Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
ReviewThe complications of uncomplicated acute type-B dissection: the introduction of the Penn classification.
Uncomplicated acute type-B aortic dissection (ATBAD) is a misnomer because it has subgroups with excessive mortality risk. The Penn classification has designated these ATBAD presentations as class-A because they initially are characterized by the absence of malperfusion and/or aortic rupture. The Penn classification also has designated class-A high-risk subgroups as type I and low-risk subgroups as type II. ⋯ Future trials in Penn class-A ATBAD should focus on type-I presentations. The Penn classification can serve as a clinical framework for trial design, laying the groundwork for future management advances. It also may provide a common language to facilitate standardized definitions, trial design, and management approaches for this high-risk patient cohort.
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
Randomized Controlled Trial Multicenter StudyIs a neutral head position as effective as head rotation during landmark-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial.
Central venous access remains a cornerstone procedure for a variety of clinical conditions. Ultrasound studies suggest that rotation of the head increases the magnitude of the overlap of the internal jugular vein with the carotid artery. The authors assessed whether a neutral position of the head during anatomic landmark-guided cannulation of the internal jugular vein (IJV) was an attractive alternative to rotating the neck to a >45° head turn. ⋯ Because of the lower success rate, the neutral head position is not an attractive alternative for IJV catheterization when compared with the rotated head position in a central landmark IJV approach.
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
ReviewA practical approach to echocardiographic assessment of perioperative diastolic dysfunction.
The Doppler assessment of diastolic dysfunction (DD) is not part of a standard comprehensive intraoperative echocardiographic examination. Although the reasons may be many, the lack of a simplified algorithm for the assessment of DD specific to the perioperative arena, the implications of this diagnosis on clinical care, and the absence of therapeutic options are some of the commonly cited reasons. In this article, the authors address these possible reasons for the lack of routine application of Doppler indices to assess perioperative DD. ⋯ The proposed algorithm is from within the premise of the published guidelines and attempts to simplify the perioperative approach. The authors hope this approach will be simple enough for routine application to affect therapy and a tangible change in outcome. The authors suggest that knowledge of left atrial size is valuable as a marker for persistently increased left ventricular end-diastolic pressure and its possible role in risk stratification.