Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Successful Use of Intraoperative Modified Valsalva Maneuver for Atrial Flutter Reversal in Pediatric Cardiac Surgery: Case Report and Review of Literature.","authors":"Gustavo A Cruz Suárez, Andrés Pombo Jiménez, Camilo A Calderón Miranda, Juan F Vélez Moreno, Sergio Alzate-Ricaurte, Juan C Arias Millán","doi":"10.1177/10892532241304278","DOIUrl":"10.1177/10892532241304278","url":null,"abstract":"<p><p>This case report describes the successful use of an intraoperative modified Valsalva maneuver to reverse atrial flutter in a pediatric patient with complex congenital heart disease undergoing systemic-to-pulmonary shunt surgery. The technique involved manipulating the Adjustable Pressure Limiting (APL) valve on the anesthesia machine to simulate the hemodynamic effects of the modified Valsalva maneuver, allowing for non-invasive management of supraventricular tachycardia without pharmacological intervention or electrical cardioversion. This intervention stabilized the patient's arrhythmia, maintaining hemodynamic stability throughout the procedure. The case highlights the potential of the maneuver as a safe, effective, and non-invasive alternative for arrhythmia management in pediatric cardiac surgeries, advocating for further research to validate this approach and possibly integrate it into standard practice for similar clinical scenarios.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"82-89"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773614","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":"Anesthetic Considerations for Repair of Thoracoabdominal Aortic Aneurysms.","authors":"David A Lyubashevsky, Thomas Powell, Ali Khalifa, Vicente Orozco-Sevilla, Daniel A Tolpin","doi":"10.1177/10892532241302967","DOIUrl":"10.1177/10892532241302967","url":null,"abstract":"<p><p>Anesthetic management of open thoracoabdominal aneurysm (TAAA) repair poses a number of challenges for even the most experienced of cardiovascular anesthesiologists. This procedure encompasses a large number of unique anesthetic techniques, including one-lung ventilation, invasive hemodynamic monitoring, left-heart bypass, massive transfusion, selective renal and visceral perfusion, and central nervous system monitoring with CSF drainage. In this article, we aim to describe the anesthetic management for thoracoabdominal aortic aneurysm repair, including preoperative workup, intraoperative management, as well as postoperative concerns in the intensive care unit.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"37-48"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Recurring Theme: Diverse Case Management for the Cardiothoracic Anesthesiologist.","authors":"Benjamin Leahy, Daniel Haines, Benjamin Abrams, Brian J Gelfand, Miklos D Kertai","doi":"10.1177/10892532251322672","DOIUrl":"https://doi.org/10.1177/10892532251322672","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"29 1","pages":"5-7"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531895","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 Pain Management for Thoracic Surgery: A Multi-Layered Approach.","authors":"Larry Tong, Che Solla, Jeffrey B Staack, Keith May, Bryant Tran","doi":"10.1177/10892532241235750","DOIUrl":"10.1177/10892532241235750","url":null,"abstract":"<p><p>Cardiothoracic surgeries frequently pose unique challenges in the management of perioperative acute pain that require a multifaceted and personalized approach in order to optimize patient outcomes. This article discusses various analgesic strategies including regional anesthesia techniques such as thoracic epidurals, erector spinae plane blocks, and serratus anterior plane blocks and underscores the significance of perioperative multimodal medications, while providing nuanced recommendations for their use. This article further attempts to provide evidence for the efficacy of the different modalities and compares the effectiveness of the choice of analgesia. The roles of Acute Pain Services (APS) and Transitional Pain Services (TPS) in mitigating opioid dependence and chronic postsurgical pain are also discussed. Precision medicine is also presented as a potential way to offer a patient tailored analgesic strategy. Supported by various randomized controlled trials and meta-analyses, the article concludes that an integrated, patient-specific approach encompassing regional anesthesia and multimodal medications, while also utilizing the services of the Acute Pain Service can help to enhance pain management outcomes in cardiothoracic surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"215-229"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177116","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":"Central Venous Catheter Migration Into Pleura Diagnosed by Transesophageal Echocardiography.","authors":"Neal S Gerstein, Alvin J Garcia, Quinn J Carbol","doi":"10.1177/10892532241294186","DOIUrl":"10.1177/10892532241294186","url":null,"abstract":"<p><p>Central venous catheter (CVC) tip migration is a well reported delayed complication of these vascular access devices with left-sided internal jugular or subclavian vein placement being the primary risk factor for this complication. We report a case of left internal jugular CVC migration and its diagnosis made by the heretofore unreported use of intraoperative transesophageal echocardiography in this context. Moreover, we describe risk factors for CVC migration along with its diagnosis and management.