposomal bupivacaine, compared with thoracic epidural analgesia (TEA), were associated with postoperative opioid pain medication consumption and hospital length of stay (LOS) after thoracic surgery.</p><p><strong>Methods: </strong>We studied 1935 patients who underwent thoracic surgery between January 1, 2010, and November 30, 2017, at a tertiary academic center. Primary and secondary outcomes were postoperative opioid consumption expressed as morphine milligram equivalents (MMEs) at 24, 48, and 72 hours after surgery, the LOS, and total MME consumption from surgery to discharge.</p><p><strong>Results: </strong>Of these patients, 888 (45.9%) received TEA, 730 (37.7%) ICNB with standard bupivacaine, 127 (6.6%) ICNB with liposomal bupivacaine, and 190 (9.8%) no regional analgesia. Compared with epidural analgesia, in 2017, ICNB liposomal bupivacaine provided similar pain control in terms of MME consumption at 24 and 72 hours, but decreased MME consumption at 48 hours (odds ratio [OR] = 0.33; confidence interval [CI] = 0.14-0.81) and at discharge (OR = 0.28; CI = 0.12-0.68) and was associated with a higher likelihood for a shorter LOS (hazard ratio = 3.46; CI = 2.42-4.96). Compared with TEA, ICNB with standard bupivacaine and no regional analgesia use showed varying impact on MME consumption between 24 and 72 hours after surgery, and their use was not associated with a significantly reduced MME consumption at discharge but with a shorter hospital LOS.</p><p><strong>Conclusions: </strong>Multimodal analgesia involving regional anesthetic alternatives to TEA could help manage postoperative pain in thoracic surgery patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"310-323"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253220949434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38489764","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}

{"title":"Regional Analgesia for Cardiac Surgery. Part 2: Peripheral Regional Analgesia for Cardiac Surgery.","authors":"Jagan Devarajan,&nbsp;Sennaraj Balasubramanian,&nbsp;Ali N Shariat,&nbsp;Himani V Bhatt","doi":"10.1177/10892532211002382","DOIUrl":"https://doi.org/10.1177/10892532211002382","url":null,"abstract":"<p><p>The introduction of regional analgesia in the past decades have revolutionized postoperative pain management for various types of surgery, particularly orthopedic surgery. Nowadays, they are being constantly introduced into other types of surgeries including cardiac surgeries. Neuraxial and paravertebral plexus blocks for cardiac surgery are considered as deep blocks and have the risk of hematoma formation in the setting of anticoagulation associated with cardiac surgeries. Moreover, hemodynamic compromise resulting from sympathectomy in patients with limited cardiac reserve further limits the use of neuraxial techniques. A multitude of fascial plane blocks involving chest wall have been developed, which have been shown the potential to be included in the regional analgesia armamentarium for cardiac surgery. In myofascial plane blocks, the local anesthetic spreads passively and targets the intermediate and terminal branches of intercostal nerves. They are useful as important adjuncts for providing analgesia and are likely to be included in \"Enhanced Recovery after Cardiac Surgery (ERACS)\" protocols. There are several small studies and case reports that have shown efficacy of the regional blocks in reducing opioid requirements and improving patient satisfaction. This review article discusses the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"265-279"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10892532211002382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25567747","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}

{"title":"Nonopioid Analgesics in Postoperative Pain Management After Cardiac Surgery.","authors":"Soheyla Nazarnia,&nbsp;Kathirvel Subramaniam","doi":"10.1177/1089253221998552","DOIUrl":"https://doi.org/10.1177/1089253221998552","url":null,"abstract":"<p><p>Opioid analgesia is still considered the standard of practice for cardiac surgery. In recent years, combinations of several nonnarcotic analgesics and regional analgesia have shown promise in restricting opioid use during and after cardiac surgery. Ketamine infusion, dexmedetomidine infusion, acetaminophen, ketorolac, and gabapentin are useful adjuvants in cardiac anesthesia practice and have opioid-sparing properties. The beneficial effects of nonnarcotic multimodal analgesia on intraoperative stress response, recovery profile, postoperative pain, and persistent opioid use after cardiac surgery are yet to be established, and further randomized clinical trials are required.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"280-288"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253221998552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38908772","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}

{"title":"Combined Liver Kidney Transplant in Adult Patient With Alagille Syndrome and Pulmonary Hypertension.","authors":"Rose K McGahan,&nbsp;Jonathan E Tang,&nbsp;Manoj H Iyer,&nbsp;Antolin S Flores,&nbsp;Leonid A Gorelik","doi":"10.1177/10892532211008742","DOIUrl":"https://doi.org/10.1177/10892532211008742","url":null,"abstract":"<p><p>In this article, we describe a case of a 33-year-old female with Alagille syndrome complicated by bilateral branch pulmonary artery stenosis resulting in moderate pulmonary hypertension, end-stage liver disease complicated by portal hypertension, and chronic renal disease who presented for combined liver-kidney transplant. Alagille syndrome is an autosomal dominant disease affecting the liver, heart, and kidneys. Multidisciplinary preoperative evaluation was performed with a team consisting of a congenital heart disease cardiologist, a cardiac anesthesiologist, a nephrologist, and a transplant surgeon. We describe Alagille syndrome and our intraoperative management. To our knowledge, this is the first description of a combined liver-kidney transplant in an adult patient with Alagille syndrome.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"191-195"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10892532211008742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25608817","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}

