Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
ReviewOff-Pump Coronary Artery Bypass Grafting: Closing the Communication Gap Across the Ether Screen.
Cardiopulmonary bypass (CPB) has been one of the most important additions to the field of heart surgery in the past century. However, significant morbidity associated with CPB has led to the increasing implementation of off-pump coronary artery bypass (OPCAB). ⋯ Technical skill at performing and interpreting transesophageal echocardiography is essential to help differentiate regional wall motion abnormalities from coronary ischemia and external compression from manipulation of the heart, which require different management strategies to resolve hemodynamic collapse. Flawless communication between the anesthesiologist and surgeons, with frequent intraoperative adjustments, is paramount for the completion of successful OPCAB.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
Dynamic Needle Tip Positioning for Ultrasound-Guided Placement of a Peripherally Inserted Central Catheter in Pediatric Patients.
Although a few studies have reported the efficacy of ultrasound-guided peripherally inserted central catheter placement for pediatric patients, the procedure still is challenging. Ultrasound-guided dynamic needle tip positioning technique is useful for vascular catheterization. There have been no reports on using dynamic needle tip positioning for peripherally inserted central catheter placement. The authors assessed the rate of successful peripherally inserted central catheter placement with dynamic needle tip positioning. ⋯ In pediatric patients, ultrasound-guided peripherally inserted central catheter placement using dynamic needle tip positioning attained a high success rate.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
ReviewCalcium Administration During Weaning From Cardiopulmonary Bypass: A Narrative Literature Review.
The search for safe and effective patient management strategies during weaning from cardiopulmonary bypass is ongoing; intravenous calcium is occasionally used as a first-line drug. The physiologic role of calcium suggests that it can support the function of the cardiovascular system during this critical period. ⋯ Nonetheless, effects on clinically relevant endpoints are unknown, and possible systemic side effects, such as transient reduction in internal mammary artery graft flow, attenuation of the effects of β-sympathomimetics, "stone heart" phenomenon, and pancreatic cellular injury, may limit the use of calcium salts. Further studies are needed to expand the understanding of the effects of calcium administration on patient outcomes.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
ReviewExtracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?
The role of extracorporeal membrane oxygenation in the adult patient population still is evolving. Technologic advancements have improved the ability to provide extracorporeal life support. ⋯ The indications for use also have diversified. In this review, the authors provide a panoramic view of extracorporeal membrane oxygenation to provide a foundation of knowledge for anesthesiologists.
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The authors hypothesized that automated tracings of both pulsed wave (PW) and continuous wave (CW) Doppler correlate well with manual measurements performed by an experienced echocardiographer. ⋯ Automated measurements of peak velocities, mean gradients, and VTI of spectral Doppler correlate closely with manual measurements performed by an experienced echocardiographer.