Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2012
ReviewThe "medial-oblique" approach to ultrasound-guided central venous cannulation--maximize the view, minimize the risk.
Carotid puncture and insertion of a large-bore catheter into the carotid artery is a feared complication associated with internal jugular vein (IJV) cannulation. The use of ultrasound with real-time imaging of the neck vessels during needle insertion has the potential to decrease the incidence of serious complications associated with central venous access. ⋯ The suggested "medial-oblique" approach allows for optimal imaging of the IJV and the carotid artery side by side and following the needle throughout the insertion from skin to vessel penetration in a medial-cephalad to lateral-caudad direction. This technique combines the advantages of the short-axis and long-axis approaches and minimizes the risk of carotid puncture from a medial-to-lateral needle direction.
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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
Controlled Clinical TrialCerebral blood flow autoregulation is preserved after continuous-flow left ventricular assist device implantation.
To compare cerebral blood flow (CBF) autoregulation in patients undergoing continuous-flow left ventricular assist device (LVAD) implantation with that in patients undergoing coronary artery bypass grafting (CABG). ⋯ These data suggest that CBF autoregulation is preserved during and immediately after surgery in patients undergoing LVAD insertion.