INTERNATIONAL ANESTHESIOLOGY CLINICS最新文献

{"title":"Mechanical circulatory support devices: historical overview and modern approach.","authors":"Danisa K Daubenspeck","doi":"10.1097/AIA.0000000000000376","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000376","url":null,"abstract":"Heart failure (HF) continues to be a pervasive problem both nationally and globally, and with an aging population its prevalence is only increasing. It is estimated that ~6 million Americans over 20 years old were diagnosed with HF between 2015 and 2018, and projections estimate that the number will be > 8 million by 2030. There have been multiple classification systems developed to help risk stratify, prognosticate, and determine treatment forHF patients. These include theNewYork Heart Association (NYHA) functional classification, the American College of Cardiology (ACC) and American Heart Association (AHA) stages, and The Interagency Registry for Mechanically Assisted Circulation (INTERMACS) profiles. The ultimate goal of these systems is to provide early identification and create a pathway for intervention whether in the form of medical therapy, mechanical circulatory support (MCS), or a combination of both. The termMCS encompasses a wide variety of options ranging from percutaneous temporary devices used as a bridge-to-transplantation (BTT) or myocardial recovery to permanent implantable devices meant as destination therapy (DT). The MCS devices commonly used today include the intraaortic balloon pump (IABP), Impella (Abiomed, Danvers, MA), TandemHeart (LivaNova, London, UK), total artificial heart (TAH), venoarterial and veno-venous extracorporeal membrane oxygenation (VA-ECMO and VV-ECMO), durable left ventricular assist devices (LVAD), and percutaneous right ventricular assist devices (RVAD). Various models and configurations of these listed devices can be used to support the left or right ventricle individually (LV, RV), and some can be used to provide biventricular support. The who, what, andwhen ofMCS requires a multidisciplinary team approach, considering numerous variables in order to provide the optimal therapy for each individual patient. This article presents an overview of the history and indications for MCS, as well as how to select patients for MCS and a brief explanation of available devices.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094181","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":"Pulsatile versus nonpulsatile blood flow during cardiopulmonary bypass.","authors":"Mark A Chaney","doi":"10.1097/AIA.0000000000000378","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000378","url":null,"abstract":"Evolution chose pulsatile blood fl ow; man developed pulseless perfusion. ” 1 Controversy surrounding the importance of pulsatile fl ow (PF) dates back to Hippocrates and Aristotle. 2 Development of cardiopulmonary bypass (CPB) in the 1950s accelerated the PF versus nonpulsatile fl ow (NPF) debate, which remains ongoing to this day. 3,4 Numerous animal studies reveal substantial potential bene fi ts of PF when compared with NPF in the acute setting of CPB (hours), but similar such comparisons in humans are not convincing. Increased use of continuous- fl ow left ventricular assist devices (CF-LVAD) has opened the door for quite unique pathophysiological manifestations of chronic NPF (months/ years).","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"8-15"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10087419","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":"Intra-aortic balloon pump counterpulsation: technical function, management, and clinical indications.","authors":"Laura S González, Michelle Grady","doi":"10.1097/AIA.0000000000000379","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000379","url":null,"abstract":"The intra-aortic balloon pump (IABP) was one of the fi rst mechanical circulatory support (MCS) devices invented and 55 years later remains one of the most commonly used. 1 IABPs are used to assist patients with acute coronary syndromes (ACS), cardiogenic shock, or decompensated heart failure (HF), as well as support high-risk patients undergoing cardiac catheterization and surgery. This paper discusses the technology and physiology of IABP counterpulsation, technical aspects of its use, and indications for counterpulsation in a variety of medical and surgical settings. 1 including lung resections, liver resections, cesarean deliveries, hip replacements, and maxillofacial reconstruction.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"16-23"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094182","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":"Mechanical circulatory support: complications, outcomes, and future directions.","authors":"Daniel S Cormican, Claire Madden, Marc F Rodrigue","doi":"10.1097/AIA.0000000000000373","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000373","url":null,"abstract":"Mechanical circulatory support (MCS) has expanded con-siderably over the past decade; conditions that were once considered invariably terminal (or at least without therapeutic option) are now routinely offered MCS, often with favorable results. However, complications associated with MCS can be fatal, intended results from therapy are not always achieved, and improvements in currently existing devices are needed. We provide a contemporary review of the complications, outcomes, and future directions of MCS.