Seminars in cardiothoracic and vascular anesthesia
-
In the busy emergency department, time-effective and accurate diagnostic and prognostic evaluation is essential Although clinical examination remains the mainstay of appropriate evaluation, remaining diagnostic uncertainty may need to be resolved by use of additional techniques. Echocardiography appears very well suited to the unique environment in the emergency department. It is portable to the patient's bedside, can be performed in minimal time, and results are immediately available. ⋯ Small, hand-carried echocardiography systems have been developed with full imaging and Doppler capabilities. Thus, availability of echocardiography is increasing. Because both image acquisition and interpretation are operator-dependent, realization of full diagnostic potential requires extensive training and post-training experience to maintain proficiency.
-
Semin Cardiothorac Vasc Anesth · Mar 2006
ReviewIntravenous anesthesia for the patient with left ventricular dysfunction.
Patients with heart failure have a diminished cardiac reserve capacity that may be further compromised by anesthesia. In addition to depression of sympathetic activity, most anaesthetics interfere with cardiovascular performance, either by a direct myocardial depression or by modifying cardiovascular control mechanisms. Etomidate causes the least cardiovascular depression. ⋯ For intravenous anesthesia, propofol is always combined with an opioid. Opioids have relatively few cardiovascular side effects and, in particular, do not cause myocardial depression. Indeed, they are cardioprotective, with antiarrhythmic activity, and induce pharmacologic preconditioning of the myocardium by a mechanism similar to the inhalational anesthetics.
-
Semin Cardiothorac Vasc Anesth · Mar 2006
ReviewHow to reliably detect ischemia in the intensive care unit and operating room.
Detection of myocardial ischemia in the perioperative period is important because it allows for intervention that may prevent progression of ischemia to myocardial infarction. Perioperative ischemia is also an important predictor of adverse cardiovascular outcomes. Patients should first be stratified according to their risk of having cardiovascular disease by identifying major, intermediate, and minor predictors of adverse cardiovascular outcome. ⋯ Also, detection of these hemodynamic changes requires insertion of invasive monitoring devices. Transesophageal echocardiography can be used to detect myocardial ischemia by identifying changes in regional wall motion. These transesophageal echocardiography changes occur sooner and more frequently than ECG changes, but require greater knowledge and skill to properly interpret.
-
Semin Cardiothorac Vasc Anesth · Dec 2005
ReviewSimulation in cardiothoracic and vascular anesthesia education: tool or toy?
The use of simulators in cardiothoracic and vascular anesthesia runs the gamut from standardized patients and part-task trainers to full-scale high-fidelity human patient simulators. The use of simulation to teach medical students, anesthesiology residents, board-certified anesthesiologists with subspecialty interests, hospital administrators, attorneys, and the lay public is still evolving as educational research evaluates the use of simulation and health professional educators struggle to define its role and value. This article provides a general overview of the field and attempts to critically evaluate what is and what is not scientifically determined about simulation and simulators.
-
Semin Cardiothorac Vasc Anesth · Dec 2005
ReviewSimulation devices in cardiothoracic and vascular anesthesia.
The subspecialty of cardiothoracic and vascular anesthesia is becoming increasingly complex. Trainees must learn to manage difficult cases and be skilled in performing a variety of procedures. With work hour limitations and societal pressures working to reduce learning and practice opportunities for trainees, new training modalities must be utilized. ⋯ They vary from the simple to the complex and from inexpensive homemade wooden devices to high-end computer-controlled virtual reality simulators. Although not all these simulators have been validated as to their educational efficacy, they offer a new avenue to improve training efficacy and efficiency. More research needs to be done to validate these devices and assess their role in anesthesia training.