Maria S Gauger, P. Kaufmann, Firmin Kamber, J. Quitt, D. Berdajs, D. Bolliger, E. Mauermann
{"title":"Rotational Thromboelastometry Values After On-Pump Cardiac Surgery – A Retrospective Cohort Study","authors":"Maria S Gauger, P. Kaufmann, Firmin Kamber, J. Quitt, D. Berdajs, D. Bolliger, E. Mauermann","doi":"10.1177/10892532221088216","DOIUrl":"https://doi.org/10.1177/10892532221088216","url":null,"abstract":"Background Viscoelastic coagulation monitoring is recommended for coagulation management after cardiac surgery, but optimum target values are poorly defined. Aims To determine “to-be-expected” values in rotational thromboelastometry (ROTEM) after heparin reversal, to correlate ROTEM parameters with fibrinogen levels and platelet count, and to estimate the effect of hemoglobin levels on these measurements. Methods We retrospectively analyzed 571 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass from 12/2018 to 08/2020. ROTEM and conventional laboratory measurements were performed 5 to 10 minutes after protamine administration. Results Clotting times in EXTEM, INTEM, and FIBTEM were significantly prolonged (72.6%, 96.1%, and 31.8% above reference ranges, respectively). Clot firmness parameters in EXTEM and INTEM were relevantly reduced (7.9% to 14.4% and 9.1% to 32.3% below the reference ranges, respectively). There was an excellent linear correlation of FIBTEM amplitude after 10 min (A10) and of maximal clot firmness (MCF) with fibrinogen concentrations (r = .81 and .80). Areas under receiver operating characteristic (AUROC) for identifying hypofibrinogenemia <1.5 g/L were between .80 and .87. No effect of hematocrit was observed. We also found a linear correlation of EXTEM, INTEM, and EXTEM-FIBTEM at both A10 and MCF with platelet counts (.32 to .68). The AUROCs for identifying thrombocytopenia (<100,000/μL) were .79 to .84, and were greater for A10 than for MCF measurements (P=.074, .001, and <.001, respectively). Conclusions “To-be-expected” ROTEM values after CPB are different from the published reference ranges. ROTEM parameters might allow for reliable estimation of fibrinogen level and platelet count without being influenced by hematocrit.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"209 - 220"},"PeriodicalIF":1.4,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47210424","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}
Nicholas J Statzer, Andreas C Plackis, Austin A. Woolard, B. Allen, Kara K. Siegrist, Yaping Shi, M. Shotwell
{"title":"Erector Spinae Plane Catheter Analgesia in Minimally Invasive Mitral Valve Surgery: A Retrospective Case–Control Study for Inclusion in an Enhanced Recovery Program","authors":"Nicholas J Statzer, Andreas C Plackis, Austin A. Woolard, B. Allen, Kara K. Siegrist, Yaping Shi, M. Shotwell","doi":"10.1177/10892532221104420","DOIUrl":"https://doi.org/10.1177/10892532221104420","url":null,"abstract":"Background. A retrospective case-control study was conducted to assess the feasibility of erector spinae plane (ESP) block as part of a multimodal enhanced recovery program for patients undergoing minimally invasive mitral valve replacement surgery. Methods. This retrospective analysis was conducted at a single center between January and August 2019. 61 patients were included; 23 received ESP and 38 did not. Erector spinae catheters (ESCs) were placed preoperatively, using a loading dose of 30 mL .5% ropivacaine, followed by an infusion of .2% ropivacaine at 10 mL/h throughout the study period. Primary outcome was 48-hour opioid consumption. Secondary outcomes included intraoperative morphine equivalents, extubation within 24 hours, reintubation, ICU length of stay and hospital length of stay and 30-day mortality. Results. Median [inter-quartile range] of the postoperative morphine milligram equivalents (MMEs) in the first 48 hours was 70[45-121] MMEs in the ESC) group, and 109[70–148] MMEs in the no ESC group (P-value = .16). No significant difference was observed in intraoperative morphine equivalents, extubation within 24 hours or ICU length of stay. The ESC group had shorter hospital length of stay (6.0 vs 7.0 days, P-value = .043). Conclusion. This study found a statistically insignificant, though potentially clinically significant reduction in postoperative opioid consumption. A reduced hospital length of stay as well as an acceptable safety profile was also observed in the ESC group. An adequately powered, prospective trial is warranted to accurately assess the potential role for ESP catheters for patients undergoing minimally invasive mitral valve surgery.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"266 - 273"},"PeriodicalIF":1.4,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48195066","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}