{"title":"The Effects of Propofol on Left Ventricular Global Longitudinal Strain.","authors":"Scott R Coleman,&nbsp;Theodore J Cios,&nbsp;Steven Riela,&nbsp;S Michael Roberts","doi":"10.1177/1089253221991372","DOIUrl":"https://doi.org/10.1177/1089253221991372","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if hemodynamic changes secondary to propofol administration are a result of direct myocardial depression as measured by global longitudinal strain (GLS). The authors hypothesized that propofol would cause a significant worsening in GLS, indicating direct myocardial depression.</p><p><strong>Design: </strong>Prospective, observational.</p><p><strong>Setting: </strong>Endoscopy suite at a single academic medical center.</p><p><strong>Participants: </strong>Patients undergoing outpatient, elective endoscopic procedures at an outpatient clinic of a single tertiary care academic medical center.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Limited transthoracic echocardiograms were performed before and after patients received propofol for endoscopic procedures. Post-processing measurements included GLS, 2D (dimensional) ejection fraction (2D EF), and 3D EF. Using paired sample Student's <i>t</i> test, no statistically significant change in GLS, 2D EF, or 3D EF was found despite statistically significant hypotension. In fact, there was a trend toward more negative GLS (improved myocardial function) in patients after receiving propofol.</p><p><strong>Conclusion: </strong>We found propofol did not cause a reduction in systolic function as measured by GLS, a sensitive measure of myocardial contractility. Therefore, decreases in blood pressure after a propofol bolus in spontaneously breathing patients are likely due to decreased vascular tone and not impaired left ventricular systolic function. These results should be considered in the management of propofol-induced hypotension for spontaneously breathing patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"185-190"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253221991372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25334574","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}

{"title":"New or Worsened Mitral Regurgitation After Surgical Aortic Valve Replacement: A Systematic Review.","authors":"Nicolas Kumar,&nbsp;Julia E Kumar,&nbsp;Nasir Hussain,&nbsp;Leonid Gorelik,&nbsp;Michael K Essandoh,&nbsp;Bryan A Whitson,&nbsp;Amar M Bhatt,&nbsp;Antolin S Flores,&nbsp;Ali Hachem,&nbsp;Tamara R Sawyer,&nbsp;Manoj H Iyer","doi":"10.1177/1089253220982202","DOIUrl":"https://doi.org/10.1177/1089253220982202","url":null,"abstract":"<p><strong>Background: </strong>New or worsened mitral regurgitation (MR) is an uncommon yet serious complication after surgical aortic valve replacement (SAVR). While there have been numerous reports of its occurrence, there is little consensus regarding its presentation and management. This systematic review summarizes the evidence in the current literature surrounding new or worsened MR after SAVR and analyzes its potential implications.</p><p><strong>Methods: </strong>Databases were examined for all articles and abstracts reporting on new or worsened MR after SAVR. Data collected included number of patients studied; patient characteristics; incidences of new or worsened MR; timing of diagnosis; and treatment.</p><p><strong>Results: </strong>Thirty-six full-text citations were included in this review. The prevalence of new or worsened MR after SAVR was 8.4%. Sixteen percent of new MR occurrences were from an organic etiology, and 83% of new MR occurrences were that of a functional etiology. Most diagnoses were made in the late or unspecified postoperative period using echocardiography (range: 0 minutes to 18 years postoperatively). While no patients died from this complication, 7.7% of patients (16 out of 207) required emergent procedural re-intervention.</p><p><strong>Conclusions: </strong>This systematic review underscores the importance of identifying new or worsened MR following SAVR and accurate scoring of MR severity to guide treatment. It also outlines the associated clinical measures commonly documented following this complication, and the usefulness of transesophageal echocardiography for the detection of significant MR. These results reflect the current, limited state of the literature on this topic and warrant further investigation into MR detection and management strategies in SAVR patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"173-184"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253220982202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38746234","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}

{"title":"Pulmonary Artery Aneurysm Associated With Severe Pulmonary Hypertension in a Patient Presenting for Double Lung Transplant: Review of a Rare Disorder and Role of Transesophageal Echocardiography.","authors":"Faisal D Arain,&nbsp;Victoria A Gilbride","doi":"10.1177/10892532211007259","DOIUrl":"https://doi.org/10.1177/10892532211007259","url":null,"abstract":"<p><p>Pulmonary artery aneurysm (PAA) is a rare disorder that may be classified as congenital, acquired, or idiopathic, in the case of unclear etiology. When associated with severe idiopathic pulmonary arterial hypertension, such a case of PAA may present to the operating room as an indication for lung transplantation. In this article, we present such a case of a patient with a giant main and right PAA that underwent a double lung transplant. We describe the pathophysiology and natural course of this PAA and discuss the role of intraoperative transesophageal echocardiography in the management of patients with this rare diagnosis.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"164-172"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10892532211007259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38829764","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}

