Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewAchieving tight glycemic control in the operating room: lessons learned from 12 years in the trenches of a paradigm shift in anesthetic care.
Intensive insulin therapy to control perioperative hyperglycemia has become the new standard of care for cardiac surgery patients. Although there are several published protocols for achieving tight glycemic control in the postoperative period, there are no such published protocols or even suggested methods for intraoperative control. At Providence St. ⋯ All four have evolved in the hands of experienced cardiac anesthesiologists. Each of these anesthesiologists was faced with the daily task of individualizing patient therapy with the common goal of eliminating intraoperative hyperglycemia. In this article we will describe each of these four generalized methodologies to give the practicing anesthesiologist a starting point from which they can develop and hone their own technique further.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewTechnical advances of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
Pulmonary endarterectomy is the definitive treatment for chronic pulmonary hypertension as the result of thromboembolic disease. Although significant progress has been made over the last decade in recognition, diagnostic modalities, and treatment of this disease, chronic thromboembolic pulmonary hypertension (CTEPH) continues to be severely underdiagnosed and as a consequence pulmonary endarterectomy remains an uncommon procedure. ⋯ Medical management in these patients is only palliative, and surgery by means of transplantation for this type of pulmonary hypertension is an inappropriate use of resources with less than satisfactory results. In this article we describe the technical advances of pulmonary endarterectomy and the current procedure as it is performed at University of California-San Diego Medical Center.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewDiagnostic studies in patients with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is a clinical-radiological diagnosis. Clinical diagnosis comprises severe hypoxemia assessed by arterial oxygen tension/fraction of inspired oxygen ratio of less than 200 and bilateral infiltrate on a chest radiograph in the absence of left atrial hypertension. The sensitivity and specificity of the clinical diagnosis vary based on the underlying etiology for ARDS. ⋯ Diffuse alveolar damage, a pathognomic of ARDS, is seen on histopathology on transbronchial lung biopsy or open lung biopsy. Most common complications of these procedures include transient hypoxemia, respiratory acidosis, and pneumothorax with occasional persistent air leak. The potential risk of diagnostic studies should be balanced against the possible foreseeable benefits of the diagnostic studies.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewCurrent perspective on aortic valve repair and valve-sparing aortic root replacement.
Aortic valve repair and valve-sparing aortic root replacement are attractive concepts because they offer the possibility of valve competence without structural deterioration due to nonviability and they preclude the need for anticoagulation. Enthusiasm for aortic valve repair has waxed and waned over the past 45 years due in part to the inherent technical difficulties and poor mid-term results. ⋯ A current perspective on aortic valve repair and valve-sparing aortic root replacement is presented in the following review. Historical background, indications for repair, technical considerations, and outcomes data are discussed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewPostoperative acute respiratory distress syndrome development in the thoracic surgery patient.
Acute respiratory distress syndrome (ARDS) in the thoracic surgery patient is a dreaded complication that occurs in 4% to 5% of pneumonectomies. This peculiar syndrome is indistinct from other forms of ARDS yet is associated with an exceedingly higher mortality rate. Current management parallels ARDS treatment of other etiologies.