Intraoperative transesophageal echocardiography following mitral valve repair: a systematic review.

OBJECTIVE: We aimed to examine the recent evidence and search for novel assessments on intraoperative TEE following mitral valve repair that can impact short and long-term outcomes. METHODS: The Ovid MEDLINE, PubMed, and EMBASE databases were searched from January 1, 2008, until January 27, 2021, for studies on patients with severe Mitral Valve Regurgitation (MR) undergoing Mitral Valve (MV) repair surgery with intraoperative Transesophageal Echocardiography (TEE) performed after the repair. Additional searches were conducted using Google search engine, Web of Science, and Cochrane Library. RESULTS: After reviewing 302 records, 8 retrospective and 22 prospective studies were included (n = 30). Due to clinical and methodological diversity, these studies are noncomparable and data were not amenable to quantitative synthesis. CONCLUSION: Although technological advances allowed the objective assessment of geometric and dynamic alterations of the MV, the impact of the use of these technologies on short- or long-term outcomes was not studied. There is uncertainty and conflicting evidence on the ideal method and metrics to evaluate MV patency post-repair. Few isolated studies validated methods to assess coaptation surface and LV function post-repair.

Cross-Cultural Analysis of Spiritual Bypass: A Comparison Between Spain and Honduras.

Religion and spirituality (R/S) serve as coping mechanisms for circumstances that threaten people's psychological well-being. However, using R/S inappropriately to deal with difficulties and problems in daily life may include the practice of Spiritual Bypass (SB). SB refers to avoiding addressing emotional problems and trauma, rather than healing and learning from them. On the other hand, coping strategies may be determined by the cultural context. This study aims to describe the presence of SB in individuals who may have experienced stressful situations and to understand the influence of culture on SB by comparing SB in two culturally different groups. The sample consists of a total of 435 people, 262 of Honduran nationality and 173 of Spanish nationality. Both groups are approximately equivalent in age and gender. The degree of SB, stressful events, perception of social support and spiritual well-being are examined, respectively, through the Spiritual Bypass Scale, and specific items and subscales from the Social Readjustment Rating Scale, Multidimensional Scale of Perceived Social Support, and the Functional Assessment of Chronic Illness Therapy - Spiritual Wellbeing. The results showed a higher spiritual well-being and use of SB in the Honduran sample as compared to the Spanish sample, but similar social support and stressful events. Furthermore, some of the factors predicting SB were different between the two samples. While age and a greater number of R/S practices were important in both samples, for the Honduran sample the variables that best explained SB were being a Christian, having greater social support, fewer stressful events, and greater attendance at church or temple. For the Spanish sample, however, the variable that best explained SB was studying R/S texts. Therefore, SB must be understood within the culture in which it develops, since in different cultural contexts it appears to relate to differing factors. Thus, SB becomes a possible functional or dysfunctional coping strategy depending on the social context.

Analysis and evaluation of the systems used for the assessment of the cervical spine function: a systematic review.

Neck injuries and pathologies are widespread and cause disability. Clinicians use different tools to measure the cervical spine' mobility to diagnose different disorders. There are many reliable assessment methods for this purpose, but their benefits have not been deeply investigated and compared, as well as their measurement results. This review aims to summarise the advantages, accuracy, and reliability, of measurement tools and devices used in studies or trails related to the neck and cervical spine evaluation, to evidence the use of inertial sensors and compare them, to highlight the best assessment systems and their characteristics. A literature review has been performed in a range of five years, to obtain information about cervical spine evaluation. Studies that met the established inclusion criteria were selected and classified according their pathology studied, objectives and methodologies followed when evaluating the cervical spine functionality. Studies were described chronologically highlighting the tools employed, where the motion capture systems and cervical range of motion devices stood out as the most used and reliable methods. Cervical spine assessment studies employing systems with inertial sensors as an accurate method, is not evidenced in the sample. However, they are widely tested and different studies validate these systems for their clinical area use, obtaining high reliability and repeatability. Thereby, this review argues that inertial sensors have proven to be a portable, and easy to use tool for the evaluation of neck and its related pathologies, with a great accuracy level.

