Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
ReviewSimulator-Based Training of Workflow in Echocardiography.
Simulator-based workflow training in echocardiography appears to be gravely lacking. Workflow, or the technical and logistical steps taken to safely and efficiently execute an ultrasound procedure, is an aspect of echocardiography nearly equivalent in importance to performing the procedure itself. ⋯ In this review, the authors describe a proficiency-based educational model for echocardiography, specifically highlighting transesophageal echocardiography, and briefly discuss its design. In addition, the review describes a simulator that when used in combination with formal didactics could provide echocardiographic workflow training.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
ReviewEchocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care.
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. ⋯ This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
ReviewTransesophageal Echocardiography in Heart and Lung Transplantation.
The number of heart and lung transplantations has risen over the years, and they remain the mainstay of treatment for end-stage heart failure and end-stage lung diseases. From the assessment of the donor's heart to intraoperative management during separation from cardiopulmonary bypass (CPB) to the postoperative follow-up of heart transplant patients, echocardiography plays a vital role throughout this process. Patients with chronic lung diseases also may have cardiovascular compromise secondary to pulmonary hypertension, pre-existing coronary artery disease, or valvular heart disease. ⋯ An intraoperative transesophageal echocardiography (TOE) for continuous monitoring of the cardiac function is important especially in a procedure where hemodynamic instability is often encountered. Postoperative complications are common, and they can be diagnosed with the help of TOE. The authors aim to conduct a narrative review on the use of TOE mainly in the intraoperative setting during heart and lung transplantation and also to highlight some of its uses preoperatively as well as in the immediate postoperative period.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
The Impact of l-Thyroxine Treatment of Donors and Recipients on Postoperative Outcomes After Heart Transplantation.
The effect of thyroid dysfunction on adverse outcomes has been studied in many different patient populations. The objective of this study was to investigate the effect of thyroid hormone supplementation of donors and recipients on postoperative outcomes after orthotopic heart transplantation. ⋯ Pretransplantation thyroid hormone supplementation of donors and recipients was associated with improved long-term survival after heart transplantation.