Seminars in cardiothoracic and vascular anesthesia
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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.
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Semin Cardiothorac Vasc Anesth · Dec 2008
ReviewEmerging concepts in acute kidney injury following cardiac surgery.
Acute kidney injury (AKI) remains a significant cause of morbidity and mortality following cardiac surgery. Through a more thorough understanding of perioperative genomics and the evolving role of early biomarkers of AKI, the authors seek to improve meaningful outcomes among cardiac surgery patients. In this review, the focus will be on advances in risk stratification, evolving definitions and improving early diagnosis of AKI, identification of effective individualized therapies, and future directions.
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Semin Cardiothorac Vasc Anesth · Dec 2008
ReviewTransesophageal echocardiography and noncardiac surgery.
The use of transesophageal echocardiography (TEE) for monitoring during cardiac and noncardiac surgery has increased exponentially over the past few decades. TEE has evolved from a diagnostic tool to a monitoring device and a procedural adjunct. The close proximity of the TEE transducer to the heart generates high-quality images of the intracardiac structures and their spatial orientation. ⋯ This article details recommendations to familiarize anesthesiologists with TEE technology to exploit it to its fullest potential to achieve better patient monitoring standards and eventually improve outcome. Training of greater numbers of anesthesiologists in TEE is needed to increase awareness of the indications and contraindications. Until relatively inexpensive TEE equipment is available, the initial cost of equipment acquisition remains a significant prohibitive factor limiting its widespread use.
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Semin Cardiothorac Vasc Anesth · Dec 2008
ReviewReal-time 3-dimensional echocardiography in the operating room.
Real-time 3-dimensional transesophageal echocardiography (RT-3D-TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging modality. The development of RT-3D-TEE allows for live 3D imaging as it circumvents most of the disadvantages of reconstructive 3D methods. RT-3D-TEE will likely revolutionize perioperative assessment of complex 3D structures, such as the mitral valve (MV), as it provides important mechanistic insights into functional and ischemic mitral regurgitation. ⋯ The 3D en face view of the MV is in accordance with the surgical view and allows to illustrate the unique saddle shape of the MV annulus and to define and localize mitral leaflet lesions in MV prolapse, endocarditis, or congenital MV abnormalities, all potentially important in guiding surgical repair. RT-3D-TEE will soon be integrated into routine perioperative practice. Its unique ability of real-time acquisition, online rendering and cropping capabilities, accurate identification of the precise pathology and location of cardiac disease, together with its ability to promptly quantify 3D data sets using built-in software, will likely help in transitioning this modality into standard of care.
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Semin Cardiothorac Vasc Anesth · Dec 2008
ReviewAn argument for routine ultrasound screening of the thoracic aorta in the cardiac surgery population.
Stroke and neurological injury are among the most devastating and disabling complications associated with cardiac surgery. Transesophageal echocardiography and epiaortic ultrasound allow for sensitive, point-of-care diagnosis of thoracic aortic disease, which is especially common in patients with heart disease. ⋯ Epiaortic ultrasound and transesophageal echocardiography screening are more accurate and more accessible to the operative team than any other available modality to diagnose atherosclerosis of the aorta. The goal of this review is to review the rationale and scientific evidence that suggests that the routine use of ultrasound guidance in cardiac surgery may improve postoperative outcomes in this patient population.