Development and Publication of Clinical Practice Parameters, Reviews, and Meta-analyses: A Report From the Society of Cardiovascular Anesthesiologists Presidential Task Force.

The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes.

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2.

Pain after cardiac surgery is of moderate to severe intensity, which increases postoperative distress and health care costs, and affects functional recovery. Opioids have been central agents in treating pain after cardiac surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure. This Practice Advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of cardiac surgical patients. This Practice Advisory provides recommendations for providers caring for patients undergoing cardiac surgery. This entails developing customized pain management strategies for patients, including preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various cardiac surgical procedures. The literature related to this field is emerging, and future studies will provide additional guidance on ways to improve clinically meaningful patient outcomes.

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1.

Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.

Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist?

PURPOSE OF REVIEW: Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. RECENT FINDINGS: Recent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery. SUMMARY: Research findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.

Asystole From Direct Laryngoscopy: A Case Report and Literature Review.

The rare and potentially fatal complication of asystole during direct laryngoscopy is linked to direct vagal stimulation. This case describes asystole in an 85-year-old female who underwent suspension microlaryngoscopy with tracheal dilation for subglottic stenosis. Quick recognition of this rare event with immediate cessation of laryngoscopy resulted in the return of normal sinus rhythm. This incident emphasizes the implications of continued vigilance during laryngoscopy and the importance of communication between the anesthesia and surgical staff to identify and treat this rare complication. The case was successfully concluded by premedication with an anticholinergic and by increasing the depth of anesthesia.

Management of thoracic aneurysm.

A review of the literature on the management of thoracic aneurysm is presented. These patients have various comorbid conditions and need thorough work-ups. Aneurysms can be classified according to shapes and locations. Various methods to maintain hemodynamic stability with adequate end-organ perfusion are presented. The success of the operation depends upon preoperative anticipation and preparation for adequate organ perfusion and hemodynamic stability along with good communication between the anesthesiologist and the surgical team.