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1.
J Emerg Med ; 66(2): 163-169, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38238230

RESUMO

BACKGROUND: Mask ventilation is a critical airway procedure made more difficult in the bearded patient. OBJECTIVE: We sought to objectively investigate whether application of transparent cling film (TegadermTM; 3M Healthcare, Maplewood, MN) over a beard in the operating room improves the quality of mask ventilation. METHODS: This was a randomized crossover trial of bearded adult patients undergoing surgery. Exclusions included emergency procedures, American Society of Anesthesiologists physical status classification > 3, a documented history of difficult mask ventilation, and body mass index (BMI) > 50. Transparent cling film was applied snuggly over the lower face with a 2- to 3-cm slit cut over the mouth after anesthesia induction. Mask ventilation performed by an anesthesiology resident, anesthesiology assistant, or anesthesiology assistant student and standardized to a thenar-eminence grip without use of airway adjuncts in a sniffing position. Standardized pressure-controlled ventilations were delivered via an anesthesia machine. A calibrated external pneumotachograph was used to measure delivered and returned tidal volumes from which raw and percent air leak were calculated. A clinically significant difference was determined a priori to be 15%, necessitating the enrollment of 25 patients. RESULTS: Of 25 subjects, 96% were men with a mean ± SD BMI of 29.3 ± 6. Seventeen (68%) had a full beard and 8 (32%) had a partial beard. The mean ± SD leakage was 48% ± 26% for transparent cling film vs. 46% ± 20% without its application, which was not significantly different (p = 0.67). CONCLUSIONS: The use of transparent cling film to cover the lower half of the bearded face did not have an impact on the ability or efficacy to perform mask ventilation in the operating room setting. CLINICALTRIALS: gov, Number NCT04274686.


Assuntos
Máscaras Laríngeas , Respiração Artificial , Adulto , Masculino , Humanos , Feminino , Respiração Artificial/métodos , Volume de Ventilação Pulmonar , Bandagens , Mãos , Face
3.
J Cardiothorac Vasc Anesth ; 36(12): 4505-4522, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36100499

RESUMO

Cardiopulmonary bypass (CPB) is a complex biomechanical engineering undertaking and an essential component of cardiac surgery. However, similar to all complex bioengineering systems, CPB activities are prone to a variety of safety and biomechanical issues. In this narrative review article, the authors discuss the preventative and intraoperative management strategies for a number of intraoperative CPB emergencies, including cannulation complications (dissection, malposition, gas embolism), CPB equipment issues (heater-cooler failure, oxygenator issues, electrical failure, and tubing rupture), CPB circuit thrombosis, medication issues, awareness during CPB, and CPB issues during transcatheter aortic valve replacement.


Assuntos
Embolia Aérea , Substituição da Valva Aórtica Transcateter , Humanos , Ponte Cardiopulmonar/efeitos adversos , Emergências , Oxigenadores , Substituição da Valva Aórtica Transcateter/efeitos adversos
4.
Saudi J Anaesth ; 16(1): 120-123, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35261602

RESUMO

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used in managing challenging airway and thoracic cases with complex airway manipulations. We present a case of a complex tracheal resection needing prolonged apnea times for which VV-ECMO was electively planned. Intraoperatively, the team was faced with continued oxygen desaturations during periods of apnea. With an algorithmic approach to troubleshooting hypoxemia, several factors were taken into consideration. Apneic oxygenation was applied to the open tracheal segment. Despite an open airway, the applied apneic oxygenation facilitated oxygenation to the portion of the cardiac output that was being shunted through the lungs as opposed to the VV-ECMO circuit, enabling uninterrupted completion of the surgical resection and reanastomosis.

5.
J Cardiothorac Vasc Anesth ; 36(4): 1132-1147, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-33563532

RESUMO

Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.


