Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Randomized Controlled TrialComputed Tomographic Window Setting for Bronchial Measurement to Guide Double-Lumen Tube Size.
The bronchial diameter measured on computed tomography (CT) can be used to guide double-lumen tube (DLT) sizes objectively. The bronchus is known to be measured most accurately in the so-called bronchial CT window. The authors investigated whether using the bronchial window results in the selection of more appropriately sized DLTs than using the other windows. ⋯ The bronchial measurement in the bronchial window guided more appropriately sized DLTs compared with the lung or mediastinal windows.
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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
Multicenter StudyHospital Outcome and Risk Indices of Mortality after redo-mitral valve surgery in Potential Candidates for Transcatheter Procedures: Results From a European Registry.
Transcatheter mitral valve-in-valve/valve-in-ring procedures (TM-VIVoR) are increasing. The authors aimed to identify independent predictors for hospital mortality in redo mitral valve surgery as possible future selection criteria for TM-VIVoR. ⋯ High EuroSCORE II and STS scores, advanced age at surgery, LVEF <30%, previous CABG, severe pulmonary hypertension or preoperative dialysis might represent in the future preferred indications for TM-VIVoR in the redo-mitral surgery scenario.
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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.