Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Mar 2009
ReviewPhysiology and pharmacology of myocardial preconditioning and postconditioning.
Perioperative myocardial ischemia and infarction are not only major sources of morbidity and mortality in patients undergoing surgery but also important causes of prolonged hospital stay and resource utilization. Ischemic and pharmacological preconditioning and postconditioning have been known for more than 2 decades to provide protection against myocardial ischemia and reperfusion and limit myocardial infarct size in many experimental animal models, as well as in clinical studies. This article reviews the physiology and pharmacology of ischemic and drug-induced preconditioning and postconditioning of the myocardium with special emphasis on the mechanisms by which volatile anesthetics provide myocardial protection. Insights gained from animal and clinical studies are reviewed and recommendations given for the use of perioperative anesthetics and medications.
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Semin Cardiothorac Vasc Anesth · Mar 2009
ReviewCurrent perioperative management of the patient with a cardiac rhythm management device.
The safe and effective perioperative management of the patient with a cardiac rhythm management device (ie, pacemaker and/or implantable cardioverter defibrillator) is based entirely on the avoidance of adverse outcomes, including damage to the device, the leads, or the site of lead implantation that might prevent the device from functioning as intended. An important management principle is the potential reprogramming of such a device in the perioperative period to avoid transient interruption of device function or the delivery of inappropriate electrophysiological therapy (eg, unnecessary defibrillation or pacing). Given the large numbers of patients worldwide currently implanted with these devices, the anesthesia practitioner should become electively familiar with the current technology. This article describes the current status of cardiac rhythm management devices and discusses recommended perioperative management.
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Semin Cardiothorac Vasc Anesth · Mar 2009
ReviewImproving the outcome of in-hospital cardiac arrest: the importance of being EARNEST.
Cardiopulmonary resuscitation techniques were introduced more than 50 years ago, yet the rate of survival from cardiac arrest, particularly in the hospital setting, remains dismally low. This article reviews the prevalence, etiology, and outcome of in-hospital cardiac arrest, with a focus on the determinants of outcome that are amenable to improvement. These include principally components of basic life support that may be supported by either prompting or mechanical assistance (eg, chest compression, ventilation, and defibrillation). Also reviewed are preevent and postevent effectors such as medical staff skills and recognition of impending arrest, induction of mild hypothermia, and stabilization after return of spontaneous circulation.
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Semin Cardiothorac Vasc Anesth · Mar 2009
ReviewNoninvasive cardiac output determination: broadening the applicability of hemodynamic monitoring.
Although cardiac output (CO) monitoring is usually only used in intensive care units (ICUs) and operating rooms, there is increasing evidence that CO should be determined and optimized as early as possible, even before admission to the ICU, in the care of hemodynamically compromised patients. A variety of different minimally or noninvasive CO determination techniques have been developed, but not all of them are suitable for early hemodynamic monitoring outside the ICU. In this review, the different available methods for CO monitoring are presented and their potential for early hemodynamic assessment is discussed.
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Semin Cardiothorac Vasc Anesth · Mar 2009
Case ReportsCerebral air embolism recognized by cerebral oximetry.
Absolute cerebral oximetry is useful in clinical settings to identify "catastrophic events" that may occur during the course of surgeries that would otherwise have gone unrecognized. This study reports a case in which cerebral desaturation occurred after commencing cardiopulmonary bypass. Consequently, the source of air entrainment was discovered and therapeutic measures implemented.