Ultrasonido de la cabeza a los pies: opinión actual sobre su utilidad en inestabilidad hemodinámica, hipoxemia, oligoanuria y en el paciente con estado neurológico alterado / Head to toe ultrasound: Current opinion on its role in hemodynamic instability, hypoxemia, oligoanuria and the patient with altered neurological status

Abstract Introduction: Bedside ultrasound is now more commonly used in anesthesiology and critical care. There are numerous applications beyond its role in regional anesthesia and vascular access. Objective: To describe how bedside ultrasound can be integrated to current clinical management is dealingwith hemodynamicallyunstable, hypoxemic, oligoanuric patient and in the patient with altered neurological status. Material and methods: Essay article describing a synthesis of the current literature, expert opinion, currentpracticeand recentclinicaltrials in the developmentofproposed algorithm dealing with the use of bedside ultrasound in the management hemodynamic instability and hypoxemia. Results: Three algorithms currently used in the hemodynamically unstable and the hypox-emic patient and the patient are described. In addition, a simple bedside ultrasound approach to oligoanuria and altered neurological status is proposed. Conclusion: Further studies incorporating head-to-toe bedside ultrasound by trained clinicians will need to be validated but are likely to demonstrate the significant advantages of incorporating bedside ultrasound in the practice of anesthesiology and critical care.

Resumen Introducción: El ultrasonido realizado al lado de la cama del paciente se utiliza cada vez con más frecuencia en anestesiología y cuidado crítico. Son muchas sus aplicaciones aparte de la anestesia regional y el acceso vascular. Objetivo: Describir la forma de integrar el ultrasonido al lado de la cama del paciente en el actual manejo clínico del paciente hemodinámicamente inestable, hipoxémico y oligoanúrico, y del paciente con estado neurológico alterado. Materiales y métodos: Ensayo que describe una síntesis de la literatura actual, las opiniones de expertos, la práctica corriente y los experimentos clínicos recientes para el desarrollo de la propuesta de un algoritmo relativo al uso del ultrasonido al lado de la cama del paciente en el manejo de la inestabilidad hemodinámica y la hipoxemia. Resultados: Se describen 3 algoritmos utilizados actualmente en el paciente hemodinámicamente inestable e hipoxémico. Adicionalmente se propone un enfoque simple de ultrasonido a la cabecera del paciente para la oligoanuria y el estado neurológico alterado. Conclusión: Será necesario validar estudios ulteriores que incorporen la realización de ultrasonido de la cabeza a los pies por parte de clínicos entrenados, pero es probable que demuestren las ventajas importantes de incorporar el ultrasonido a la cabecera del paciente en la práctica de la anestesiología y el cuidado crítico.

Super obese patient undergoing minimally invasive mitral repair: perioperative management

Obesity is an epidemic health issue showing increasing numbers all over the world. In the United States one third of adults are obese and 10 percent of health cost is related to obesity. Airway management, vascular access and positioning can be more challenging. Anaesthesiologists need to be prepared to the particular challenges these patients pose in cardiac rooms. Minimally invasive cardiac surgery (MICS) is an alternative to perform cardiac surgical procedures that has been related to decreased rate of infection and lower transfusion rates. This case report outlines the perioperative anesthetic management of a super obese patient undergoing a minimally invasive mitral valve repair.

La obesidad es una problema epidémico de salud que ha aumentado en el mundo. En los Estados Unidos, un tercio de los pacientes adultos son obesos y un 10 por ciento del costo de salud es asociado a la obesidad. Los anestesistas necesitan estar preparados para los retos particulares que tiene estos pacientes en los pabellones cardiacos. La cirugía cardiaca mínimamente invasiva es una alternativa para realizar los procedimientos cardiacos con menor tasa de infección y transfusiones. Este reporte de caso describe el manejo anestésicos perioperatorio de un paciente super obeso para una cirugía mínimamente invasiva de la válvula mitral.