Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"A Retrospective Study of the Role of Perioperative Serum Albumin and the Albumin-Bilirubin Grade in Predicting Post-Liver Transplant Length of Stay.","authors":"Ryan Wang,&nbsp;Daniel Katz,&nbsp;Hung-Mo Lin,&nbsp;Yuxia Ouyang,&nbsp;Jonathan Gal,&nbsp;Sumanth Suresh,&nbsp;Ismail Labgaa,&nbsp;Parissa Tabrizian,&nbsp;Samuel Demaria,&nbsp;Jeron Zerillo,&nbsp;Natalie K Smith","doi":"10.1177/10892532221141138","DOIUrl":"https://doi.org/10.1177/10892532221141138","url":null,"abstract":"<p><strong>Introduction: </strong>Serum albumin's association with liver transplant outcomes has been investigated with mixed findings. This study aimed to evaluate perioperative albumin level, independently and as part of the albumin-bilirubin (ALBI) grade, as a predictor of post-liver transplant hospital and intensive care unit (ICU) length of stay (LOS).</p><p><strong>Methods: </strong>Adult liver-only transplant recipients at our institution from September 2011 to May 2019 were included in this retrospective study. Repeat transplants were excluded. Demographic, laboratory, and hospital course data were extracted from an institutional data warehouse. Negative binomial regression was used to assess the association of LOS with ALBI grade, age, BMI, ASA score, Elixhauser comorbidity index, MELD-Na, warm ischemia time, units of platelets and cryoprecipitate transfused, and preoperative serum albumin.</p><p><strong>Results: </strong>Six hundred and sixty-three liver transplant recipients met inclusion criteria. The median preoperative serum albumin was 3.1 [2.6-3.6] g/dL. The median postoperative ICU and hospital LOS were 3.8 [2.4-6.8] and 12 [8-20] days, respectively. Preoperative serum albumin predicted hospital but not ICU LOS (ratio .9 [95% confidence interval (CI) .84-.99], <i>P</i> = .03, hospital LOS vs ratio .92 [95% CI 0.84-1.02], <i>P</i> = .10, ICU LOS). For patients with MELD-Na ≤ 20, ALBI grade-3 predicted longer hospital and ICU LOS (ratio 1.40 [95% CI 1.18-1.66], <i>P</i> < .001, hospital LOS vs ratio 1.62 [95% CI 1.32-1.99], <i>P</i> < .001, ICU LOS). These associations were not significant for patients with MELD-Na > 20.</p><p><strong>Conclusions: </strong>Serum albumin predicted post-liver transplant hospital LOS. ALBI grade-3 predicted increased hospital and ICU LOS in low MELD-Na recipients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"16-24"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9339394","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":"Thoracic Interfascial Plane Blocks and Outcomes After Minithoracotomy for Valve Surgery.","authors":"Sreekanth R Cheruku,&nbsp;Amanda A Fox,&nbsp;Hooman Heravi,&nbsp;Neelan Doolabh,&nbsp;Jennifer Davis,&nbsp;Jenny He,&nbsp;Christopher Deonarine,&nbsp;Lauren Bereuter,&nbsp;Joan Reisch,&nbsp;Farzin Ahmed,&nbsp;Lisa Skariah,&nbsp;Anthony Machi","doi":"10.1177/10892532221136386","DOIUrl":"https://doi.org/10.1177/10892532221136386","url":null,"abstract":"<p><p><i>Introduction.</i> Thoracic interfascial plane blocks are increasingly used for pain management after minimally invasive thoracotomy for valve repair and replacement procedures. We hypothesized that the addition of these blocks to the intercostal nerve block injected by the surgeon would further reduce pain scores and opioid utilization. <i>Methods.</i> In this retrospective cohort study, 400 consecutive patients who underwent minimally invasive thoracotomy for mitral or aortic valve replacement and were extubated within 2 hours of surgery were enrolled. The maximum pain score and opioid utilization on the day of surgery and other outcome variables were compared between patients who received interfascial plane blocks and those who did not. <i>Results.</i>193 (48%) received at least one interfascial plane block while 207 (52%) received no interfascial plane block. Patients who received a thoracic interfascial plane block had a maximum VAS score on the day of surgery (mean 7.4 ± 2.5) after the block was administered which was significantly lower than patients in the control group who did not receive the block (mean 7.9 ± 2.2) (<i>P</i> = .02). Opioid consumption in the interfascial plane block group on the day of surgery was not significantly different from the control group. <i>Conclusion.</i> Compared to intercostal blocks alone, the addition of thoracic interfascial plane blocks was associated with a modest reduction in maximum VAS score on the day of surgery. However, no difference in opioid consumption was noted. Patients who received interfascial plane blocks also had decreased blood transfusion requirements and a shorter hospital length of stay.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"8-15"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10775789","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 Neurocognitive Disorders in Adults Requiring Cardiac Surgery: Screening, Prevention, and Management.","authors":"Kimberly F Rengel,&nbsp;Christina S Boncyk,&nbsp;Daniella DiNizo,&nbsp;Christopher G Hughes","doi":"10.1177/10892532221127812","DOIUrl":"https://doi.org/10.1177/10892532221127812","url":null,"abstract":"<p><p>Neurocognitive changes are the most common complication after cardiac surgery, ranging from acute postoperative delirium to prolonged postoperative neurocognitive disorder. Changes in cognition are distressing to patients and families and associated with worse outcomes overall. This review outlines definitions and diagnostic criteria, risk factors for, and mechanisms of Perioperative Neurocognitive Disorders and offers strategies for preoperative screening and perioperative prevention and management of neurocognitive complications.