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"72-80"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097815","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":"Ethical issues surrounding mechanical circulatory support.","authors":"Victoria Yin, Baddr A Shakhsheer, Peter Angelos, Sean C Wightman","doi":"10.1097/AIA.0000000000000372","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000372","url":null,"abstract":"Recent innovations in mechanical circulatory support (MCS) have significantly increased survival for patients with cardiac and respiratory failure. The introduction ofMCS into patient care has profoundly changed the management of heart failure and other previously fatal medical conditions. Among other devices, MCS therapies include ventricular assist devices (VAD), total artificial hearts, and extracorporeal membrane oxygenation (ECMO). Due to the quality of life implications associated with these devices, many ethical issues arise that providers must face when treating patients with MCS. Here we outline the ethical considerations physicians should understand while offering and managing MCS. The initial conversationwhen approaching patients regardingMCS should include an ethical process of informed consent, planned surrogate involvement for possible future decision-making, and clarification of bridge versus destination therapy. We discuss why routine palliative care involvement is recommended in the management of MCS patients. We examine how MCS impacts patients, families, caregivers, and clinicians, including physicians, respiratory therapists, and nurses. We also discuss ethical dilemmas that arise with the use of emergency MCS. In addition, deactivation of MCS is an ethically challenging process. Lastly, we discuss specific considerations for the use of MCS in pediatric patients. As MCS is a resource-intensive and invasive therapy with significant risks, physicians should be educated and aware of the ethical issues surrounding it.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"64-71"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097816","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":"Percutaneous mechanical circulatory support for the anesthesiologist: indications, management, and basic physiological principles.","authors":"Elizabeth K H Cotter, Shea Stoops, Chinwe Dryer","doi":"10.1097/AIA.0000000000000380","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000380","url":null,"abstract":"in advanced stages of heart failure or cardiogenic shock (CS) Since the 1960s, the primary form of mechanical support has been the intra-aortic balloon pump (IABP). As technology has advanced, smaller, more minimally invasive devices for ventricular support have been developed. In fact, the use of temporary mechanical circulatory support (MCS) has grown more than 30-fold since 2007. 1 Some MCS devices require surgical insertion, but the area of largest growth is in devices that can be placed percutaneously for rapid stabilization of hemodynamics. Increased utilization of MCS will require anesthesiologists to be familiar with the commonly used devices and basic principles of management. General anesthesiologists may be asked to support patients during elective high-risk electrophysiology procedures or emergent noncardiac Anesthesiologists with certi fi cation in echocardiography may be asked to assist in image guidance for insertion of these devices, and anesthesia intensivists may help care for these patients during their potentially lengthy stays in the intensive care unit (ICU). This paper seeks to provide a basic understanding of the indications, management, and basic physiological principles of percutaneous MCS (pMCS) devices as well as speci fi c considerations for the anesthesiologist.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 4","pages":"31-38"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094183","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":"Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing.","authors":"Yuriy S Bronshteyn, Jeanna Blitz, Nazish Hashmi, Sundar Krishnan","doi":"10.1097/AIA.0000000000000369","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000369","url":null,"abstract":"In modern health care, the performance of many bedside procedures and the evaluation of critically ill patients is facilitated by point-of-care ultrasound (PoCUS). PoCUS has unique and evolving value to each specialty. Thus, the chronology of adoption of PoCUS has varied significantly across specialties. For instance, anesthesiologists were early to adopt PoCUS for regional anesthesia, vascular access, and transesophageal echocardiography, but slow to integrate other PoCUS applications that were more rapidly adopted by acute care specialties such as critical care and emergency medicine. These latter 2 specialties have shown that PoCUS of the heart, lungs, abdomen, and/or lower extremity veins can be used to rapidly narrow the differential diagnosis of hypotension, respiratory failure, and other kinds of acute organ dysfunction. Since acute organ dysfunction management is also part of the routine work of anesthesiologists, it is not surprising that anesthesiologists are now trying to integrate more diagnostic PoCUS into their work. Furthermore, separate from acute organ dysfunction, diagnostic PoCUS has relevance to anesthesiologists in nonacute settings, such as the preoperative evaluation clinic where the ultrasound data can help with risk stratification and the evaluation of chronic symptoms. To use diagnostic PoCUS successfully, anesthesiologists will need to overcome, at minimum, the challenges that have historically hampered diagnostic PoCUS use in critical care and emergency medicine: variability in training and uncertainties in credentialing/privileging and billing. To address these challenges, anesthesiology departments will need to standardize training and work with hospital administrators to define locally appropriate credentialing/privileging and billing protocols. The following review offers a roadmap on how these things could be accomplished by drawing on both the experiences of other specialties and on guidance recently published by anesthesiology-specific professional medical organizations. Specifically, the review covers the following diagnostic PoCUS topics: (i) nomenclature; (ii) anesthesiology-relevant scope of practice; (iii) minimum level of training needed to achieve competence; (iv) credentialing/privileging; and (v) billing.