Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
The Effect of Regional Anesthesia on Outcomes After Minimally Invasive Ivor Lewis Esophagectomy.
The objective of the present study was to determine whether regional anesthesia in addition to general anesthesia was associated with improved outcomes compared with general anesthesia alone in minimally invasive Ivor Lewis esophagectomy. ⋯ Despite potential benefits of regional anesthesia for minimally invasive Ivor Lewis esophagectomy, the present study did not show significant differences in any outcomes between regional and general anesthesia versus general anesthesia alone.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
A Case Series of Devastating Intracranial Hemorrhage During Venovenous Extracorporeal Membrane Oxygenation for COVID-19.
Anticoagulation may be a challenge in coronavirus disease 2019 (COVID-19) extracorporeal membrane oxygenation due to endothelial injury and dysregulation of coagulation, which may increase the risk of thrombotic and bleeding complications. This report was created to describe the authors' single institutional experience, with emphasis on the high rate of intracranial hemorrhage for the first 10 patients with COVID-19 placed on venovenous extracorporeal membrane oxygenation (VV ECMO). ⋯ In this small study of 10 patients, intracranial hemorrhage was a common complication, resulting in a high rate of death. The authors urge caution in the anticoagulation management of VV ECMO for patients with severe ARDS and COVID-19 patients. Close monitoring of all hematologic parameters is recommended during ECMO support while awaiting larger, multicenter studies to examine the best practice.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
Airway Management in Patients With a History of Esophagectomy: A Case Series.
Esophagectomy is a highly invasive surgery, and it often is accompanied by various postoperative complications. With increases in the rate and length of patient survival in postoperative esophagectomy patients, the number of said patients receiving subsequent surgeries is increasing. However, airway management in post-esophagectomy patients is yet to be researched widely. This study used anesthesia records from the Kitakyushu Municipal Medical Center to examine airway conditions and complications in patients who had undergone 1 or more additional surgeries following an esophagectomy. ⋯ The possibility of aspiration-especially in cases of retrosternal reconstruction-should be considered in post-esophagectomy patients. Based on computed tomography findings, rapid- sequence induction with head-up position is recommended. Conversely, lung ventilation (inflation) and routine cricoid pressure may be less effective or, in some patients, even harmful.