The MIDCAB experience: a current look at evolving surgical and anesthetic approaches.

This article reviews and updates the recent modifications in patient selection and revisions in the anesthetic approach to MIDCAB surgery. It outlines the changing surgical selection criteria, current ways to assess graft patency, and evolving anesthetic management. A promising new advancement in coronary artery bypass, the minimally invasive technique has received varying reviews and undergoes careful evaluation. Increasing surgical experience, immediate postoperative assessment of graft patency, and improvement in surgical instruments are expected to improve patient outcome. A stratification of MIDCAB patients into status I and status II patients will aid in future evaluation of surgical and anesthetic outcome. Communication of newly developed techniques to those caring for cardiovascular patients is imperative.

Pro: one-lung ventilation is best accomplished with the Univent endotracheal tube.

Over the years, thoracotomy has changed from a procedure that prompted major concern over cross-contamination caused by infection to pulmonary tumors. Assisting the thoracic surgeon by providing OLV is one of the most specialized skills an anesthesiologist can offer. This must be done in a safe, easy, and efficient manner. The Univent tube appears to be a hybrid, combining the best qualities of both the DLT and the single-lumen endotracheal tube with separate Fogarty-like catheter. The Univent tube is a technical improvement over separate endobronchial blocking catheters because its blocker shaft is attached to the main tube and, therefore, displacement is less likely. In addition, the Univent's axial blocker shaft has a lumen that provides for irrigation, suction, oxygen insufflation, CPAP, and HFV. Though equally as effective as the DLT in treatment of intraoperative hypoxemia, the Univent tube presents a unique advantage in the areas of aspiration prevention, prolonged intubation without tube exchange, and selective blockade of lung segments. The Univent tube is also easier to insert and has fewer associated risks compared to the DLT. Is it my purpose to suggest that because the Univent tube is equal to, or better than, the DLT in many areas, we should abandon the use of DLTs? Definitely not. Double-lumen tubes have performed well in the past and will continue to offer specialized functions, such as postoperative independent lung ventilation in single-lung transplant recipients. As with the acquisition of any new medical skill, the use of the Univent tube has a learning curve. It is worth the time and effort to learn to use the Univent tube.(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple pneumococcal pyarthrosis complicating rheumatoid arthritis.

Pneumococcal pyarthrosis was documented in seven and ten joints, respectively, in two patients with rheumatoid arthritis. The recognition of multiple pyarthrosis superimposed upon rheumatoid arthritis can be difficult. The present cases are compared with eight previously reported cases of pneumococcal arthritis in patients with rheumatoid arthritis.