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"25-41"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10776098","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":"Airway and Hemodynamic Considerations for the Anesthetic Management of an Intraluminal Tracheal Plasmacytoma.","authors":"Joseph E Morabito,&nbsp;Colby G Simmons,&nbsp;Giorgio Zanotti,&nbsp;John D Mitchell,&nbsp;Karsten Bartels,&nbsp;Barbara J Wilkey","doi":"10.1177/10892532221140235","DOIUrl":"https://doi.org/10.1177/10892532221140235","url":null,"abstract":"<p><p>Central airway obstruction due to tracheal tumors presents unique challenges to the anesthesiologist. We present the case of a 44-year-old male taken to the OR for biopsy and resection of an undiagnosed tracheal mass. Intraoperative management was complicated by bleeding and significant hemodynamic instability, necessitating rapid surgical and anesthetic intervention. This ultimately led to abortion of surgical resection. Pathologic examination revealed a primary tracheal plasmacytoma, a rare type of tracheal tumor. Here, we describe anesthetic and hemodynamic considerations for a tracheal plasmacytoma. We discuss the approach to airway management in variable intrathoracic tracheal obstruction and the unpredictability of tracheal tumors.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"64-67"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10781422","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 Circulatory Support and Management for Lung Transplantation: A Case-Based Review.","authors":"Hong Liang,&nbsp;Ashley V Fritz,&nbsp;Archer K Martin","doi":"10.1177/10892532221134574","DOIUrl":"https://doi.org/10.1177/10892532221134574","url":null,"abstract":"<p><p>Lung transplantation (LTx) historically was performed with cardiopulmonary bypass (CPB) or Off-pump. Recent data suggest an increased interest in extracorporeal membrane oxygenation (ECMO) as perioperative circulatory support by many lung transplantation centers worldwide. However, there are no established guidelines for anesthetic management for LTx. We present a patient with a history of systemic sclerosis and interstitial lung disease complicated by acute onset of systemic pulmonary hypertension and right heart failure undergoing LTx. We aim to discuss perioperative circulatory support, including ECMO bridge to LTx, and how best to consider the varied intraoperative strategies of CPB vs ECMO vs off-pump during LTx, intraoperative maintenance, and coagulation management.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"68-74"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10775777","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":"Managing Diastolic Dysfunction Perioperatively.","authors":"Theodore J Cios,&nbsp;John C Klick,&nbsp;S Michael Roberts","doi":"10.1177/10892532221142441","DOIUrl":"https://doi.org/10.1177/10892532221142441","url":null,"abstract":"<p><p>Preoperative cardiac evaluation is a cornerstone of the practice of anesthesiology. This consists of a thorough history and physical attempting to elucidate signs and symptoms of heart failure, angina or anginal equivalents, and valvular heart disease. Current guidelines rarely recommend preoperative echocardiography in the setting of an adequate functional capacity. Many patients may have poor functional capacity and/or have medical history such that echocardiographic data is available for review. Much focus is often placed on evaluating major valvular abnormalities and systolic function as measured by ejection fraction, but a key impactful component is often overlooked-diastolic function. A diagnosis of diastolic heart failure is an independent predictor of mortality and is not uncommon in patients with normal systolic function. This narrative review addresses the clinical relevance and management of diastolic dysfunction in the perioperative setting.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"42-50"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/82/10.1177_10892532221142441.PMC9968995.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793848","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 Review of Biventricular Repair for the Congenital Cardiac Anesthesiologist.","authors":"Sean J Davies,&nbsp;James A DiNardo,&nbsp;Sitaram M Emani,&nbsp;Morgan L Brown","doi":"10.1177/10892532221143880","DOIUrl":"https://doi.org/10.1177/10892532221143880","url":null,"abstract":"<p><p>The management of children with a borderline ventricle has been debated for many years. The pursuit of a biventricular repair in these children aims to avoid the long-term sequelae of single ventricle palliation. There is a lack of anesthesia literature relating to the care of this complex heterogenous patient population. Anesthesiologists caring for these patients should have an understanding on the many different forms of physiology and the impact on provision of anesthesia and hemodynamic parameters, the goals of biventricular staging and completion