importance of training for ultrasound guidance in central vein catheterization

To review the complication and success rates associated with CVC placement in patients undergoing cardiovascular surgery depending on the technique utilized and the degree of ultrasound experience of the anesthesia provider. Randomized controlled trial. Operating room and post anesthesia care unit. 325 patients with CAD requiring cardiovascular surgery with an ASA of III or above. The subjects underwent CVC of the Internal Jugular vein with or without ultrasound guidance in preparation for cardiovascular surgery. Utilization of US, carotid artery puncture/cannulation and the presence of post procedure pneumothorax. When comparing the group that had CVC without US versus the group having CVC placement with US, there was significant difference in complication rates based on Z-testing [95% confidence level]. Furthermore, with 90% confidence [based on Z-testing] there was a significant difference in complication rates between the experienced and non experienced US practitioners. With adequate US training, the complications from CVC including carotid artery puncture and pneumothorax can be significantly reduced

Anesthesia and congestive heart failure: pathology, medical and surgical management

Congestive heart failure [CHF] is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed