Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Pressure-Volume Loops for Reviewing Right Ventricular Physiology and Failure in the Context of Left Ventricular Assist Device Implantation.","authors":"Stefaan Bouchez, Joachim Erb, Luc Foubert, Eckhard Mauermann","doi":"10.1177/10892532231198797","DOIUrl":"10.1177/10892532231198797","url":null,"abstract":"<p><p>Right ventricular (RV) function is complex as a number of determinants beyond preload, inotropy and afterload play a fundamental role. In particular, arterial elastance (E_a), ventriculo-arterial coupling (VAC), and (systolic) ventricular interdependence play a vital role for the right ventricle. Understanding and actively visualizing these interactions in the failing RV as well as in the altered hemodynamic and morphological situation of left ventricular assist device (LVAD) implantation may aid clinicians in their understanding of RV dysfunction and failure. While, admittedly, hard data is scarce and invasive pressure-volume loop measurements will not become routine in cardiac surgery, we hope that clinicians will benefit from the comprehensive, simulation-based review of RV pathology. In particular, the aim of this article is to first, address and clarify the pathophysiologic hemodynamic factors that lead to RV dysfunction and then, second, expand upon this basis examining the changes occurring by LVAD implantation. This is illustrated using <i>Harvi</i> software which shows elastance, ventricular arterial coupling, and ventricular interdependence by simultaneously showing pressure volume loops of the right and left ventricle.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127066","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":"Surgical Considerations in Shone Complex.","authors":"Roderick Yang, Christina L Greene","doi":"10.1177/10892532231203372","DOIUrl":"10.1177/10892532231203372","url":null,"abstract":"<p><p>Shone complex is defined by 4 anomalies: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and coarctation of the aorta. Establishing a clear definition is one of the principal challenges in the study of Shone complex as not all patients have all lesions. The essential feature of Shone complex is multilevel left-sided obstruction involving both the left ventricular inflow and outflow. This anatomic variability is reflected in the clinical presentation as signs of left ventricular inflow obstruction are often masked by outflow obstruction and the multilevel nature of the condition is thus underappreciated. Surgical treatment is often stepwise addressing the outflow obstruction first. In this review, geared to the pediatric cardiac anesthesiologist, we review the pathophysiology, diagnosis, treatment, and outcomes of Shone complex.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153630","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":"Preoperative Sildenafil in Pediatric Patients Undergoing Congenital Heart Surgeries: A Systematic Review and Meta-Analysis.","authors":"Yusuf Ananda Fikri, Eka Prasetya Budi Mulia, Faris Wahyu Nugroho","doi":"10.1177/10892532231205752","DOIUrl":"10.1177/10892532231205752","url":null,"abstract":"<p><p><i>Background.</i> Pulmonary hypertension (PH) is a common complication of congenital heart disease (CHD). With early surgical intervention, outcomes have improved over the last two decades. Persistent PH, however, may still occur following surgery. Sildenafil has been shown to be beneficial for postoperative pulmonary hypertensive crises. The role of preoperative sildenafil in controlling postoperative PH is poorly elucidated. This study aimed to evaluate the effect of preoperative sildenafil on pediatric patients undergoing congenital heart surgeries. <i>Methods.</i> A comprehensive literature search was conducted in scientific databases. We included randomized controlled trials which assessed the effect of preoperative sildenafil in pediatric patients with CHD undergoing repair surgeries. Primary outcomes were pre- and postoperative differences in mean pulmonary arterial pressure (mPAP) and mean pulmonary artery/aortic pressure ratio (PA/Ao ratio). <i>Results.</i> Four studies (n = 233) were retained for the final analysis. Dose of sildenafil ranged from .3 to .5 mg/kg every 4-6 hours via oral/nasogastric route, with timing of administration varied from 1 to 2 weeks before surgery. Compared to controls, preoperative sildenafil was associated with greater reduction in postoperative mPAP (MD -5.02; 95% CI [-8.91, -1.13]) and mean PA/Ao ratio (MD -.11; 95% CI [-.17, -.06]). Shorter CPB time, ICU length of stay, and duration of mechanical ventilation were also observed in the sildenafil group. <i>Conclusion.