Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Mar 2014
ReviewPain management strategies for thoracotomy and thoracic pain syndromes.
Pain after thoracic surgery can be severe and, in the acute phase, contribute to perioperative morbidity and mortality. Unfortunately, patients also incur a significant risk of chronic pain. Although there are guidelines for postoperative pain management in these patients, there is no widespread surgical or anesthetic "best practice." Here, we review the recent literature on techniques specific to perioperative pain control for thoracic patients, including medical management, neuraxial blockade, and other regional techniques, and suggest an algorithm for developing a multimodal pain management strategy.
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Semin Cardiothorac Vasc Anesth · Mar 2014
ReviewPerioperative fluid management for pulmonary resection surgery and esophagectomy.
Perioperative fluid management is of significant importance during pulmonary resection surgery and esophagectomy. Excessive fluid administration has been consistently shown as a risk factor for lung injury after thoracic procedures. ⋯ Multiple minimally invasive hemodyamic monitoring devices, including pulse pressure/stroke volume variation, esophageal Doppler, and extravascular lung water measurement, were evaluated for optimizing perioperative fluid therapy. Further research regarding the prevention, diagnosis, and treatment of acute lung injury after pulmonary resection and esophagectomy is required.
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Semin Cardiothorac Vasc Anesth · Mar 2014
ReviewThe year in review: anesthesia for congenital heart disease 2013.
Congenital cardiac anesthesiology is a young and rapidly growing subspecialty. It embraces a large spectrum of congenital and acquired heart diseases, which now affect the entire life span of patients from "cradle to grave." One of the challenges faced by congenital cardiac anesthesiologists is reading the large amount of relevant literature from the fields of cardiology, cardiac surgery, intensive care medicine, and anesthesiology. This review highlights some of the current themes in the literature during the past year.
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Semin Cardiothorac Vasc Anesth · Mar 2014
ReviewManagement of patients with implanted ventricular assist devices for noncardiac surgery: a clinical review.
While originally primarily used as bridge to cardiac transplantation and bridge to recovery, more commonly ventricular assist devices (VADs) are being inserted as destination therapy. These patients are being discharged from transplant and mechanical assist centers, living as outpatients, and thus the pool of community-dwelling patients with VADs continues to expand. ⋯ This scenario may be more common in patients with VADs placed for destination therapy because these patients tend to be older and have more comorbidities and are living longer with their device. Thus, it is important for all anesthesiologists to be aware of the special anesthesia needs of patients with VADs requiring noncardiac surgery.
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The regional anesthesia literature was quite active in the calendar year 2013. In typical fashion, the literature was composed of articles representing neuraxial analgesia, peripheral nerve blocks, patient outcomes, regional anesthesia adjuvant medications, and patient safety. The goal of this article is to summarize and present the most relevant articles from each of these arenas.