Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Sep 2024
Modernization of Cardiac Advanced Life Support: Role and Value of Cardiothoracic Anesthesiologist Intensivist in Post-Cardiac Surgery Arrest Resuscitation.
Cardiac arrest in the postoperative cardiac surgery patient requires a unique set of management skills that deviates from traditional cardiopulmonary resuscitation and Advanced Cardiovascular Life Support (ACLS). Cardiac Advanced Life Support (CALS) was first proposed in 2005 to address these intricacies. The hallmark of CALS is early chest reopening and internal cardiac massage within 5 minutes of the cardiac arrest in patients unresponsive to basic life support. ⋯ As such, we have proposed a modified CALS approach to (1) adapt to a newer generation of cardiac surgery patients and (2) incorporate advanced resuscitative techniques. These include rescue-focused cardiac ultrasound to aid in the early identification of underlying pathology and guide resuscitation and early institution of extracorporeal cardiopulmonary resuscitation instead of chest reopening. While these therapies are not immediately available in all cardiac surgery centers, we hope this creates a framework to revise guidelines to include these recommendations to improve outcomes and how cardiac anesthesiologist intensivists' evolving role can aid resuscitation.
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J. Cardiothorac. Vasc. Anesth. · Sep 2024
Perioperative Anesthetic Considerations for Catheter-Based Pulmonary Vein Interventions in Fibrosing Mediastinitis.
Fibrosing mediastinitis (FM) is a rare disease characterized by abnormal proliferation of fibrous tissue, causing compression and narrowing of the airway, blood vessels, and other mediastinal structures, including the pulmonary veins. Catheter-based interventions are available as palliative strategies. Due to the complex nature of the disease and the profound respiratory and hemodynamic sequelae that may ensue, anesthetic management requires meticulous interdisciplinary planning. ⋯ Patients with FM can achieve successful intraprocedural outcomes by ensuring a comprehensive understanding of the disease, addressing significant anesthetic concerns and considerations, and engaging a multidisciplinary team.
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J. Cardiothorac. Vasc. Anesth. · Sep 2024
Effect of Deep Hypothermia (18°C) on Dioxygen Metabolism During Pulmonary Thromboendarterectomy Surgery.
The aim of this physiological pilot study was to investigate the effect of deep hypothermia on oxygen extraction (OE) and consumption (VO2) in normothermic conditions (36-37°C), and at different stages of cooling: 30°C, 25°C, and 18°C. ⋯ There were VO2 and OE decreases of more than half their baseline values at 18°C. Given that metabolic needs are essentially supplied by dissolved O2 during cooling from 30°C to 18°C, the authors suggest that PaO2 should be increased during the period of cooling and/or deep hypothermia to prevent hypoxia.
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J. Cardiothorac. Vasc. Anesth. · Sep 2024
Safe Landing: Feasibility and Safety of Operating Room Extubation in Minimally Invasive Cardiac Valve Surgery.
This study was designed to explore key safety outcomes after operating room (OR) extubation in minimally invasive cardiac valve surgery. ⋯ OR extubation was not associated with increased postoperative delirium or reintubation rates but did decrease intubation duration. Successful OR extubation relies upon the consideration of various patient perioperative characteristics.