Assuntos
Anestesiologistas , Sistemas Automatizados de Assistência Junto ao Leito , Humanos , Unidades de Terapia Intensiva , Testes Imediatos , Ultrassonografia/métodos
8.
Anesth Analg ; 131(4): 1111-1123, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925332

RESUMO

Aspirin is considered critical lifelong therapy for patients with established cardiovascular (CV) disease (including coronary artery, cerebrovascular, and peripheral arterial diseases) and is consequently one of the most widely used medications worldwide. However, the indications for aspirin use continue to evolve and recent trials question its efficacy for primary prevention. Although one third of patients undergoing noncardiac surgery and at risk for a major adverse CV event receive aspirin perioperatively, uncertainty still exists about how aspirin should be optimally managed in this context, and significant practice variability remains. Recent trials suggest that the risks of continuing aspirin during the perioperative period outweigh the benefits in many cases, but data on patients with high CV risk remain limited. We performed a comprehensive PubMed and Medline literature search using the following keywords: aspirin, aspirin withdrawal, perioperative, coronary artery disease, cerebrovascular disease, peripheral artery disease, and CV disease; we manually reviewed all relevant citations for inclusion. Patients taking aspirin for the primary prevention of CV disease should likely discontinue it during the perioperative period, especially when there is a high risk of bleeding. Patients with established CV disease but without a coronary stent should likely continue aspirin during the perioperative period unless undergoing closed-space surgery. Patients with a history of coronary stenting also likely need aspirin continuation throughout the perioperative period for nonclosed space procedures. Perioperative clinicians need to balance the risks of ceasing aspirin before surgery against its continuation during the perioperative interval using a patient-specific strategy. The guidance on decision-making with regard to perioperative aspirin cessation or continuation using currently available clinical data from studies in high-risk patients along with nonclinical aspirin studies is conflicting and does not enable a simplified or unified answer. However, pertinent guidelines on CV disease management provide a basic framework for aspirin management, and large trial findings provide some insight into the safety of perioperative aspirin cessation in some contexts, although uncertainty on perioperative aspirin still exists. This review provides an evidence-based update on perioperative aspirin management in patients undergoing noncardiac surgery with a focus on recommendations for perioperative clinicians on continuing versus holding aspirin during this context.


Assuntos
Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Cuidados Intraoperatórios/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Humanos , Período Intraoperatório , Prevenção Primária , Procedimentos Cirúrgicos Operatórios
9.
A A Pract ; 14(11): e01285, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32985854

RESUMO

During surgery, cardiac implantable electronic device (CIED) function may be disrupted by electromagnetic interference (EMI) from monopolar electrosurgery and cause adverse sequelae. Monopolar electrosurgery requires a dispersive electrode. While a conventional electrode is affixed to the patient, use of "underbody" electrodes placed on the operating table is increasing. We present a case in which an underbody electrode was used, and EMI occurred even though the surgical site was inferior to the umbilicus. Since little is known about EMI risk with underbody electrodes, practitioners should be wary of their use in CIED patients undergoing surgery until more information is available.


Assuntos
Desfibriladores Implantáveis , Desfibriladores Implantáveis/efeitos adversos , Fenômenos Eletromagnéticos , Eletrocirurgia/efeitos adversos , Humanos
10.
Semin Cardiothorac Vasc Anesth ; 24(4): 293-303, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32706293

RESUMO

Coronavirus disease 2019 (COVID-19) has a clinical course predominated by acute respiratory failure due to viral pneumonia with possible acute respiratory distress syndrome. However, nearly one third of infected patients, especially those with preexisting cardiovascular (CV) disease, are reported to present with some combination of acute cardiac injury, myocarditis, heart failure, cardiogenic shock, or significant dysrhythmias. In addition, COVID-19 infections are also associated with high rates of thromboembolic and disseminated intravascular coagulation complications. Severe myocarditis and heart failure have both been reported as the initial presenting conditions in COVID-19 infection. This review highlights the important considerations related to the CV manifestations of COVID-19 infections, describes the mechanisms and clinical presentation of CV injury, and provides practical management and therapy suggestions. This narrative review is based primarily on the multiple case series and cohorts from the largest initial COVID-19 outbreak centers (ie, Wuhan, China, and Italy); hence, nearly all presented data and findings are retrospective in nature with the attendant limitations of such reports.


