Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Mar 2019
Comparative StudyThoracic Epidurals are Associated With Decreased Opioid Consumption Compared to Surgical Infiltration of Liposomal Bupivacaine Following Video-Assisted Thoracoscopic Surgery for Lobectomy: A Retrospective Cohort Analysis.
Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control in thoracic surgery, however it is associated with the undesirable risks of hypotension urinary retention, and bleeding. Recently, surgical site infiltration with liposomal bupivicaine (LB) has been suggested as a comparable alternative to TEA. The authors compared total opioid consumption in patients who received either TEA or LB undergoing video-assisted thorascopic surgery (VATS) for lobectomy. ⋯ VATs lobectomy patients consumed 43.4% less opioids on POD 0-2 with TEA when compared to surgical site infiltration of LB. Further prospective randomized controlled trials are required to demonstrate superior analgesia of TEA in this surgical population.
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J. Cardiothorac. Vasc. Anesth. · Mar 2019
Comparative StudyValidation of Quantitative 3-Dimensional Transesophageal Echocardiography Mitral Valve Analysis Using Stereoscopic Display.
The use of 3-dimensional (3D) transesophageal echocardiography (TEE) in perioperative evaluation of the mitral valve (MV) is increasing progressively, including the use of 3D MV models for quantitative analysis. However, the use of 3D MV models in clinical practice still is limited by the need for specific training and the long time required for analysis. A new stereoscopic visualization tool (EchoPixel True 3D) allows virtual examination of anatomic structures in the clinical setting, but its accuracy and feasibility for intraoperative use is unknown. The aim of this study was to assess the feasibility of 3D holographic display and evaluate 3D quantitative measurements on a volumetric MV image using the EchoPixel system compared with the 3D MV model generated by QLAB Mitral Valve Navigation (MVN) software. ⋯ EchoPixel proved to be reliable to display 3D TEE datasets and accurate for direct linear measurement of both MV annular sizes and prolapse height compared to QLAB MVN software; it also carries a low interobserver and intraobserver variability for most measurements.
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J. Cardiothorac. Vasc. Anesth. · Mar 2019
Letter Review Case ReportsIntraoperative Rescue Transesophageal Echocardiography in a Prone Patient.