Detection of inadvertent passage of guide wire into the false lumen during thoracic endovascular aortic repair of Type B aortic dissection by transesophageal echocardiography.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has become a widely accepted treatment strategy for patients with thoracic aortic pathologies. We present a case of TEVAR where transesophageal echocardiography (TEE) played a crucial role for adequate placement of an endovascular stent graft. CASE PRESENTATION: A 71-year-old male received TEVAR for type B aortic dissection. TEE detected both true/false lumens with an intimal tear. A guidewire was inserted into the descending aorta via the left femoral artery; however, angiography failed to identify the precise location of the tip of the guidewire. TEE detected the guide wire passing through the intimal tear into the false lumen, promoted the surgeon to manipulate and advance it to the true lumen, followed by placement of a stent graft. The patient was hemodynamically stable through the whole procedure. CONCLUSION: TEE was crucially important for detecting the precise location of the guidewire and preventing complications during TEVAR.

A systematic review and meta-analysis of acute severe complications of pediatric anesthesia.

BACKGROUND: Quantification of acute severe complications of pediatric anesthesia is essential to plan clinical guidelines and educational curricula. AIM: Our aim was to identify complications in terms of frequency and outcomes. METHODS: We defined acute severe complications as an unexpected perioperative event, which without intervention by the anesthesiologist within 30 min may lead to disability or death. A systematic search was performed using MEDLINE, EMBASE, and CINAHL. Screening and data extraction were performed independently. Assessment of bias was conducted using GRADE guidelines. RESULTS: Of 3002 abstracts, 25 met all inclusion criteria. The most common acute severe complications in pediatric anesthesia are related to airway management and respiratory system, followed by cardiovascular events. There was a great variation in reporting the methods, particularly poor definitions of diagnostic criteria for complications. Data were heterogeneous and pooled estimates may not be generalizable. Some studies failed to define potential source of bias, explain how missing data were addressed, describe acute severe complications, and had incomplete postoperative follow-up. CONCLUSION: The data on pediatric anesthesia acute severe complications are poorly defined with large variation in the specificity of diagnostic reporting even within studies. We suggest that it is vital for future studies in this area to be based on a standardized system of diagnostic reporting (possibly with a hierarchical system of coding) with adequate description of population details to describe heterogeneity of data.