Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Mar 2010
The importance of oral health for cardiothoracic and vascular patients.
Prior to cardiothoracic or vascular surgery, a patient's oral health is not usually a high priority for the surgical team. Yet, oral neglect often mirrors systemic disease and the need for proper dental care is often unmet. ⋯ Considering scheduling constraints and the urgency of the procedure, a pre-operative dental screening is suggested for patients who undergo elective cardiothoracic or vascular surgery, to ensure that any oral infection is diagnosed and definitively treated. Implementing such an effective and preventive approach can improve surgical outcome and overall patient health.
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Semin Cardiothorac Vasc Anesth · Mar 2010
Left ventricular assist devices: an evolving state of the art.
Heart failure is a disease of increasing prevalence around the world. The treatment options for patients suffering from this ailment range from pharmacologic to surgical. Heart failure, however, continues to harbor a dismal prognosis despite conventional treatments. ⋯ Heart transplantation continues to generate the most reproducible survival benefit to patients with advanced heart failure, but is limited by a lack of donors. It is therefore the goal of mechanical assist therapy to improve patient survival and quality of life in heart failure in light of the limitations of heart transplantation. In this article we examine the evolving utility of LVAD's in the treatment of heart failure.
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Semin Cardiothorac Vasc Anesth · Mar 2010
Highlights of anesthetic considerations for intraoperative neuromonitoring.
Though relatively new, intraoperative neurophysiological monitoring (IONM) has become standard of care for many neurosurgical procedures. The use of IONM has substantially decreased the rate of paralysis after deformity surgery, and has been validated in cervical spine surgery, and thoracic and lumbar laminectomy (1) (2), (3). The main modalities are: somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMGs). ⋯ The anesthesiologist should strive to understand the rationale behind monitoring and the basis of its utility. IONM has many implications for anesthetic technique and need for control of the physiologic milieu. With this knowledge the anesthesiologist can work together with the neuromonitoring team and surgeon to ensure patient safety during and after surgery.
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In the past decade, concern has been raised about the safety of anesthetic agents on the developing brain. Animal studies have shown an increase in apoptosis in the developing brain when exposed to N-methyl-D-asparate receptor blockers and/or gamma-aminobutyric acid receptor agonists that is related to the dose and duration of anesthetic agents. Whether these studies can be extrapolated to humans is being investigated. ⋯ They found that the animal data available were inadequate to extrapolate to humans and determined that human studies were necessary. Human studies are underway but the challenge they face is how to delineate the effects of anesthesia from those of the underlying medical condition and surgery itself. At this time, we must continue to make decisions based on the known risks and benefits of anesthetics and apply it on an individual basis.
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This article summarizes techniques used in reoperative cardiac surgery, outlines a risk-stratified approach to operative planning, and reviews the literature on outcomes after reoperative valvular and coronary surgery.