{"title":"Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective.","authors":"Dash F T Newington,&nbsp;Fabrizio De Rita,&nbsp;Alan McCheyne,&nbsp;Claire Louise Barker","doi":"10.1177/1089253221998546","DOIUrl":"https://doi.org/10.1177/1089253221998546","url":null,"abstract":"<p><strong>Background: </strong>Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures.</p><p><strong>Aims: </strong>To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease.</p><p><strong>Methods: </strong>Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019.</p><p><strong>Results: </strong>Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%).</p><p><strong>Conclusions: </strong>Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"229-238"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253221998546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25482528","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}

{"title":"Dabigatran Reversal With Idarucizumab in 2 Patients With Portal Vein Thrombosis Undergoing Orthotopic Liver Transplantation.","authors":"Cynthia Williams,&nbsp;Erin Stewart,&nbsp;Kendra D Conzen,&nbsp;Scott Wolf,&nbsp;Timothy T Tran","doi":"10.1177/1089253220982183","DOIUrl":"https://doi.org/10.1177/1089253220982183","url":null,"abstract":"<p><p>There are limited data to guide the use of anticoagulation in cirrhotic patients prior to liver transplantation especially when using direct oral anticoagulants. In this article, we present 2 cases. The first is a 42-year-old male with cirrhosis complicated by portal vein thrombosis (PVT) treated with dabigatran who underwent orthotopic liver transplantation without complication. The second case is a 65-year-old man with alcoholic cirrhosis complicated by PVT treated with dabigatran who underwent orthotopic liver transplantation and required reoperation for surgical bleeding. Both patients were treated with dabigatran's reversal agent idarucizumab prior to incision. In this case series, we discuss the treatment of cirrhotic patients with various anticoagulants, considerations for anticoagulant selection and reversal prior to liver transplant, and questions for future investigation.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"200-207"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253220982183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38777028","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}

{"title":"Continuing Research in the Face of Adversity.","authors":"Benjamin Abrams,&nbsp;Gregory J Latham,&nbsp;Miklos D Kertai,&nbsp;Nathaen Weitzel","doi":"10.1177/10892532211038779","DOIUrl":"https://doi.org/10.1177/10892532211038779","url":null,"abstract":"The COVID-19 pandemic has presented significant challenges to many forms of research and other scholarly activity. Patient enrollment has been hampered, collaboration among coinvestigators and coauthors has been difficult, and simply the allotted time to pursue research and academic projects during the strain of the pandemic on clinical and family life has been a significant hurdle. However, many groups have managed to overcome these obstacles and continued to produce important work across a broad range of subspecialties within the field of anesthesiology. This issue of Seminars in Cardiothoracic and Vascular Anesthesia highlights the impressive dedication and fortitude of those who have managed to overcome the pandemic in this regard. The work includes review articles on pulmonary artery aneurysm (PAA) and mitral regurgitation (MR) following surgical aortic valve replacement (SAVR), an original research article investigating the direct myocardial effects of propofol, as well as 2 separate forums in abdominal transplantation and congenital cardiac diseases. The first of 2 articles in the Reviews section of the journal offers a thorough discussion of PAA. Here, Drs Arain and Gilbride1 describe a unique case of a patient with PAA secondary to severe pulmonary hypertension presenting for double lung transplantation. They include impressive intraoperative transesophageal echocardiography images along with a description of the successful perioperative management of this patient. The authors then go on to provide a thorough description of the etiology, pathophysiology, and various imaging modalities for assessment of PAA. They provide a discussion of the various treatment options for PAA, including surgical repair and lung transplant, depending on the etiology. They also highlight the unique anesthetic considerations for these patients intraoperatively, including specific approaches to ventilator management as well as hemodynamic considerations in order to avoid catastrophic rupture of the PAA. Kumar et al2 produced the second article in the Reviews section, providing a thorough evaluation of the literature with regard to new or worsened MR following SAVR. The group identified 36 full-text citations describing this specific complication of SAVR, representing 207 patients. As the primary outcome of their work, they estimated the prevalence of new or worsened MR after SAVR to be 8.4%. They went on to classify unique subgroups by the specific mechanism of MR: extravalvular (prosthetic aortic valve components or sutures interfering with mitral valve function), intravalvular (Manouguian patch degeneration or iatrogenic injury), and various forms of functional MR. Interestingly, the vast majority of cases were not identified intraoperatively or even within the first 48 hours postoperatively. Functional MR was by far the most commonly reported mechanism, including both systolic anterior motion of the mitral valve and left ventricular dysfunction. Consistent w","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"161-163"},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311769","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}