Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
ReviewAnesthesiologists Guide to the 2019 AHA/ACC/HRS Focused Update for the Management of Patients With Atrial Fibrillation.
Perioperative physicians should be well versed in atrial fibrillation (AF) management because it is the most common sustained arrythmia in the United States. In this narrative review of the 2019 American Heart Association/American College of Cardiologists/Heart Rhythm Society Focused Update on Atrial Fibrillation, the authors detail the emergence of new evidence from completed studies that may affect the management of patients with AF presenting for surgery. Updates regarding non-vitamin K oral anticoagulants (NOACs) comprise the bulk of the update with newer evidence emerging regarding their equivalence and/or superiority compared to Coumadin. ⋯ Patients with nonvalvular AF may not exhibit an added benefit from bridging of anticoagulation, and perioperative physicians should balance the risks of stroke and major bleeding before surgery. Advances in nonpharmacologic treatment and management of AF are outlined, including left atrial appendage occlusion devices, catheter ablations, and electrical cardioversion. Anesthesiologists' understanding of these 2019 updated guidelines will allow for more adept optimization of patients with AF presenting for surgery.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
ReviewAnesthesia for Resection and Reconstruction of the Trachea and Carina.
Airway surgery poses a host of unique challenges to both the surgical and anesthesiology teams. Accordingly, there are a variety of surgical, anesthetic, and airway management options to be strategically considered. Management can be challenging during multidisciplinary preoperative planning, during the surgical procedure itself, and during recovery. In this review, emphasis is placed on anesthesia challenges for patients undergoing major tracheal or carinal surgery with specific considerations related to perioperative management.