as well as the pre-operative, intra-operative, and post-operative considerations relating to this high-risk group of patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"27 1","pages":"51-63"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10781922","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":"Challenging Paradigms and Trusting Evidence: New Approaches to Perioperative Care.","authors":"Meghan Prin,&nbsp;Nathan Clendenen,&nbsp;Hillary Lum,&nbsp;Miklos D Kertai,&nbsp;Benjamin A Abrams","doi":"10.1177/10892532221138170","DOIUrl":"https://doi.org/10.1177/10892532221138170","url":null,"abstract":"the novel perspectives on the complexities of clinical perioperative care are impera-tive. This issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) emphasizes this ethos. Two original research studies evaluate methods to reduce the quantity of anesthetic and opioid medications needed for surgery, and a comprehensive two-part review evaluates the evidence for “ prehabilitation ” before cardiac surgery. This issue is rounded out by two systematic reviews on the use of TEE in liver transplantation, and two case reports describing the challenging management of intracardiac masses. This literature will guide readers towards a more patient-centered approach with less dependence on polypharmacy and, hopefully, optimize outcomes for cardiac surgery. This approach is all the more relevant as the population ages; surgical populations are aging faster than the general population and phrases like “ potentially inappropriate medications ” and “ deprescribing ” entered the perioperative lexicon. we the the are visible on the horizon and the of famed to The you know, the less you","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 4","pages":"257-259"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117732","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":"Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory Analysis.","authors":"Kan Zhang,&nbsp;Nikhil Kumar,&nbsp;Andrej Alfirevic,&nbsp;Shiva Sale,&nbsp;Jing You,&nbsp;Andrew Bauer,&nbsp;Andra E Duncan","doi":"10.1177/10892532221114791","DOIUrl":"https://doi.org/10.1177/10892532221114791","url":null,"abstract":"<p><p><i>Introduction.</i> We examined whether intraoperative assessment of left ventricular (LV) twist mechanics is feasible with transesophageal echocardiography (TEE). We then explored whether twist mechanics were altered by hemodynamic conditions or patient comorbidities. <i>Methods.</i> In this sub-analysis of clinical trial data, transgastric short-axis echocardiographic images of the LV base and apex were collected in patients having aortic valve replacement (AVR) at baseline and end of surgery. Transvalvular gradients and LV systolic and diastolic function were assessed using two-dimensional (2D) and Doppler echocardiography. 2D speckle-tracking echocardiography was used for off-line analysis of LV twist, twisting rate, and untwisting rate. We examined the intraoperative change in twist mechanics before and after AVR. LV twist mechanics were also explored by diabetic status, need for coronary artery bypass grafting (CABG), and use of epinephrine/norepinephrine. <i>Results.</i> Of 40 patients, 16 patients had acceptable TEE images for off-line LV twist analysis. Baseline median [Q1, Q3] LV twist was 12 [7, 16]°, twisting rate was 72 [41, 97]°/sec, and untwisting rate was -91 [-154, -56]°/s. Median [Q1, Q3] change in LV twist at end of surgery was -2 [-5, 3]°, twisting rate was 7 [-33, 31]°/s, and untwisting rate was 0 [-11, 43]°/s. No difference was noted between diabetic and non-diabetic patients or AVR and AVR-CABG patients. <i>Conclusion.</i> LV twist was augmented in patients with aortic stenosis, though twist indices were not affected by reduced afterload, diabetes, or coronary artery disease. Intraoperative assessment of twist mechanics may provide unique information on LV systolic and diastolic function, though fewer than 50% of TEE examinations successfully assessed twist. <i>Clinical Trial Registry.</i> This work is a sub-analysis of a clinical trial, registered on ClinicalTrials.gov on August 19, 2010 (NCT01187329), Andra Duncan, Principal Investigator.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 3","pages":"226-236"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156174/pdf/nihms-1889862.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9407310","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":"Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia.","authors":"Aaron Smoroda,&nbsp;David Douin,&nbsp;Joseph Morabito,&nbsp;Matthew Lyman,&nbsp;Meghan Prin,&nbsp;Bryan Ahlgren,&nbsp;Andrew Young,&nbsp;Elijah Christensen,&nbsp;Benjamin A Abrams,&nbsp;Nathaen Weitzel,&nbsp;Nathan Clendenen","doi":"10.1177/10892532221100660","DOIUrl":"https://doi.org/10.1177/10892532221100660","url":null,"abstract":"<p><p>In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: \"cardiac anesthesiology and outcomes\" (n = 177), \"cardiothoracic anesthesiology\" (n = 34), \"cardiac anesthesia,\" and \"clinical outcomes\" (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 2","pages":"107-119"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9588253/pdf/nihms-1841224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9114468","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}