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 3","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073870","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":"Applications of perioperative lung ultrasound: from the clinic to the ICU.","authors":"Theresa Northern, Matthew G Broyles, Nishankkumar P Nooli, Albert Peirce, Benjamin C Tuck, Bradley J Coker","doi":"10.1097/AIA.0000000000000370","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000370","url":null,"abstract":"Contemporary lung ultrasound (LUS) use spansmany disciplines, and its ability to favorably impact care and improve patient safety has been described extensively in emergency medicine and critical care populations. LUS has shown excellent diagnostic accuracy in respiratory failure associated with several common conditions many of which can impact patients in the perioperative period. Anesthesiologists have historically embraced technological advances to improve patient safety. Point-of-care ultrasound (POCUS), including LUS, is another tool which anesthesiologists should eagerly adopt and add to their armamentarium. LUS, like many other components of POCUS, may guide therapeutic procedures or provide rapid diagnostic information, which enables a provider to make better informed and time-sensitive clinical decisions. The American Board of Anesthesiology (ABA) and the Accreditation Council for Graduate Medical Education (ACGME) have also adopted changes which will ensure that current anesthesiology trainees are both trained and evaluated on their knowledge and proficiency with LUS. In 2021 the ACGME designated POCUS as a separate milestone in the category of Patient Care, and it is expected that residents will be able to detect pneumothorax and pleural effusion with transthoracic LUS. In 2022 the ABA will include LUS in addition to other aspects of POCUS as an item on the Content Outline for the Objective Structured Clinical Examination (OSCE) portion of the ABA Applied Examination. Several professional societies including the Society for Critical Care Medicine, the American Society of Echocardiography, and the American Society of Anesthesiologists have developed POCUS guidelines for its use across a wide range of clinical settings. Despite the endorsement of LUS by these societies, obstacles remain to its widespread adoption by anesthesiologists, most notably a lack of trained providers and heterogeneity in training programs. Recognizing the substantial utility of LUS in the perioperative setting and the fact that it is an expected milestone for anesthesiology trainees, this article will discuss practical aspects of the utilization of LUS in the perioperative period. This article is not intended to discuss the technical aspects of LUS image acquisition or image interpretation, but rather it is practical application in a busy clinical setting.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 3","pages":"41-44"},"PeriodicalIF":0.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10449825","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 gastric ultrasound: utility and limitations.","authors":"Austin J Adams, Jeffrey C Songster, Jason P Harig, Nicholas W Markin","doi":"10.1097/AIA.0000000000000365","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000365","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 3","pages":"45-54"},"PeriodicalIF":0.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10064064","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 applications of focused cardiac ultrasound.","authors":"McKenzie M Hollon, Caitlin Bradley, Ian McCullough, Emilee Borgmeier","doi":"10.1097/AIA.0000000000000371","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000371","url":null,"abstract":"Over the past decade, transthoracic cardiac ultrasound as a bedside assessment tool has seen tremendous growth; it is unparalleled in value as a diagnostic modality that is portable and low in cost and risk to the patient. Advances in ultrasound technology and a growing body of scientific evidence supporting the role of diagnostic ultrasound assessment in all areas of anesthesiology practice have propelled this growth.With these advances, the utility of perioperative ultrasound has been solidified and incorporated into educational directives. Cardiac ultrasound has been added to the list of core competencies for anesthesiologists provided by governing bodies of medical education (Accreditation Council for GraduateMedical Education), and onto the content outline for anesthesiology board certification (American Board of Anesthesiology) in the United States. Despite the growing support for focused cardiac ultrasound (FOCUS), there is still wide variation in the utilization of this technology in perioperative environments. There are myriad reasons for delayed adoption of FOCUS by anesthesiologists, including lack of training and potential unfamiliarity with when and how to incorporate FOCUS into anesthetic practice. As the phrases point of care ultrasound (POCUS), “FOCUS,” and “perioperative echocardiography” come into daily use, anesthesiologists have the opportunity to advance patient care and add value to their practice with ultrasound. This article will review the scope and limitations of FOCUS, and the current evidence for the use of FOCUS throughout the perioperative setting, including preoperative, intraoperative, and postoperative arenas and relevant work-flow considerations.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"60 3","pages":"24-33"},"PeriodicalIF":0.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10449824","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}