Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2017
Determination of the True Inclination Angle of the Main Bronchi Relative to the Median Sagittal Plane for Placement of a Left-Sided Double-Lumen Tube.
This study aimed to determine the true inclination angle of the main bronchi relative to the median sagittal plane, using CT imaging to help increase accuracy of double-lumen tube (DLT) placement. ⋯ The data suggested that the trachea does not merely branch in the horizontal plane but branches posteriorly as well, with a true mean anatomic angle between the left main bronchus and trachea of 108.4°. This finding concurred with the authors' suggestion that the DLT be rotated to 110° counterclockwise instead of the routine practice of 90°. The authors suggest clinicians rotate the DLT an additional 20° counterclockwise and direct the top of the DLT to the 11 o'clock position.
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J. Cardiothorac. Vasc. Anesth. · Apr 2017
Comparative StudyTricuspid Annular Plane Systolic Excursion: Comparing Transthoracic to Transesophageal Echocardiography.
Tricuspid annular plane systolic excursion (TAPSE) represents movement of the lateral annulus of the tricuspid valve toward the apex and denotes right ventricular contractility in the long axis. In transesophageal echocardiography with the probe in the mid-esophagus, TAPSE occurs at a significant angle to the M-mode scan line. The authors describe a novel method to assess TAPSE in 2 dimensions (2D) and compare this with an established method. ⋯ Transesophageal 2D-TAPSE appeared to be a reliable and simple method to assess right ventricular function, and demonstrated a close correlation with transthoracic M-TAPSE.
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J. Cardiothorac. Vasc. Anesth. · Apr 2017
Associated Risk Factors and Complications in Vascular Surgery Patients Requiring Unplanned Postoperative Reintubation.
To determine the frequency of reintubation within 30 days in vascular surgery patients and the associated risk factors and complications. ⋯ Patients undergoing major vascular surgery represent a high-risk population for unplanned postoperative reintubation. Preoperative evaluation should include the consideration of the positively associated risk factors found in this study. Due to the significant morbidity associated with unplanned reintubation, additional work is needed to identify risk factors amenable to optimization in the preoperative period.
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J. Cardiothorac. Vasc. Anesth. · Apr 2017
Left Ventricular Assist Device Thrombosis is Associated With an Increase in the Systolic-to-Diastolic Velocity Ratio Measured at the Inflow and Outflow Cannulae.
To determine whether the ratio of peak systolic-to-nadir diastolic velocity (S/D ratio) measured using Doppler at the left ventricular assist device (LVAD) inflow and outflow cannulae is associated with pump thrombosis and to determine whether there is an absolute decrease in the diastolic cannula velocities in LVAD thrombosis. ⋯ An increased S/D ratio measured with Doppler at the LVAD inflow and outflow cannulas may be associated with pump thrombosis. Decreased diastolic cannula velocities were not observed in LVAD thrombosis.