Faith J. Ross, D. Joffe, Leah M Landsem, Gregory J. Latham
{"title":"The Year in Review: Anesthesia for Congenital Heart Disease 2021","authors":"Faith J. Ross, D. Joffe, Leah M Landsem, Gregory J. Latham","doi":"10.1177/10892532221095038","DOIUrl":"https://doi.org/10.1177/10892532221095038","url":null,"abstract":"This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"129 - 139"},"PeriodicalIF":1.4,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44420666","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":"Abdominal Organ Transplantation: Noteworthy Literature in 2021","authors":"Robert St Jules, Daniel Blech, N. Smith, T. Sakai","doi":"10.1177/10892532221093955","DOIUrl":"https://doi.org/10.1177/10892532221093955","url":null,"abstract":"This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"140 - 153"},"PeriodicalIF":1.4,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44013598","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}
Ivana Wrobleski, Nischal K. Gautam, Richard M. Hubbard
{"title":"Anesthetic Challenges in a Patient With TANGO2 Gene Deletion, DiGeorge Syndrome, and Tetralogy of Fallot: A Case Report","authors":"Ivana Wrobleski, Nischal K. Gautam, Richard M. Hubbard","doi":"10.1177/10892532221080946","DOIUrl":"https://doi.org/10.1177/10892532221080946","url":null,"abstract":"Mutations of the transport and Golgi organization 2 (TANGO2) genes are linked with both long-term neurological decline and acute metabolic crises during stress, leading to significant anesthetic risk. Crises are marked by rhabdomyolysis, lactic acidosis, seizures, cardiac dysfunction, and dysrhythmias. Much is unknown about optimal management of this condition, especially in the acute and critical care settings. The following report describes the anesthetic challenges of a patient with simultaneous TANGO2 gene deletion, DiGeorge Syndrome, and Tetralogy of Fallot, who presented for an interventional cardiac procedure with the goal of metabolic crisis-avoidance and facilitation of safe but expeditious recovery and discharge home.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"241 - 244"},"PeriodicalIF":1.4,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48519784","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}
J. Hoffman, Kelly Higa, Yihan Lin, T. B. Reece, J. Cleveland, Muhammad Aftab, Jessica Y. Rove
{"title":"Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling","authors":"J. Hoffman, Kelly Higa, Yihan Lin, T. B. Reece, J. Cleveland, Muhammad Aftab, Jessica Y. Rove","doi":"10.1177/10892532221101298","DOIUrl":"https://doi.org/10.1177/10892532221101298","url":null,"abstract":"Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"154 - 161"},"PeriodicalIF":1.4,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41983535","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}
Samuel Gilliland, Sarah M. Alber, Hans Tregear, Andrew W. Hennigan, N. Weitzel
{"title":"Year in Review 2021: Noteworthy Literature in Cardiothoracic Critical Care","authors":"Samuel Gilliland, Sarah M. Alber, Hans Tregear, Andrew W. Hennigan, N. Weitzel","doi":"10.1177/10892532221100663","DOIUrl":"https://doi.org/10.1177/10892532221100663","url":null,"abstract":"This year marked a number of milestones in critical care. As vaccines for the SARS-CoV-2 virus became widely available and were confirmed to be exceptionally effective against severe illness and hospitalization, we were then faced with new variants and the resource-intense responses necessary to combat them. Despite challenges new and old, we have persevered and continued to provide excellent care to our patients while pushing the boundaries of clinical research. This article is a collection of studies published in 2021 relevant to critical care, with a specific focus on cardiothoracic critical care. To ignore the impact of the COVID-19 pandemic would do a disservice to our colleagues, many of whom have made incredible breakthroughs in novel therapies to the coronavirus, and yet we present additional themes of delirium, acute kidney injury, lung transplant, advances in ECMO as well as biomarkers of sepsis.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"120 - 128"},"PeriodicalIF":1.4,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49038356","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}
Rohesh J. Fernando, Sean D. Johnson, K. Richardson