</i> Preoperative sildenafil is beneficial in reducing PAP, thereby reducing the risk of postoperative PH crisis. Further studies are warranted to identify the optimal dosage and timing of administration of sildenafil in CHD patients prior to surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239781","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":"Tracheal Bronchus and Successful Right-Sided Isolation With a Bronchial Blocker.","authors":"Jonathan E Tang,&nbsp;Caroline E Tybout,&nbsp;Lidia M Csernak,&nbsp;Hamdy Awad,&nbsp;Pamela P Benavidez,&nbsp;Michael K Essandoh","doi":"10.1177/10892532231151461","DOIUrl":"10.1177/10892532231151461","url":null,"abstract":"<p><p>The presence of a tracheal bronchus, which is often incidentally discovered, complicates endotracheal intubation and lung isolation during thoracic surgery. Prior reports of successful right-sided lung isolation in the presence of tracheal bronchus required utilization of a double lumen tube. Although right-sided lung isolation was required in our case, due to other patient factors, it was determined that a double lumen tube of a suitable size would be unlikely to be placed safely and successfully. We describe the successful use of a Rüsch EZ-Blocker bronchial blocker in obtaining right-sided isolation in a patient with a difficult airway and tracheal bronchus.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9072257","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":"Perioperative Point of Care Ultrasound for Hemodynamic Assessment: A Narrative Review.","authors":"Caitlin A Bradley,&nbsp;Chris Ma,&nbsp;McKenzie M Hollon","doi":"10.1177/10892532231165088","DOIUrl":"10.1177/10892532231165088","url":null,"abstract":"<p><p>While transesophageal echocardiography (TEE) has traditionally been used in perioperative care, there is growing evidence supporting point of care ultrasound (POCUS) for the anesthesiologist in guiding patient care. It is a quick way to non-invasively evaluate hemodynamically unstable patients and ascertain their state of shock, determine volume status, and guide resuscitation in cardiac arrest. In addition, through use of POCUS, the anesthesiologist is able to identify signs of chronic heart disease to provide a more tailored and safer approach to perioperative care.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9154041","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":"Native Whole Blood (TRUE-NATEM) and Recalcified Citrated Blood (NATEM) Reference Value Validation with ROTEM Delta.","authors":"Uzung Yoon","doi":"10.1177/10892532231151528","DOIUrl":"10.1177/10892532231151528","url":null,"abstract":"<p><p><i>Background:</i> Thromboelastography is a viscoelastic test of whole blood hemostasis. Currently, no reference value exists for native whole blood and recalcified citrated blood without activators. The aim of this study was to compare the results of ROTEM^® tests using fresh native blood without decalcification \"TRUE-NATEM\" with those using decalcified citrated blood \"NATEM\" and provide reference values for each. <i>Methods:</i> Inclusion criteria were healthy adult volunteers (18-65 years). Exclusion criteria were any medical condition or medication affecting coagulation. Native whole blood testing was defined as \"TRUE-NATEM-test.\" For recalcified citrated blood testing, the NATEM function was used on ROTEM^®. <i>Result:</i> The reference value for TRUE-NATEM was CT: 872-1595s, A10: 14-34 mm, A20: 26-48 mm, CFT: 314-839s, MCF: 34-55 mm, and alpha angle: 17-40°. The reference value for NATEM was CT: 757-1327s, A10: 19-43 mm, A20: 33-55 mm, CFT: 219-615s, MCF: 37-61 mm, alpha angle: 24-51°, and ML: 0-3%. When comparing the reference value of NATEM to TRUE-NATEM, the CT and CFT values are decreased and the MCF and alpha angle are increased. The recalcification process of citrated blood in NATEM shows significant activation of coagulation. Female healthy volunteers had enhanced coagulation when activators were used. Age-related statistical difference was seen when activators were used. Ethnicity did not show any difference on the ROTEM values. <i>Conclusion:</i> We determined the reference value for native whole blood and recalcified whole blood using ROTEM®. A significant discrepancy in native whole blood and recalcified citrated blood coagulation was found. Our study underlines the importance of native whole blood as the gold standard reference value in coagulation.