Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
ReviewExpiratory Central Airway Collapse in Adults: Anesthetic Implications (Part 1).
Expiratory central airway collapse (ECAC) is a general term that incorporates tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC). TBM and EDAC are progressive, degenerative disorders of the tracheobronchial tree, causing airway collapse. ⋯ This crisis presents as the sudden inability to ventilate, which can lead to life-threatening hypoxemia and hypercapnia. This article reviews the definition, pathophysiology, diagnosis, and anesthetic implications of ECAC.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
ReviewExpiratory Central Airway Collapse in Adults: Corrective Treatment (Part 2).
Corrective treatment of expiratory central airway collapse (ECAC) consists of placement of airway stents or tracheobronchoplasty (TBP). The indication for corrective treatment is severe central airway collapse (>90 %), and severe symptoms that cause decline in quality of life. Patients are selected to undergo a trial of tracheal "Y" stent placement. ⋯ Patients who are considered poor surgical candidates because of the severity of comorbidities can be offered permanent stenting to palliate symptoms. The anesthetic management of airway stent placement and TBP is complex. This article reviews the medical management and corrective treatment of ECAC, anesthetic management of airway stent placement, and considerations during TBP.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
ReviewUltrasound Imaging for Diaphragm Dysfunction: A Narrative Literature Review.
Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and challenge the effort of this muscle; this was achieved by measuring transdiaphragmatic pressure-an invasive technique involving a double-balloon probe inserted through the esophagus-or by measuring twitch pressure (ie, the pressure generated at the outside tip of the endotracheal tube). However, the prevalence of diaphragm dysfunction in critically ill patients requiring intubation can exceed 60% (at the time of hospital admission) and may rise to as high as 80% in patients requiring prolonged mechanical ventilation and experiencing difficult weaning. ⋯ Furthermore, US enables the course of diaphragmatic function to be followed on a day-to-day basis, from intensive care admission to discharge, and it can help us understand the different causes of underlying disease: trauma, infection (eg, sepsis-induced diaphragm dysfunction), cancer, weaning problems (eg, ventilation-induced diaphragm dysfunction), etc. Today, the assessment of diaphragm dysfunction with US provides an important first step toward improving the detection of diaphragm dysfunction and as a protective and supportive strategy for its management. The purposes of this review are as follows: (1) to explore which US method is best for evaluating diaphragm function in the intensive care unit and how and when it should be used, and (2) to discuss which diseases may involve the diaphragm, and what therapies should be used.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
Observational StudyThe Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player.
To prospectively assess the diagnostic performance of echocardiographic measurements before spinal anesthesia in elderly patients undergoing lower limb surgery. Emphasis was placed on the dIVCmax-to-IVCCI ratio and IVCCI, where dIVCmax was the maximum diameter of inferior vena cava (IVC) at expiration and IVCCI was the collapsibility index of IVC. ⋯ The preoperative dIVCmax-to-IVCCI ratio can predict spinal-induced hypotension greater than IVCCI and other echocardiographic measurements in elderly patients. Both dIVCmax-to-IVCCI ratio and patient age can act as predictors of spinal-induced hypotension in elderly patients.
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J. Cardiothorac. Vasc. Anesth. · Sep 2019
ReviewMyasthenia Gravis and Thymoma Surgery: A Clinical Update for the Cardiothoracic Anesthesiologist.
Myasthenia gravis (MG) is a rare neuromuscular disorder characterized by skeletal muscle weakness. Patients with MG who have thymoma and thymic hyperplasia have indications for thymectomy. ⋯ If NMBs are used, sugammadex appears to be the drug of choice to restore adequately the neuromuscular transmission. In patients with postoperative myasthenic crisis, plasma exchange or intravenous immune globulin and mechanical support is recommended.