Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
ReviewAssessment of Pulmonary Edema: Principles and Practice.
Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. ⋯ In this review, advances in understanding the physiology of extravascular lung water accumulation in health and in disease and the various mechanisms that protect against the development of pulmonary edema under physiologic conditions are discussed. In addition, the various bedside modalities available to diagnose early accumulation of extravascular lung water and pulmonary edema, including chest auscultation, chest roentgenography, lung ultrasonography, and transpulmonary thermodilution, are examined. Furthermore, advantages and limitations of these methods for the operating room and intensive care unit that are critical for proper modality selection in each individual case are explored.
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Randomized Controlled TrialA Randomized Controlled Trial Examining the Effect of the Addition of the Mandibular Block to Cervical Plexus Block for Carotid Endarterectomy.
Although the cervical plexus block generally provides adequate analgesia for carotid endarterectomy, pain caused by metal retractors on the inferior surface of the mandible is not prevented by the cervical block. Different pain relief methods can be performed for patients who experience discomfort in these areas. In this study, the authors evaluated the effect of mandibular block in addition to cervical plexus block on pain scores in carotid endarterectomy. ⋯ Mandibular block in addition to cervical plexus block provides better intraoperative pain control and greater patient satisfaction than cervical plexus block alone.
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
ReviewNoninvasive Ventilation During Endoscopic Procedures: Rationale, Clinical Use, and Devices.
Endoscopic procedures, such as transesophageal echocardiography, gastroscopy, and airway fibroscopy, routinely are performed in a heterogenous population of patients for diagnostic/interventional purposes (eg, transfemoral aortic valve replacement, airway fibroscopies, and intubation). Sedation frequently is administered to achieve an appropriate degree of patient compliance and procedure success. Patients with reduced respiratory reserve or those who are overly sedated, however, may develop hypoxia and respiratory failure during endoscopies, necessitating premature termination of the examination itself. ⋯ Ventilatory support has been delivered during prolonged transesophageal cardiac examinations and interventions, broncoscopic maneuvers, and in difficult airway scenarios. Furthermore, the availability of innovative dedicated devices has allowed for some interventional procedures that require endoscopy to be peformed with the patient under sedation and on ventilatory support with noninvasive ventilation instead of general anesthesia. These approaches might be further expanded in the future and possibly reduce costs, organizational requirements, and complications compared using standard management with general anesthesia.