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10521027","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":"Refractory Hypotension During Implantation of a 70 mL Total Artificial Heart in a Patient With Pectus Excavatum: A Case Report.","authors":"Brendon Hart,&nbsp;Nahush A Mokadam,&nbsp;Karina Anam,&nbsp;Samiya Saklayen,&nbsp;Galina Dimitrova,&nbsp;Alix Zuleta-Alarcon,&nbsp;Jordan Holloway,&nbsp;Hamdy Awad,&nbsp;David Convissar,&nbsp;Michael Essandoh","doi":"10.1177/10892532231157529","DOIUrl":"10.1177/10892532231157529","url":null,"abstract":"<p><p>The Syncardia total artificial heart system is the only commercially approved durable device for treating biventricular heart failure patients awaiting heart transplantation. Conventionally, the Syncardia total artificial heart system is implanted based on the distance from the anterior aspect of the 10th thoracic vertebra to the sternum and the patient's body surface area. However, this criterion does not account for chest wall musculoskeletal deformities. This case report describes a patient with a pectus excavatum who developed compression of the inferior vena cava after Syncardia total artificial heart implantation and how transesophageal echocardiography guided chest wall surgery to accommodate the total artificial heart system.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10752204","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":"Endobronchial Intubation With the King Vision^® and McGrath^® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath).","authors":"Alaa M Khidr,&nbsp;Jumana Masoudi,&nbsp;Sarah AlAboud,&nbsp;Mashael Alshahrani,&nbsp;Aziza Bokhari,&nbsp;Massimiliano Sorbello,&nbsp;Ivana Zdravkovic,&nbsp;Mohamed A Khalil,&nbsp;Saeed Al Shadowy,&nbsp;Talal Al Ghamdi,&nbsp;Abdulmohsen Al'ghamdi,&nbsp;Summayah Fallatah,&nbsp;Mohamed R El Tahan","doi":"10.1177/10892532231163963","DOIUrl":"10.1177/10892532231163963","url":null,"abstract":"<p><p><i>Objective</i>. The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial intubations can be improved with constant training as assessed by measuring the learning curves. We hypothesized that the time to DLT intubation would be reduced over the intubation attempts. <i>Design</i>. A crossover manikin study. <i>Settings</i>. University-affiliated hospital. <i>Participants</i>. Forty-two novice medical students unfamiliar with DLT intubation. <i>Interventions.</i> Participants were randomly allocated to two sequences, including DLT intubation, using King Vision and McGrath VLs. Each participant completed 100 DLT intubation attempts on both simulated easy and difficult airways on two different mannikins using the study devices (25 attempts for each). <i>Measurements and</i> <i>Main</i> <i>Results</i>. The primary outcome was the time to DLT intubation. The secondary outcomes included the best glottic view, optimizing maneuvers, and intubation first-pass success. The use of King Vision VL was associated with a significantly shorter time to DLT intubation (<i>P</i> < 0.044 and <i>P</i> < 0.05, respectively) and a higher percentage of glottic opening (POGO) compared to the McGrath VL (<i>P</i> < 0.011 and <i>P</i> < 0.002, respectively) in the simulated \"easy\" and \"difficult\" over most of the intubation attempts. In the simulated \"easy\" airway, the first-pass success ratio was higher when using the King Vision VL (median [Minimum-Maximum] 100% [100%-100%] and 100% [88%-100%], <i>P</i> = 0.012). <i>Conclusion</i>. Novice medical students developed skills over intubation attempts, meaning achievement of a faster DLT intubation, better laryngeal exposure, and higher success rate on simulated \"easy\" and \"difficult\" airways. A median of 9 DLT intubations was required to achieve a 92% or greater DLT intubation success rate.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9154381","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":"Embracing Scrutiny: The Importance of Critical Evaluation and Transparency in Research.","authors":"Ross S Hanson,&nbsp;Ollin G Venegas,&nbsp;Lindsey A Alverson,&nbsp;Benjamin A Abrams,&nbsp;Miklos D Kertai","doi":"10.1177/10892532231189788","DOIUrl":"10.1177/10892532231189788","url":null,"abstract":"In its 1952 second annual report, the fledgling National Science Foundation framed the process of technological innovation as a “sequence [consisting] of basic research, applied research, and development... each of the successive stages [depending] upon the preceding.” Medical advancement has proven no exception to this, and the relationship between basic science, applied research, and clinical development underpins the modern framework of evidencebased medicine. As much as we may bias toward thinking of this sequence as linear, it is imperative that we also look at innovation critically and publish studies that detail what doesn’t work. This issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) is