RESUMO
The use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists' training and practice. While a special "certification in Critical Care Echocardiography" was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists. In this review, the authors describe the categories, indications and applications of perioperative TTE and provide a recommended sequence for performing an examination tailored to the evaluation of perioperative patients. Although the authors describe a protocol utilized at their institution, there are no standards described in the literature for PTTE. Cardiac anesthesiologists and cardiac anesthesia societies (Society of Cardiovascular Anesthesiologists, European Association of Cardiothoracic Anesthesiologists) must come forward to establish standards working in collaboration with echocardiography societies (American Society of Echocardiography, European Society of Cardiology).
Assuntos
Anestesiologistas , Anestesiologia , Ecocardiografia , Ecocardiografia Transesofagiana , Humanos , Assistência Perioperatória , Literatura de Revisão como AssuntoRESUMO
Elevated peak inspiratory pressures (PIPs) cause harm via hypoventilation, barotrauma, and hemodynamic instability. Heat and moisture exchangers (HMEs) are used during mechanical ventilation to prevent heat loss, dehydration of airway mucosa, and accumulation of dried secretions. Multiple reports detail sudden HME occlusions causing increased PIPs. We describe 4 cases of gradually increasing PIPs from progressive HME obstruction that occurred within 6 months of an institutional change to a newer model. HME obstruction should be considered when PIPs are elevated. Alternative heat and moisture preservation strategies should be contemplated, as HMEs increase airflow resistance and add another point of possible malfunction.
Assuntos
Temperatura Alta , Respiração Artificial , Humanos , Umidade , Pulmão , Fenômenos Fisiológicos RespiratóriosAssuntos
Raquianestesia , Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Anestesistas , Betacoronavirus , COVID-19 , Estudos de Coortes , Humanos , Estudos Retrospectivos , SARS-CoV-2RESUMO
Transcatheter aortic valve replacement (TAVR) is an alternative to traditional surgery in patients considered to be at high or intermediate risk for open surgical repair of aortic stenosis. Despite its overall safety and efficacy, TAVR is associated with potentially serious complications including major vascular injury. Tracheal compression resulting from vascular pathology has been previously reported; however, airway compromise secondary to vascular injury during TAVR has not been described. We report a case of airway compression and respiratory compromise resulting from injury to the right subclavian artery during TAVR.
Assuntos
Traqueia/lesões , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Artéria Subclávia/cirurgia , Traqueia/diagnóstico por imagem , Resultado do TratamentoRESUMO
Malignant Hyperthermia (MH) is a life-threatening biochemical process of hypermetabolism brought about in susceptible individuals by a triggering drug or event. Type A aortic dissections are surgical emergencies requiring cardiopulmonary bypass and frequently deep hypothermic circulatory arrest. We present a case of suspected MH in a patient undergoing emergent repair of a type A aortic dissection. Upon arrival at our institution, the patient had multiple signs of MH. However, no known triggering agent had been administered. Eventually, the unique physiologic changes of cardiopulmonary bypass provided strong support for the diagnosis of MH and dantrolene was administered, effectively treating the episode.
Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Hipertermia Maligna/etiologia , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Succinilcolina/efeitos adversos , Ponte Cardiopulmonar/métodos , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Dantroleno/uso terapêutico , Humanos , Intubação Intratraqueal/métodos , Masculino , Hipertermia Maligna/tratamento farmacológico , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/uso terapêutico , Período Pré-OperatórioAssuntos
Amnésia Retrógrada , Consolidação da Memória , Amnésia , Emoções , Hipocampo , Humanos , MemóriaRESUMO
BACKGROUND AND AIMS: Tranexamic acid (TA) is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG) surgery in this retrospective cohort study at a tertiary care referral centre. METHODS: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB) via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit) and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit) groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. RESULTS: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05) between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. CONCLUSIONS: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.
RESUMO
Perioperative management of thrombocytopenia is often focused on platelet transfusion. However, there are thrombocytopenic cases that are refractory to platelet transfusion as a result of immune response or consumptive coagulopathy. Acuity of the disease may necessitate an invasive procedure despite a grossly abnormal platelet count. We describe a case of severe thrombocytopenia refractory to platelet transfusion and hemostatic management after an urgent pulmonary valve replacement and pulmonary embolectomy.
Assuntos
Implante de Prótese de Valva Cardíaca , Hemostasia Cirúrgica/métodos , Valva Pulmonar/cirurgia , Trombocitopenia/terapia , Adulto , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Humanos , Contagem de Plaquetas , Transfusão de Plaquetas/efeitos adversos , Trombocitopenia/complicaçõesRESUMO
Transesophageal echocardiography (TEE) is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28-year-old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed.
Assuntos
Anestesia Geral , Tamponamento Cardíaco/diagnóstico por imagem , Ecocardiografia Transesofagiana , Torção do Cordão Espermático , Adulto , Tamponamento Cardíaco/cirurgia , Humanos , MasculinoRESUMO
BACKGROUND: The attitudes of residency applicants regarding social media resources and how these resources affect their decisions during residency selection have not been well-studied. The objective of this study was to evaluate the use of electronic and social media resources by residency applicants and the impact of these resources on their residency selection decisions. METHODS: Interviewees at our anesthesiology residency program during the 2012-2013 interview cycle were surveyed anonymously regarding their use of electronic and social media resources. RESULTS: On a scale from 1 to 5 (1=not at all important, 5=very important), social media resources were given a ranking of 3 (2-3) (median [25%-75%]) for importance for gathering residency program information. Our Facebook page was accessed by 47% of respondents. Thirty-seven percent did so before applying and 58% did so after applying but before interviewing. The Facebook page was useful to 12% when deciding whether to apply to our program, 25% when deciding whether to interview, and 29% when deciding where to rank our program on their rank order list. Participants who responded that our Facebook page was useful in three domains (applying, interviewing, and ranking) credited it for increasing the likelihood that they applied to, interviewed at, and preferentially ranked our program. CONCLUSIONS: Social media resources serve a valuable role for residency applicants. Applicants who accessed our program's Facebook page reported that it made them more likely to apply to our program, interview at our program, and that it increased the position of our program on their rank order lists.