Current opinion in anaesthesiology
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Aortic stenosis is the most frequent valvular heart disease in the USA, and aortic valve replacement remains the only definitive treatment. For patients who cannot have surgery or who are at an increased risk for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) has become an established treatment option. New technological developments in valve design will make TAVR available to an even wider group of patients. This review describes the TAVR procedure and its critical stages. ⋯ TAVR is a treatment option for patients who are at an increased risk for SAVR. Evolving technology will likely expand the patient population eligible for this type of treatment in the very near future. Multidisciplinary heart team is essential in improving current techniques and patient selection, as well as evaluating new technologies.
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Curr Opin Anaesthesiol · Feb 2015
ReviewExpanding role of perioperative transesophageal echocardiography in the general anesthesia practice and residency training in the USA.
To review the perioperative use of noncardiac transesophageal echocardiography in anesthesiology and to explore the current mechanisms of teaching and certification. ⋯ Transesophageal echocardiography can have many helpful uses in perioperative patient care. This study summarizes many noncardiac uses, certification, and echocardiography education for anesthesiologists.
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Open cardiac surgery may cause severe postoperative pain and the activation of a perioperative stress response. If not treated adequately, the patient may suffer increased morbidity, a longer hospital stay, and higher overall costs. This article reviews the literature regarding various modalities for management of postoperative pain after cardiac surgery. ⋯ Although published data remain limited, recent evidence indicates that patients may benefit from the addition of a variety of novel pain-management strategies currently under investigation. Selection of a multimodal approach to perioperative pain management is advocated, including selective application of regional analgesia, non-narcotic medications, and complimentary alternative options to improve patient comfort and overall outcome.
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Chest tube protocols are still largely dictated by personal preferences and experience. A general lack of published evidence encourages individual decision-making and hinders the development of clear-cut guidelines. The aim of this review is to establish standardized procedures with recommendations for size and number of inserted tubes, ideal suction levels and duration of thoracostomy. ⋯ Thoracic procedures are heterogeneous and postsurgical requirements vary in accordance. Most resections will not require more than one large bore (≥20F) catheter and will benefit from postoperative active suction. Even though only moderate-quality evidence suggests that suction reduces incidence of pneumothorax if compared to water seal and its effects on prolonged air leak are controversial, recent studies encourage application of active suction. Removal of chest tubes appears to be well tolerated even with a secretion of above 450 ml/day.