Assuntos
Doenças Cardiovasculares/complicações , Infecções por Coronavirus/complicações , Assistência Perioperatória/métodos , Pneumonia Viral/complicações , Betacoronavirus , COVID-19 , Doenças Cardiovasculares/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Humanos , Pandemias , Pneumonia Viral/fisiopatologia , SARS-CoV-2
11.
Saudi J Anaesth ; 14(2): 253-256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32317888

RESUMO

Pulmonary hemorrhage (PH) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been primarily reported in pediatric patients. We report a case of fatal PH during VA-ECMO for cardiogenic shock after myocardial infarction (MI). PH, in this case, was secondary to a triad of aortic insufficiency, left ventricle distension, and severe laminar mitral regurgitation. This case scenario, previously unreported in adults, illustrates the need for the echocardiographic assessment of left-sided heart valves prior to VA-ECMO initiation after MI as well as management considerations for massive PH in this context.

13.
Saudi J Anaesth ; 13(4): 359-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31572083

RESUMO

Electrical storm (ES) is a potentially lethal syndrome defined as three or more sustained episodes of ventricular tachycardia or ventricular fibrillation within 24 h. There are multiple inciting factors for ES, one of which involves excess catecholamine (endogenous and exogenous) effects. Exogenous catecholamines used for hemodynamic support can paradoxically engender or exacerbate an underling arrhythmia leading to ES. We report on an 63-year-old man who presented for repair of an ascending aortic dissection. After cardiopulmonary bypass separation assisted with high-dose epinephrine, ES developed requiring over 40 defibrillatory shocks. The epinephrine infusion was held and within 5 min, the ES self-terminated. ES in the context of cardiovascular surgery with the use of epinephrine for hemodynamic support has not be previously reported. Clinicians need to be cognizant of the seemingly paradoxical effect of epinephrine to induce ES. Initial ES treatment involves acute stabilization (treating or removing exacerbating factors (i.e., excess catecholamines)).

16.
J Cardiothorac Vasc Anesth ; 33(9): 2431-2444, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31076310

RESUMO

This article is the third of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series. In most cases, these will be research articles targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but in some cases, these articles will target the use of perioperative echocardiography in general.


Assuntos
Ecocardiografia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Assistência Perioperatória/métodos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Ecocardiografia/tendências , Implante de Prótese de Valva Cardíaca/tendências , Humanos , Insuficiência da Valva Mitral/cirurgia , Assistência Perioperatória/tendências , Resultado do Tratamento , Insuficiência da Valva Tricúspide/cirurgia
17.
J Cardiothorac Vasc Anesth ; 33(6): 1722-1730, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30685157

RESUMO

This is a review of the 2017 AHA/ACC/HRS Guidelines with guidance for intraoperative physicians. Ventricular arrhythmias occurring during the perioperative period have the potential for significant morbidity and mortality. Hence, an in-depth knowledge of VA mechanisms, prevention, and management is crucial for all clinicians caring for these at-risk patients in the perioperative period. Perioperative optimization of patients with a known or suspected VA should be tailored to the specific patient population and condition as outlined in this manuscript.


Assuntos
American Heart Association , Anestesiologistas/normas , Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/normas , Morte Súbita Cardíaca/prevenção & controle , Guias de Prática Clínica como Assunto , Sociedades Médicas , Arritmias Cardíacas/complicações , Cardiologia , Morte Súbita Cardíaca/etiologia , Humanos , Estados Unidos
18.
J Cardiothorac Vasc Anesth ; 33(2): 348-356, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30181085

RESUMO

OBJECTIVE: Administration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. DESIGN: Prospective, randomized, and single-blinded trial. SETTING: Single university medical center. PARTICIPANTS: Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. INTERVENTIONS: Subjects were randomized to receive either NS or Isolyte during the intraoperative period. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). CONCLUSION: The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.


Assuntos
Injúria Renal Aguda/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Taxa de Filtração Glomerular/fisiologia , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/urina , Lactato de Ringer/administração & dosagem , Solução Salina/administração & dosagem , Inibidor Tecidual de Metaloproteinase-2/urina , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/urina , Idoso , Biomarcadores/urina , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/urina , Estudos Prospectivos , Curva ROC , Método Simples-Cego
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