Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Transesophageal Echocardiographic Assessment of the Repaired Mitral Valve: A Proposed Decision Pathway.","authors":"Jose Liza Reshmi,&nbsp;G Gopan,&nbsp;Praveen Kerala Varma,&nbsp;Madathil Thushara,&nbsp;Vanga Babu Sudheer,&nbsp;Rajesh Gopalakrishnan Madavathazhathil,&nbsp;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}

{"title":"Anesthetic Considerations in Pediatric Patients With Acute Decompensated Heart Failure.","authors":"Roby Sebastian,&nbsp;Sana Ullah,&nbsp;Pablo Motta,&nbsp;Bibhuti Das,&nbsp;Luis Zabala","doi":"10.1177/10892532211044977","DOIUrl":"https://doi.org/10.1177/10892532211044977","url":null,"abstract":"<p><p>Acute decompensated heart failure (ADHF) in pediatrics is a significant cause for morbidity and mortality in children. Congenital heart disease and cardiomyopathy are the leading etiologies of ADHF. It is common for these children to undergo diagnostic, therapeutic, or surgical procedure under anesthesia, which may be associated with significant morbidity and mortality. The importance of preanesthetic multidisciplinary planning with all involved teams, including anesthesia, cardiology, intensive care, perfusion, and cardiac surgery, cannot be emphasized enough. In order to safely manage these patients, it is imperative for the anesthesiologist to understand the complex pathophysiological interactions between cardiopulmonary systems and anesthesia during these procedures. This review discusses the etiology, pathophysiology, clinical manifestations, and perioperative management of these patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"41-53"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39839155","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":"Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study.","authors":"Elisabetta Auci,&nbsp;Igor Vendramin,&nbsp;Federico Barbariol,&nbsp;Ilaria Riccardi,&nbsp;Andrea Gigante,&nbsp;Antonio Baroselli,&nbsp;Tiziana Bove,&nbsp;Flavio Bassi,&nbsp;Luigi Vetrugno,&nbsp;Ugolino Livi","doi":"10.1177/10892532211064041","DOIUrl":"https://doi.org/10.1177/10892532211064041","url":null,"abstract":"<p><p><i>Purpose.</i> Cardiac surgery is characterized by a high risk of complications related to perioperative bleeding. Guidelines suggest the use of local algorithms based on perioperative point-of-care tests to assess and manage potential coagulation abnormalities. We investigated whether heparin reversal administration affects the adenosine-5-diphosphate (ADP) test values, thus identifying the earliest time point following cardio-pulmonary bypass that permits the promptest detection and treatment of potential platelet dysfunctions. <i>Methods.</i> This was a retrospective, single-center, observational study enrolling cardiac surgery patients requiring cardiac bypass. ADP-tests at 4 different time-points during surgery (T0: baseline, T1: at aortic de-clamping, T2: 10 minutes after protamine administration, and T3: at the end of surgery) were performed. <i>Results.</i> 63 patients undergoing elective cardiac surgery were studied. Baseline ADP-test values were almost constantly greater than intraoperative values, and end of surgery values were often greater than previous intraoperative values. The only difference that proved to be not statistically significant was between T1 and T2, with a clinically insignificant mean difference of -.2 U (95%CI of difference: -6.9 - 6.5 U). There was no correlation between the variation in ADP-test values pre- and post-protamine administration and the protamine-to-heparin ratio. <i>Conclusion.</i> The results of the present study support the hypothesis that the ADP-test could be performed early, at aortic de-clamping before protamine administration. This approach allows for the promptest assessment of a potential impairment in platelet function, and its timely correction.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"8-14"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39916817","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":"Mitral Regurgitation in Patients Undergoing Noncardiac Surgery.","authors":"Ellen W Richter,&nbsp;Islam M Shehata,&nbsp;Hamdy M Elsayed-Awad,&nbsp;Matthew A Klopman,&nbsp;Sujatha P Bhandary","doi":"10.1177/10892532211042827","DOIUrl":"https://doi.org/10.1177/10892532211042827","url":null,"abstract":"<p><p>Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College of Cardiologists (ACC) and the American Heart Association (AHA) that inform decision-making for the anesthesiologist caring for a patient with MR undergoing noncardiac surgery. The pathophysiology and natural history of acute and chronic MR, staging of chronic primary and secondary MR, and considerations for timing of valvular corrective surgery are reviewed. These topics are then applied to a discussion of anesthetic management, including preoperative risk evaluation, anesthetic selection, hemodynamic goals, and intraoperative monitoring of the noncardiac surgical patient with MR.