The Year in Electrophysiology: Selected Highlights From 2023.

This special article is a continuation of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia, highlighting the latest developments in the field of electrophysiology, particularly concerning cardiac anesthesiologists. The selected topics in the specialty for 2023 include consensus statements on left atrial appendage closure, outcomes in patients with atrial fibrillation and heart failure after ablation, further developments in the field of pulse field ablation, alternate defibrillation strategies for refractory ventricular fibrillation, updates on conduction system pacing, new devices such as the Aurora EV system and AVEIR leadless pacemaker system, artificial intelligence and its use in electrocardiogram-based diagnosis and latest evidence regarding the impact of anesthetic techniques on patient outcomes undergoing electrophysiology procedures.

Comparison of i-gel® and LMA® Supreme™ for Facilitating Fiberoptic Endotracheal Intubation: A Prospective Randomized Trial.

Supraglottic airway (SGA) is an alternative to endotracheal intubation, however endotracheal intubation is often essential. One method to convert from an SGA to an endotracheal tube (ETT) is utilizing the SGA as a conduit for fiberoptic-guided advancement of an Aintree catheter (airway exchange catheter), and exchange of the SGA for an ETT. In this prospective randomized study, we compared two SGA devices in facilitating this exchange. Subjects were randomized to receive either the i-gel® or LMA® Supreme™ SGA. The SGA was placed and an Aintree intubation catheter was inserted through the SGA over a fiberoptic bronchoscope. Next, the SGA was removed, leaving the Aintree within the trachea, and an ETT was placed over the Aintree catheter and advanced into the trachea. The i-gel group exhibited shorter time to successful intubation (median, 191 vs. 434 seconds; P = .002). The i-gel group also had fewer study subjects requiring more than one attempt for successful Aintree placement (33% vs. 75%, P = .02). The i-gel group showed superior laryngeal view score (LVS) (6 vs. 4; P = .003). The i-gel SGA achieved a faster time to successful intubation, higher rate of first attempt Aintree placement, and superior LVS.

The Year in Electrophysiology: Selected Highlights From 2022.

This special article is the fifth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors would like to thank the Editor-in-Chief, Dr Kaplan, the Associate Editor-in-Chief, Dr Augoustides, and the editorial board for the opportunity to author this series, which summarizes the key research papers in the electrophysiology (EP) field relevant to cardiothoracic and vascular anesthesiologists. These articles are shaping perioperative EP procedures and practices, such as pulsed-field ablation, cryoablation for first-line treatment for atrial fibrillation, advancements in conduction system pacing, safety issues related to smartphones and cardiac implantable electronic devices, and alterations in EP workflow as the world emerges from the COVID-19 pandemic. Special emphasis is placed on the implications of these advancements for the anesthetic care of patients undergoing EP procedures.

Terminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era.

PURPOSE OF REVIEW: Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery. RECENT FINDINGS: We highlight key recent studies from the perioperative and informatics literature, placing each in the context of how it has, or how it may conceivably be applied to, improved NORA care. SUMMARY: There is significant opportunity for anaesthesiologists and clinical informaticians to collaborate and apply major advances in the perioperative informatics field to NORA environments, particularly given rapid recent changes in the field during the COVID-19 epidemic. Given the complexity of NORA patients and care delivered in NORA environments, applied clinical informatics has the potential to drastically improve care delivered.

Type A intramural haematoma secondary to penetrating atherosclerotic ulcer of the ascending aorta.

Intramural haematoma and penetrating atherosclerotic ulcer belong to the group of acute aortic syndromes. The combined presentation of both intramural haematoma and a penetrating atherosclerotic ulcer in the ascending aorta is a very rare finding. Here, we present the case of a 72-year-old female, who was admitted to our centre with acute chest and back pain. She was diagnosed with type A intramural haematoma secondary to a penetrating atherosclerotic ulcer of the ascending aorta, and she underwent subsequent emergent surgical management. The diagnosis was confirmed intraoperatively and histopathologically. This case depicts the dynamic pathophysiological development of acute aortic syndromes and the finding that different entities of acute aortic syndromes may evolve or lead to another.