Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 1992
ReviewThe modified Fontan procedure: physiology and anesthetic implications.
The modified Fontan operation has gained wide acceptance as a functional corrective procedure for patients with CHD with single ventricle physiology. Long-term survival and palliation of symptoms are excellent with most patients able to lead normal lives. The absence of a pulmonary contractile ventricle means that the single ventricle is responsible for perfusion of both the pulmonary and systemic circulations. Elevated systemic venous pressure is required to overcome PVR and this state of systemic venous hypertension has a significant impact on the anesthetic and postoperative care of these patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 1992
Prognostic value of biventricular function in hypotensive patients after cardiac surgery as assessed by transesophageal echocardiography.
In patients after cardiac surgery, hypotension, defined as a mean arterial pressure less than 65 mmHg despite adequate filling pressures and positive inotropic medication, poses a problem. In addition, it is often difficult to determine whether these patients have suffered irreversible myocardial injury or if they are likely to recover. In this study, left and right ventricular function, as assessed by transesophageal echocardiography (TEE), was related to mortality both (1) quantitatively, using fractional area change (FAC), and (2) qualitatively, using a segmental wall motion analysis, which assigned a score to myocardial wall segments, in order to determine whether this technique can be used to predict survival. ⋯ A wall motion index derived from only 6 segments at the mid-papillary muscle level was found to be as reliable as one based on 16 segments of the entire left ventricle. Thus, TEE provided information about the degree of left and right ventricular dysfunction by using a single cross-section at the papillary muscle level. It identified patients at high risk of death, ie, those with compromised right and biventricular function.
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J. Cardiothorac. Vasc. Anesth. · Aug 1992
The effect of the extended (3-year) anesthesia curriculum on anesthesia subspecialty education.
The purpose of this study was to determine the effect of lengthening the anesthesia residency by the American Board of Anesthesiology on the education of anesthesia subspecialists. A survey of anesthesia residency programs was conducted from 1987 to 1991. The most frequent subspecialty practice in the clinical anesthesia (CA) 3 year is cardiovascular anesthesia. ⋯ For example, the percentage of CA3 residents spending 12 months in subspecialty education has decreased 83%. There appears to be a slight increase in the number of CA4 or PGY5 residents (fellows) electing subspecialty practice. It is concluded that the 3-year curriculum has produced a negative impact on the education of anesthesia subspecialists.
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J. Cardiothorac. Vasc. Anesth. · Aug 1992
The relationship among bronchial blocker cuff inflation volume, proximal airway pressure, and seal of the bronchial blocker cuff.
The resting volume and diameter of the bronchial blocker cuff (defined as inflation of the cuff to just its natural shape) of the Univent (Fuji Systems Corp, Tokyo, Japan) tube are 2 mL and 5 mm. However, much larger inflation volumes may be required to seal an adult mainstem bronchus and the surface area of contact between the resultant spherical or ellipsoid-shaped cuff and the wall of the mainstem bronchus may be small and susceptible to leak with the application of high proximal airway pressures. This experiment determined the relationship among airway diameter, proximal airway pressure, inflation volume of the bronchial blocker cuff, and leakage of air around the bronchial blocker cuff in an in vitro model. ⋯ The space between the tracheal cuff and the bronchial blocker cuff was then progressively pressurized in either a static or pulsed manner. The very distal end of the bronchus was functionally submerged under a beaker of water so that a bronchial blocker cuff leak would be indicated by bubbling. It was found that the Univent bronchial blocker cuff sealed the 12.8- and 16.0-mm ID mainstem bronchi against airway pressures as great as 100 cmH2O, with inflation volumes that were within the manufacturer's recommendation of 6 to 7 mL.(ABSTRACT TRUNCATED AT 250 WORDS)