true to this ethos and encompasses the entirety of this arc. We present both positive and negative Original Research spanning basic science in thromboelastographic testing, applied research in arterial line ultrasound and video laryngoscopy training, as well as clinical development of lung isolation devices and opioid sparing cardiothoracic anesthetic techniques. Rounding this out is an excellent review of perioperative point of care ultrasound (POCUS) for hemodynamic assessment and 2 case reports describing ingenuity in the face of the unexpected. Finally, we present a retraction of a previously published study to correct the evidence-based medical record as well as reflect on the risks inherent in stepping away from the process of innovation framed by the National Science Foundation so many years ago. In the first Original Research article, Mathew et al report the results of the first pairwise meta-analysis of clinical outcomes for opioid-free anesthesia (OFA) vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery. Including 919 patients across 8 studies, they found that OFA in cardiovascular surgery patients was associated with significantly reduced postoperative nausea and vomiting (PONV), inotrope need, and non-invasive ventilation while there was no observed difference in 24-hour pain scores, 48-hour morphine equivalent consumption, or length of hospital stay. Interestingly, these same trends were not observed in thoracic surgery patients, among whom there was no significant difference in any of the explored outcomes. In this first meta-analysis of OFA techniques specific to cardiothoracic surgical patients, the findings echo similar patterns of reduced PONV in the absence of increased pain scores across multiple surgical specialties. Taken together with literature demonstrating reductions in long-term opioid dependence and concurrent improvements in clinical outcomes and patient satisfaction with cardiac Enhanced Recovery After Surgery (ERAS), this study offers compelling support of OFA techniques within cardiothoracic-specific Enhanced Recovery After Surgery programs. While innovation is a constant driver of clinical care improvement and medical device development, not all novel techniques and t","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9775519","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":"Ultrasound-Guided Radial Arterial Catheterization in Patients With Regurgitant and Stenotic Left-Sided Cardiac Valvular Lesions.","authors":"C M Rakhi Krishna,&nbsp;Sandeep Kumar Mishra,&nbsp;Ajay Kumar Jha,&nbsp;Muthapillai Senthilnathan,&nbsp;Satyen Parida","doi":"10.1177/10892532231181481","DOIUrl":"10.1177/10892532231181481","url":null,"abstract":"<p><p><i>Background.</i> The pulse characteristics of arterial circulation might affect radial artery catheterization's success rate. Therefore, we hypothesized that the success rate of radial artery catheterization would be lower in the left-sided severe stenotic valvular lesion group than severe regurgitant valvular lesion group. <i>Methods.</i> This prospective study was conducted among patients with left-sided cardiac valvular lesions undergoing cardiac and non-cardiac surgery. The patients with left-sided severe valvular stenosis and left-sided severe valvular regurgitation were included in the study. Radial artery cannulation was performed using an ultrasound-guided out-of-plane short-axis approach. The outcome measures were success rate, number of attempts, and cannulation time. <i>Result.</i> One hundred fifty-two patients were recruited for the study, and all were eligible for final analysis. The first attempt success rate was non-significantly higher in the stenotic valvular lesion group than the regurgitant group (69.7% vs 56.6%; <i>P</i> = .09). Furthermore, the number of attempts (median; 95% CI) was significantly higher in the regurgitant group (1; 1.2-1.43 vs 1; 1.38-1.67; <i>P</i> = .04). However, it may not be of clinical relevance. Moreover, the cannulation time and the number of redirections of the cannula were comparable. Heart rate was significantly higher in the regurgitant group (91.8 ± 13.9 vs 82.26 ± 15.92 beats/min; <i>P</i> = .00), while the incidence of atrial fibrillation was significantly higher in the stenotic lesion (<i>P</i> = .00). No failure was reported, and the incidence of periarterial hematoma was comparable. <i>Conclusion.</i> The success rate of ultrasound-guided radial arterial catheterization is comparable in left-sided stenotic valvular and regurgitant lesion groups.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569324","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}