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"54-67"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39374036","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":"Cefazolin-Induced Thrombocytopenia in a Patient with Polycythemia Vera Following Coronary Artery Bypass.","authors":"Racha Boulos,&nbsp;Katja Turner,&nbsp;Samiya Saklayen,&nbsp;William Perez,&nbsp;Manoj H Iyer","doi":"10.1177/10892532211065234","DOIUrl":"https://doi.org/10.1177/10892532211065234","url":null,"abstract":"<p><p>Cefazolin is an antibiotic that is commonly administered perioperatively to reduce the risk of surgical site infections. Cephalosporins have a well-established safety profile, but have been associated with thrombocytopenia and neutropenia due to their myelosuppressive effects. While this effect may be benign in healthy patients undergoing minor surgery, it can be detrimental in patients with underlying hematologic disorders presenting for open-heart surgery. Herein, we discuss the first case in the literature of cefazolin-induced thrombocytopenia and severe coagulopathy in a patient with polycythemia vera (PCV) during a coronary artery bypass-grafting surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"83-85"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39770416","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":"Recommendations From the Society for the Advancement of Transplant Anesthesiology Fellowship Committee: Core Competencies and Milestones for the Kidney/Pancreas Component of Abdominal Organ Transplant Anesthesia Fellowship.","authors":"Fouad G Souki,&nbsp;Ryan Chadha,&nbsp;Raymond Planinsic,&nbsp;Jeron Zerillo,&nbsp;Christine Nguyen-Buckley,&nbsp;Natalie Smith,&nbsp;M Susan Mandell,&nbsp;Tetsuro Sakai,&nbsp;Ramona Nicolau-Raducu","doi":"10.1177/10892532211058574","DOIUrl":"https://doi.org/10.1177/10892532211058574","url":null,"abstract":"<p><p>The Society for the Advancement of Transplant Anesthesia (SATA) is dedicated to improving patient care in all facets of transplant anesthesia. The anesthesia fellowship training recommendations for thoracic transplantation (heart and lungs) and part of the abdominal organ transplantation (liver) have been presented in previous publications. The SATA Fellowship Committee has completed the remaining component of abdominal transplant anesthesia (kidney/pancreas) and has assembled core competencies and milestones derived from expert consensus to guide the education and overall preparation of trainees providing care for kidney/pancreas transplant recipients. These recommendations provide a comprehensive approach to pre-operative evaluation, vascular access procedures, advanced hemodynamic monitoring, assessment of coagulation and metabolic abnormalities, operative techniques, and post-operative pain control. As such, this document supplements the current liver/hepatic transplant anesthesia fellowship training programs to include all aspects of \"Abdominal Organ Transplant Anesthesia\" recommended knowledge.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"15-26"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39951456","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 Anesthesiologist's Perspective and Experience in Global Congenital Cardiac Surgery: Results of a Survey of the Congenital Cardiac Anesthesia Society Membership.","authors":"Richard M Hubbard,&nbsp;Lindsey B Buchbinder,&nbsp;Joseph D Tobias,&nbsp;Luis M Zabala,&nbsp;Gregory J Latham,&nbsp;Nischal K Gautam","doi":"10.1177/10892532211047641","DOIUrl":"https://doi.org/10.1177/10892532211047641","url":null,"abstract":"<p><p>Anesthesiologists are important components of volunteer teams which perform congenital cardiac surgery in low-resource settings throughout the world, but limited data exist to characterize the nature and breadth of their work. A survey of Congenital Cardiac Anesthesia Society (CCAS) members was conducted with the objective of understanding the type of voluntary care being provided, its geographic reach, the frequency of volunteer activities, and factors which may encourage or limit anesthesiologists' involvement in this work. The survey was completed by 108 participants. Respondents reported a total of 115 volunteer trips during the study period, including work in 41 countries on 5 continents. Frequent motivating factors to begin volunteering included invitations from charitable groups, encouragement from senior colleagues, and direct connections to individual locations. Discouraging factors included familial responsibilities, the need to use vacation time, and a lack of support from home institutions. The year 2020 saw a marked decrease in reported volunteer activity, and respondents reported multiple pandemic-related factors which might discourage future volunteer activities. The results of this study demonstrate the global reach of anesthesiologists in providing care for children having cardiac surgery. It also offers insights into the challenges faced by interested individuals, many of which are related to a lack of institutional support. These challenges have only mounted under the COVID-pandemic, leading to a dramatic downturn in volunteer activities. Finally, the survey reinforces the need for better coordination of volunteer activities to optimize clinical impact.