Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comment Letter Case ReportsCoopdech bronchial blocker is useful in abnormalities of the tracheobronchial tree.
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J. Cardiothorac. Vasc. Anesth. · Aug 2010
Comparative StudyAsleep-awake-asleep technique during carotid endarterectomy: a case series.
Carotid endarterectomy (CEA) has become one of the most common vascular procedures in the world. It can be performed both under general anesthesia (GA) and regional anesthesia (RA). The aim of this study was to present results of a technique for CEA in which the patients anesthetized with target-controlled infusions of propofol and remifentanil were awake during the endarterectomy phase. Neurologic function was evaluated as if under RA. Patient satisfaction and the incidence of major complications also were investigated. ⋯ Although this is a case series, the authors believe that this technique combines the advantages of RA (good evaluation of the patients' neurologic status) and GA (patients relaxed and comfortable). Moreover, the analysis of the results of the questionnaire suggests that the patients can tolerate the operation awake under propofol and remifentanil, and major complications also were low. It can be concluded that this technique appears to be safe and well accepted by patients and could be a good alternative in patients in whom RA cannot be performed.
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In this review, the authors discussed criteria for diagnosing ALI; incidence, etiology, preoperative risk factors, intraoperative management, risk-reduction strategies, treatment, and prognosis. The anesthesiologist needs to maintain an index of suspicion for ALI in the perioperative period of thoracic surgery, particularly after lung resection on the right side. Acute hypoxemia, imaging analysis for diffuse infiltrates, and detecting a noncardiogenic origin for pulmonary edema are important hallmarks of acute lung injury. ⋯ NO is not recommended as a treatment. Strategies such as bronchodilation, smoking cessation, steroids, and recruitment maneuvers are unproven to benefit mortality although symptomatically they often have been shown to help ALI patients. Further studies to isolate biomarkers active in the acute setting of lung injury and pharmacologic agents to inhibit inflammatory intermediates may help improve management of this complex disease.