{"title":"Intraoperative Transesophageal Echocardiographic Detection of a Gerbode Defect in a Patient Referred for Aortic Valve Endocarditis: A Case Report","authors":"Rohesh J. Fernando, Sean D. Johnson, K. Richardson","doi":"10.1177/10892532221080920","DOIUrl":"https://doi.org/10.1177/10892532221080920","url":null,"abstract":"This clinical challenge discusses a case in which a patient was referred for aortic valve repair or replacement due to severe aortic regurgitation from infective endocarditis. In addition to discovering a previously unknown tricuspid valve vegetation, the intraoperative echocardiographic evaluation was instrumental in revealing an undiagnosed Gerbode defect. The flow through this Gerbode defect was previously mistaken for tricuspid regurgitation, and the patient was misdiagnosed as exhibiting severe pulmonary hypertension. This case highlights the importance of reviewing preoperative echocardiographic imaging, as well as diligence in completing a thorough intraoperative transesophageal echocardiographic exam prior to cardiopulmonary bypass. In addition, while flow typically occurs in Gerbode defects during systole, this case demonstrates that flow can also occur during diastole, which was most likely due to the severe aortic regurgitation. Fortunately, the patient was able to undergo successful treatment for the unexpected sequalae of the infective endocarditis, including repair of the Gerbode defect, tricuspid valve repair, and aortic valve and root replacement. Importantly, the incorrect diagnosis of severe pulmonary hypertension was removed.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"245 - 252"},"PeriodicalIF":1.4,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49488096","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}
Daniel A Friedlander, Rabi Panigrahi, Dhamodaran Palaniappan
{"title":"Tracheal Bronchus With Difficult Lung Isolation: A Case Report","authors":"Daniel A Friedlander, Rabi Panigrahi, Dhamodaran Palaniappan","doi":"10.1177/10892532211069243","DOIUrl":"https://doi.org/10.1177/10892532211069243","url":null,"abstract":"Tracheal bronchus (TB) occurs in 0.1–3% of the population as an accessory bronchus that originates in the trachea, typically supplying the right upper lobe. The presence of a TB can pose unique airway challenges, particularly during procedures that require lung isolation. Here, we describe a case of TB with difficult lung isolation. Careful examination with fiberoptic bronchoscopy permitted double lumen tube positioning without obstruction of the TB. A second case is presented where the presence of TB did not affect anesthetic management. Implications of TB for airway management and strategies for successful one-lung ventilation are discussed.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"237 - 240"},"PeriodicalIF":1.4,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45650840","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}
Jose Liza Reshmi, G Gopan, Praveen Kerala Varma, Madathil Thushara, Vanga Babu Sudheer, Rajesh Gopalakrishnan Madavathazhathil, Aveek Jayant
{"title":"Transesophageal Echocardiographic Assessment of the Repaired Mitral Valve: A Proposed Decision Pathway.","authors":"Jose Liza Reshmi, G Gopan, Praveen Kerala Varma, Madathil Thushara, Vanga Babu Sudheer, Rajesh Gopalakrishnan Madavathazhathil, Aveek Jayant","doi":"10.1177/10892532211036655","DOIUrl":"https://doi.org/10.1177/10892532211036655","url":null,"abstract":"<p><p>The indications for mitral valve repair extend across the entire spectrum of degenerative mitral valve disease, ranging from fibroelastic degeneration to Barlow's disease. Collaboration between the surgeon and anesthesiologist is essential for ensuring optimal results. Echocardiographic assessment of the repair can be challenging but is essential to the success of the procedure, as even mild residual mitral regurgitation can portend poor patient outcomes. In addition to determining the severity of residual regurgitation, the anesthesiologist must elucidate the mechanism of disease in order to inform appropriate re-intervention measures. Finally, there are unique complications of mitral valve surgery for the anesthesiologist to understand and assess by echocardiography. This review describes a systematic pathway for a comprehensive intraoperative assessment of the mitral valve following surgical repair.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"68-82"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39374959","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}