Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2020
ReviewPatients with left ventricle assist devices presenting for thoracic surgery and lung resection: tips, tricks and evidence.
Over a thousand left ventricular-assist device (LVAD) implants were performed for heart failure destination therapy in 2017. With increasing survival, we are seeing increasing numbers of patients present for noncardiac surgery, including resections for cancer. This article will review the relevant literature and guidelines for patients with LVADs undergoing thoracic surgery, including lung resection. ⋯ Successful thoracic surgery requires understanding of the LVAD physiology. Modern devices are preload dependent and afterload sensitive. The effects of one-lung ventilation, including hypoxia and hypercapnia, may increase pulmonary vascular resistance and impair the right ventricle. Successful surgery necessitates a multidisciplinary approach, including thorough preoperative assessment; optimization and planning of intraoperative management strategies; and approaches to anticoagulation, right ventricular failure and LVAD flow optimization. This article discusses recent evidence on these topics.
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Curr Opin Anaesthesiol · Feb 2020
Transesophageal echocardiography in minimally invasive cardiac surgery.
Transesophageal echocardiography (TEE) has made its way into the cardiac surgery realm and spurred the development of many interventions. In the domain of minimally invasive cardiac surgery (MICS), TEE has become central to reducing cardiovascular complications. ⋯ Advanced imaging modalities are essential for the sustained growth of MICS, particularly with the evolution of novel transcatheter systems. These techniques rely on exceptional imaging quality at all stages of the perioperative period to modify surgical-risk and improve patient outcomes. TEE has the additional benefit of providing real-time information on intrathoracic structures to guide intraoperative management.
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Curr Opin Anaesthesiol · Feb 2020
ReviewA narrative review of electroencephalogram-based monitoring during cardiovascular surgery.
The current narrative review focuses on depth of hypnosis monitoring with electroencephalography (EEG) during cardiovascular surgery. There have been important findings in recent years regarding the challenges and limitations of EEG-based monitoring during general anesthesia. The purpose of this review is to summarize key EEG-related concepts, as well as to highlight some of the advantages and disadvantages of processed and unprocessed EEG monitoring, especially for older patients with comorbidities undergoing cardiovascular surgery. ⋯ Ability to interpret the EEG during surgery might help anesthesia clinicians to individualize anesthetic administration to prevent adverse events, and optimize postoperative recovery.
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Curr Opin Anaesthesiol · Feb 2020
ReviewAnesthetic considerations for tracheobronchial resection in oncologic surgery.
Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases. ⋯ With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.
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Curr Opin Anaesthesiol · Feb 2020
ReviewAnesthetic management of lung transplantation: impact of presenting disease.
Recent literature has described the emerging role of anesthesiologists as key members of the lung transplantation team and the impact of anesthetic management on outcomes. This review examines the impact of presenting cause of end-stage lung disease (ESLD) on anesthetic management. ⋯ The application of these updated findings should assist anesthesiologists as they develop internal protocols and external guidelines to integrate within multidisciplinary teams caring for the lung transplant patient.