ABSTRACT
BACKGROUND: This survey aimed to explore the availability and accessibility of echocardiography during noncardiac surgery worldwide. METHODS: An internet-based 45-item survey was sent, followed by reminders from August 30, 2021, to August 20, 2022. RESULTS: 1189 responses were received from 62 countries. Nearly seventy-one percent of respondents had intraoperatively used transesophageal or transthoracic echocardiography (TEE and TTE, respectively) for monitoring or examination. The unavailability of echocardiography machines (30.3%), lack of trained personnel (30.2%), and absence of clinical indications (22.6%) were the top 3 reasons for not using intraoperative echocardiography in noncardiac surgery. About 61.5% of participants had access to at least one echocardiography machine. About 41% had access to at least 1 TEE probe, and 62.2% had access to at least 1 TTE probe. Seventy-four percent of centers had a procedure to request intraoperative echocardiography if needed for noncardiac cases. Intraoperative echocardiography service was immediately available in 58% of centers. CONCLUSIONS: Echocardiography machines and skilled echocardiographers are still unavailable at many centers worldwide. National societies should aim to train a critical mass of certified TEE/TTE anesthesiologists and provide all anesthesiologists access to perioperative TEE/TTE machines in anesthesiology departments, considering the increasing number of older and sicker surgical patients scheduled for noncardiac surgery.
Subject(s)
Anesthesiologists , Point-of-Care Systems , Humans , Ultrasonography , Point-of-Care Testing , Heart , Clinical CompetenceABSTRACT
Abstract Background Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. Methods Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p= 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. Conclusions When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.
Subject(s)
Humans , Adult , Acute Kidney Injury/chemically induced , Acute Kidney Injury/epidemiology , Cardiac Surgical Procedures , Anesthesia/adverse effects , Postoperative Complications/chemically induced , Postoperative Complications/epidemiology , Creatinine , Sevoflurane/adverse effectsABSTRACT
BACKGROUND: Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. METHODS: Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min-1) or high FGF (2.0 L.min-1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. RESULTS: Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p = 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. CONCLUSIONS: When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.
Subject(s)
Acute Kidney Injury , Anesthesia , Cardiac Surgical Procedures , Adult , Humans , Sevoflurane/adverse effects , Creatinine , Acute Kidney Injury/chemically induced , Acute Kidney Injury/epidemiology , Anesthesia/adverse effects , Postoperative Complications/chemically induced , Postoperative Complications/epidemiologySubject(s)
Humans , Point-of-Care Systems , Anesthesiologists , Ultrasonography , Clinical Competence , Point-of-Care Testing , HeartABSTRACT
It is established that coronaviruses are transmitted most through aerosols produced when an infected individual coughs or sneezes.1 Although there is no clear evidence of person-to-person airborne transmission, it is possible that part of this component could be due to microscopic respiratory droplets at short to medium distances (up to several meters, or room scale) and deposits from respiratory droplets on surfaces.2,3 However, recent studies revealed that infected patients can potentially be a source of the virus not only through respiratory but also fecaloral or body fluid routes, raising also the theoretical possibility of bloodborne transmission.4 Based on these arguments, the possibility has also been raised of some equipment that could be a new source of transmission, like the membranes used for extracorporeal oxygenation, which act the same as lungs and also have a direct contact with the blood. Most centers worldwide report a reduction in the cardiac procedures due to the pandemic, however emergency surgeries with conventional cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) procedures have been performed every day. Despite guidelines and modifications for operating theatre preparation for the management of suspected or confirmed SARS-CoV-2 patients submitted to cardiac surgery, many aspects still need to be clarified.5 Potential risk of transmission with these membranes exists, so much that Dres et al.6 reported a study evaluating the risks of SARS-CoV-2 dissemination through membranes used for extra corporeal organ support in critically ill patients, within 48 h after ECMO and continuous renal replacement therapy (CRRT) initiation. They investigated whether SARS-CoV-2 RNA was detected in the dialysis effluent fluid or in the condensate collected from the ECMO membrane gas outlet, when the virus was present in the lower respiratory tract and the plasma. Results showed that in 25 patients on veno-venous ECMO, SARSCoV-2 RNA was not detected in the membrane oxygenator gas outlet condensate in any of 25 patients of whom 13 were plasma RNA positive. Also, they were not able to measure any SARS-CoV-2 RNA in the dialysate of those patients who additionally were treated by CRRT.
Subject(s)
Oxygenators, Membrane , Coronavirus , Aerosols , MembranesABSTRACT
A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transesofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma força-tarefa para normatizar a feitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocardiografistas brasileiros com base nas evidências científicas da Sociedade dos Anestesiologistas Cardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileira de Cardiologia
Subject(s)
Humans , Anesthesiology/methods , Anesthesiology/standards , Echocardiography, Transesophageal/methods , Echocardiography, Transesophageal/standards , Aortic Valve , Brazil , Esophagus , Evidence-Informed Policy , Guidelines as Topic/standards , Heart , Heart Atria , Heart Ventricles , Hemodynamic Monitoring/methods , Mitral Valve , Prospecting Probe , Pulmonary Artery , Thoracic Surgery/methods , Tricuspid ValveABSTRACT
RESUMO: A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transesofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma força-tarefa para normatizar a feitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocardiografistas brasileiros com base nas evidências científicas da Sociedade dos Anestesiologistas Cardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileira de Cardiologia.
ABSTRACT: Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
Subject(s)
Preoperative Care , Echocardiography, Transesophageal , AnesthesiologyABSTRACT
RESUMO A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transe-sofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascularda Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma forc ̧a-tarefa para normatizar afeitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocar-diografistas brasileiros com base nas evidências científicas da Sociedade dos AnestesiologistasCardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileirade Cardiologia.
ABSTRACT Through the Life Cycle of Intraoperative Transesophageal Echocardiography(ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardi-ovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force tostandardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesi-ologists and echocardiographers based on scientific evidence from the Society of CardiovascularAnesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society ofCardiology.
Subject(s)
Humans , Echocardiography, Transesophageal/standards , Heart/diagnostic imaging , Cardiac Surgical Procedures , Intraoperative Care , Echocardiography, Transesophageal/adverse effects , Echocardiography, Transesophageal/methodsABSTRACT
Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
