Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Jun 2012
ReviewPerioperative management of pheochromocytoma: focus on magnesium, clevidipine, and vasopressin.
The perioperative management of pheochromocytomas requires meticulous anesthetic care. There has been considerable progress in its management, recently 3 agents that may be particularly advantageous to the anesthetic team have been identified. Magnesium sulfate is readily available, cheap, safe, and effective for hemodynamic control before tumor resection. ⋯ Its application in the perioperative management of pheochromocytoma before tumor resection recently has been described and likely will expand in the near future. Vasopressin has demonstrated utility in the management of catecholamine-resistant shock after tumor resection. A familiarity with these 3 agents offers anesthesia providers further effective pharmacologic options for managing the hemodynamic challenges inherent to this population before and after tumor resection.
-
J. Cardiothorac. Vasc. Anesth. · Jun 2012
Case ReportsA method for automating 3-dimensional proximal isovelocity surface area measurement.
The proximal isovelocity surface area (PISA) is used for the echocardiographic quantification of effective orifice areas in valvular stenosis and regurgitation. Typically measured in 2 dimensions, the PISA relies on the geometric assumption that the shape of flow convergence is a hemisphere and that the orifice is a single circular point. Neither assumption is true. The objective was to develop a method for automating the measurement of the PISA in 3 dimensions and to illuminate the actual shape of the flow convergence pattern and how it changes over time. ⋯ An automated analysis of 3D color Doppler data is feasible and allows a direct and accurate measurement of a 3D PISA, thus avoiding reliance on simplistic geometric assumptions. The dynamic aspect of cardiac orifices also must be considered in orifice analysis.
-
J. Cardiothorac. Vasc. Anesth. · Jun 2012
Postoperative respiratory failure after cardiac surgery: use of noninvasive ventilation.
To analyze the use of noninvasive ventilation (NIV) in respiratory failure after extubation in patients after cardiac surgery, the factors associated with respiratory failure, and the need for reintubation. ⋯ Reintubation was required in half of the NIV-treated patients and was associated with an increased hospital mortality rate. Early respiratory failure after extubation (≤24 hours) is a predictive factor for NIV failure.