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"27-31"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39849693","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":"Face-To-Face Double-Lumen Tube Intubation With the Airtraq Video Laryngoscope for Emergency Thoracic Surgery: A Case Report.","authors":"Yacine Ynineb,&nbsp;Emilie Boglietto,&nbsp;Francis Bonnet,&nbsp;Christophe Quesnel,&nbsp;Marc Garnier","doi":"10.1177/10892532211007664","DOIUrl":"https://doi.org/10.1177/10892532211007664","url":null,"abstract":"<p><p>Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"90-94"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10892532211007664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25578316","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":"Corticosteroid Administration and Impaired Glycemic Control in Mechanically Ventilated COVID-19 Patients.","authors":"David J Douin,&nbsp;Martin Krause,&nbsp;Cynthia Williams,&nbsp;Kenji Tanabe,&nbsp;Ana Fernandez-Bustamante,&nbsp;Aurora N Quaye,&nbsp;Adit A Ginde,&nbsp;Karsten Bartels","doi":"10.1177/10892532211043313","DOIUrl":"https://doi.org/10.1177/10892532211043313","url":null,"abstract":"<p><strong>Objective: </strong>Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Design: </strong>Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission.</p><p><strong>Setting: </strong>Twelve hospitals in a United States health system.</p><p><strong>Patients: </strong>Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"32-40"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927893/pdf/10.1177_10892532211043313.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39374958","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":"Cardiac Anesthesiology - Paving the Way across Multiple Subspecialties.","authors":"Benjamin Abrams,&nbsp;Markus Kowalsky,&nbsp;Nathaen Weitzel,&nbsp;Miklos D Kertai","doi":"10.1177/10892532221076655","DOIUrl":"https://doi.org/10.1177/10892532221076655","url":null,"abstract":"Specialists in cardiothoracic and abdominal transplant anesthesia offer unique expertise and a vast breadth of knowledge that contribute to the management of these notably complex patients. Furthermore, these contributions extend beyond intraoperative management, to include leadership throughout the perioperative period, critical care medicine, and even global health. This issue of Seminars in Cardiothoracic and Vascular Anesthesia highlights this broad spectrum of expertise through original research, review articles, and case reports, spanning topics as diverse as airway management, coagulopathy, pediatric heart failure, echocardiography, and educational milestones for fellowship training for abdominal transplant. In the first article of the Original Research section, Auci et al present a retrospective, single-center, observational trial evaluating the optimal time to assess platelet dysfunction during cardiac surgery through the use of platelet aggregometry. In this trial of 63 patients, they utilized an adenosine-50-diphosphate (ADP)-test to compare platelet function at four separate time periods (baseline, aortic declamping, 10 minutes after protamine administration, and end of surgery). There were statistically significant differences in ADP-test results between almost all time periods, with one notable exception: aortic de-clamping vs 10 minutes following protamine. Clinically, this study demonstrates potential value in early identification of platelet dysfunction through assessment at the time of aortic de-clamping, thus allowing timely recognition and thus more effective treatment of platelet impairment following cardiopulmonary bypass (CPB). Anesthesiologists play an essential role for teams performing congenital cardiac surgery in resource-poor conditions throughout the world. To better characterize this work with the goal of improving participation and directing resources, Hubbard et al surveyed members of the Congenital Cardiac Anesthesia Society (CCAS). Survey participants (n = 108) reported 115 total trips to 41 countries spanning 5 continents. The survey covered a broad range of topics, including the nature of the work, trends in geographic locations, and factors that may influence an anesthesiologist’s participation in these efforts. Notably, many of the barriers that interested individuals reported facing stemmed from a lack of institutional support. Not surprisingly, there was also a sharp decline in participation for the year 2020 due to pandemicrelated factors, generating a backlog of cases and further expanding the need for participation in this work in the years to come. With the understanding of dexamethasone’s benefits in treating severe COVID-19 infections, Douin et al performed a multicenter retrospective cohort study to investigate the association between corticosteroid administration and impaired glycemic control in critically ill COVID-19 patients. The study included 292 patients from 12 centers in the United States w","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"5-7"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914027","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}