Journal of cardiothoracic and vascular anesthesia
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Over the past decade, the role of the anesthesiologist has evolved continuously into a sine qua non component of the EP team, having intimate knowledge of the complex interventional procedures and the specific demands of the EP environment. With emphasis on coordination of care, resource optimization, and implementation of a climate of teamwork and collaboration, the anesthesiologist very likely will assume an even more enhanced role in the future. Future design of the EP suite ergonomics must take into account the needs of the anesthesia team to improve procedural workflow and maintain the focus on the patient.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
ReviewThe PhysiologicPerspective in FluidManagement in VascularAnesthesiology.
Vascular surgery patients frequently suffer from atherosclerosis and peripheral arterial occlusive disease generating endothelial dysfunction. Furthermore, ischemia and reperfusion during surgery damage endothelial cells and, especially, the endothelial glycocalix. The damage of the glycocalix promotes an increase in permeability. ⋯ From a theoretical physiologic point of view, iso-osmolar albumin is the best choice regarding volume effect, antioxidative properties, and protection against destruction of the glycocalix. Nonetheless, albumin experimentally has not lived up to its promise in the clinical setting. Thus, further well-conducted large randomized clinical trials are necessary to ascertain the optimal fluid therapy in vascular surgery patients.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Observational StudyAortic Valve Replacement Reduces Valvuloarterial Impedance but Does Not Affect Systemic Arterial Compliance in Elderly Men with Degenerative Calcific Trileaflet Aortic Valve Stenosis.
Standard methods of quantifying aortic valve stenosis (AS), which focus entirely on the valve itself, do not adequately characterize the magnitude, predict the onset, progression, and severity of symptoms, or identify the incidence of subsequent adverse events. Valvuloarterial impedance (Z(va)) is an index of global left ventricular (LV) afterload that incorporates valvular and arterial loads. The authors tested the hypothesis that aortic valve replacement (AVR) reduces Z(va) but does not affect the arterial component of LV afterload in elderly patients with degenerative calcific trileaflet AS. ⋯ The current results showed that AVR acutely reduced Zva, improved energy loss index, and decreased stroke work loss, but did not affect systemic arterial compliance in elderly men with degenerative calcific trileaflet AS.
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J. Cardiothorac. Vasc. Anesth. · Dec 2014
Comparative StudyDiagnostic Value of Chest Ultrasound after Cardiac Surgery: A Comparison with Chest X-ray and Auscultation.
Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. ⋯ Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements.