Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
ReviewImplementing a Cardiac Enhanced Recovery After Surgery Protocol: Nuts and Bolts.
The use of Enhanced Recovery After Surgery (ERAS) protocols among various surgical subspecialties is increasing, including in cardiac surgery. The goal of these protocols is to optimize patient outcomes and satisfaction and improve the value of healthcare delivered. Cardiac ERAS protocols are divided into the following 3 stages of perioperative care: preoperative, intraoperative, and postoperative. ⋯ The ERAS team should consist of clinicians involved in the patient's care throughout the entire ERAS process. A cardiac ERAS program is an example of value-based care applied to a specific surgical specialty with goals to improve patient satisfaction, provide earlier recovery, and reduce hospital cost. This narrative review details the updates and gaps in the literature regarding the efficacy and utility of an ERAS protocol in cardiac surgery, outlines the individual components of a cardiac surgery ERAS protocol, and describes the implementation science that can be used to execute a cardiac ERAS protocol successfully.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
Opioid-Free Anesthesia for Lung Cancer Resection: A Case-Control Study.
To assess the feasibility and effectiveness of an opioid-free anesthesia (OFA) technique in lung cancer resection surgery versus standard opioid-based techniques. ⋯ This case-control study demonstrated that an OFA technique in lung cancer resection surgery offers a feasible and safe approach, resulting in similar postoperative pain scores and morphine consumption compared with standard opioid-containing techniques.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
The Incidence of Tracheal Bronchus in Thoracic Surgery Patients and Its Implication for Lung Isolation: A Retrospective Cohort Study.
To investigate the incidence of tracheal bronchus (TB) and explore its implication for lung isolation. ⋯ Preoperative diagnosis of TB is important when lung isolation is needed. The left-sided DLT can be used for most patients with a TB.
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J. Cardiothorac. Vasc. Anesth. · Nov 2020
Effect of Prior Formal Education on Successful Thoracic Epidural Placement By Anesthesia Residents.
Catheter placement for thoracic epidural analgesia (TEA) is technically challenging; however, methods for teaching this technique to anesthesia residents have not been well-studied. The present study aimed to determine optimal teaching methods for proficient TEA catheter placement by comparing video-based formal resident education with traditional bedside training by attending physicians. ⋯ Formal video education for TEA catheter placement provided no additional improvement of resident proficiency compared with traditional training at a high-volume academic center. The success rate was very high in this group of residents; however, experiences at other institutions may vary. Future studies are needed to determine optimum teaching strategies for TEA.