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"230-234"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477415","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":"Intracardiac Echocardiography-Applications in the Electrophysiology and the Cardiac Catheterization Labs.","authors":"Rahul Myadam, Jeffrey Kolominsky, Pranav Mankad, Jayanthi Koneru","doi":"10.1177/10892532241267351","DOIUrl":"10.1177/10892532241267351","url":null,"abstract":"<p><p><i>Background.</i> Intracardiac echocardiography (ICE) is routinely used in cardiac electrophysiology and catheterization labs. It plays a vital role in understanding cardiac anatomy, procedural planning, and early identification of complications. In this review, we describe the utility of ICE for procedures in the electrophysiology lab, including atrial fibrillation ablation, left atrial appendage occlusion device implantation, and cardiac implantable electronic device (CIED) extraction. Intracardiac echocardiography also helps in the identification of complications such as pericardial effusion, pulmonary vein stenosis, and left atrial appendage thrombus. Compared with traditional echocardiographic modalities such as transesophageal echocardiogram (TEE), ICE has equivalent image quality, requires less sedation, and possesses no risk of esophageal injury. The disadvantages of ICE include a learning curve and necessity for central vascular access.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"203-214"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749245","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":"Our Mission as Cardiothoracic Anesthesiologists … Pushing Boundaries With Novelties in Technique and Approach to Patient Care.","authors":"Lyndsey C M Grae, Miklos D Kertai, Benjamin A Abrams","doi":"10.1177/10892532241298939","DOIUrl":"10.1177/10892532241298939","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"193-194"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606833","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":"Estimation of Systolic and Diastolic Left Ventricular Blood Flow From Derivatives of Transesophageal Echocardiographic 3D Volume Curves in Cardiac Surgery Patients: A Proof-of-Concept Study.","authors":"Paul-Michael Jokiel, Thilo Schweizer, Dominik P Guensch, Denis Berdajs, Joachim Erb, Daniel Bolliger, Firmin Kamber, Eckhard Mauermann","doi":"10.1177/10892532241286663","DOIUrl":"10.1177/10892532241286663","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether estimates of peak global systolic (S') and diastolic (E') left ventricular (LV) flow rates based on 3D echocardiographic volumes are feasible and match physiology.</p><p><strong>Methods: </strong>In this retrospective feasibility study, we included patients undergoing major cardiac surgery. S' and E' were derived from 190 patients by taking the first derivative of the volume-time relationship of 3D ecg-gated transesophageal echocardiography (TEE) images. To examine the quality of images upon which the estimates of flow were based we correlated intraoperative 3D TEE and preoperative 2D transthoracic echocardiography (TTE) volumes. As a proof-of-concept, we then correlated S' flow with stroke volume and S' and E' were compared by valve pathology.</p><p><strong>Results: </strong>In each of the 190 images, S' and E' were derived. There was good correlation between 1) the ejection fraction (EF) of 3D LV images obtained intraoperatively by TEE and preoperatively by TTE (Pearson's r = 0.65) and also 2) S' and stroke volume (Pearson's r = 0.73). Patients with aortic or mitral regurgitation showed higher S' than patients without valve pathologies (-315 mL/s [95% CI -388 mL/s to -264 mL/s]<i>P</i> = 0.001, -319 mL/s [95% CI -397 mL/s to -246 mL/s]<i>P</i> = 0.001 vs -242 mL/s [95% CI -300 mL/s to -196 mL/s]). These patients also showed higher E' than patients without valve pathologies (302 mL/s [95% CI 237 mL/s to 384 mL/s]<i>P</i> = 0.006, 341 mL/s [95%CI 227 mL/s to 442 mL/s]<i>P</i> = 0.001 vs 240 mL/s [95%CI 185 mL/s to 315 mL/s]). Patients with aortic stenosis showed no difference in S' or E' (-263 mL/s [95%CI -300 mL/s to -212 mL/s]<i>P</i> = 0.793, 255 mL/s [95%CI 188 mL/s to 344 mL/s]<i>P</i> = 0.400).</p><p><strong>Conclusions: </strong>Estimates of global peak systolic and diastolic LV flow based on 3D TEE are feasible, promising, and match valve pathologies.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"195-202"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298353","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 Important Thing Is Not to Stop Questioning.","authors":"Daniel Haines, Ryan Grell, Jiapeng Huang, Benjamin Abrams, Miklos D Kertai","doi":"10.1177/10892532241279627","DOIUrl":"10.1177/10892532241279627","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"133-134"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113309","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 and Anesthetic Considerations in Vascular Rings and Slings.","authors":"Michael Wadle, Denise Joffe, Carl Backer, Faith Ross","doi":"10.1177/10892532241234404","DOIUrl":"10.1177/10892532241234404","url":null,"abstract":"<p><p>Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"152-164"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913746","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}