Anesthesiology clinics
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Anesthesiology clinics · Jun 2013
ReviewFluid management in cardiac surgery: colloid or crystalloid?
The crystalloid-colloid debate has raged for decades, with the publication of many meta-analyses, yet no consensus. There are important differences between colloids and crystalloids, and these differences have direct relevance for cardiac surgical patients. Rather than asking crystalloid or colloid, we believe better questions to ask are (1) High or low chloride content? and (2) Synthetic or natural colloid? In this paper we review the published literature regarding fluid therapy in cardiac surgery and explain the background to these two important and unanswered questions.
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Anesthesiology clinics · Jun 2013
ReviewAnesthetic considerations for electrophysiologic procedures.
The array of diagnostic and therapeutic procedures performed in the cardiology electrophysiology laboratory has expanded rapidly. Increasingly more facilities and cardiologists are performing these procedures, and the number of patients for whom these procedures are indicated is expanding. ⋯ Therefore, anesthesia providers must be prepared to handle a broad range of case complexity. This article addresses the implications of providing anesthesia safely and effectively in the electrophysiology laboratory.
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After more than a decade of attention, the risks inherent in cardiac surgery have been well documented, but examples of effective interventions to reduce this risk remain scarce. The need is great, because the patient population is vulnerable and the potential consequences of poor outcomes are ever present and significant. This article reviews a decade of discussion surrounding quality and safety issues in cardiac surgery, and concludes with examples of strategies that have shown great promise for improving cardiac surgery quality and safety.
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Anesthesiology clinics · Jun 2013
Anesthetic considerations for adults undergoing fontan conversion surgery.
There are currently in North America more adults with congenital heart disease than children. This article discusses the anesthetic considerations in adults with single-ventricle physiology and prior repairs who present for Fontan conversion surgery as a demonstration of the challenges of caring for adults undergoing interventions for the repair of congenital heart defects. The care of these patients requires an understanding of the impact of passive pulmonary blood flow and single systemic ventricular physiology. The perioperative morbidity in this patient population remains high.