Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Observational StudyComparison of Glycemic Variability Indices Blood Glucose Risk Index and Coefficient of Variation in Predicting Adverse Outcomes for Patients Undergoing Cardiac Surgery.
Fluctuations in blood glucose (glycemic variability) increase the risk of adverse outcomes. No universally accepted tool for glycemic variability exists during the perioperative period. The authors compared 2 measures of glycemic variability-(1) coefficient of variation (CV) and (2) the Blood Glucose Risk Index (BGRI)-in predicting adverse outcomes after cardiac surgery. ⋯ Both CV and the BGRI had good predictive ability. The BGRI being a continuous variable could be a preferred measure of glycemic variability in predicting adverse outcomes (cutoff value 2.24) after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Socioeconomic Disparities in Carotid Revascularization Procedures.
Several studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures. ⋯ These results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Case ReportsPulmonary Venous Flow After Lung Transplantation: Turbulence and High Velocities.
Lung transplantation is the definitive treatment for end-stage lung disease. The pulmonary venous anastomosis has the potential for significant obstructive complications that can lead to considerable morbidity and mortality. The use of intraoperative transesophageal echocardiography, including color-flow and spectral Doppler, is instrumental in evaluating the pulmonary veins after lung transplantation. In this E-challenge, a case of intraoperative pulmonary venous obstruction after bilateral lung transplantation is described, the echocardiographic principles required to evaluate the pulmonary veins and screen for complications are reviewed, and when intervention may be required is discussed.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
A Focused Transesophageal Echocardiography Protocol for Intraoperative Management During Orthotopic Liver Transplantation.
The value of a simplified, focused intraoperative transesophageal echocardiography (TEE) protocol in patients undergoing liver transplantation (LT) is unknown. We sought to create and assess a 5-view LT TEE examination focused on 5 prespecified common causes of hypotension during LT. ⋯ In a retrospective cohort study, a simplified LT TEE protocol would have detected 92% of prespecified TEE findings. Management changes occurred in 94% of those patients, while changes rarely occurred in patients with other TEE findings. A focused LT TEE protocol may diagnose critical pathology adequately and guide management during LT when standard monitors are insufficient.
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J. Cardiothorac. Vasc. Anesth. · Jul 2020
Observational StudyWhose Voices Are Heard? Speaker Gender Representation at the Society of Cardiovascular Anesthesiologists Annual Meeting.
Gender disparities in academic medicine continue to be prevalent despite significant advances in the number of women entering medicine over the last decades. The purpose of the present study was to investigate gender representation of speakers at Society of Cardiovascular Anesthesiologists (SCA) Annual Scientific Sessions meetings from 2015 to 2018. ⋯ Between 2015 and 2018, the majority of lectures at the SCA annual meetings were given by men, with women consistently giving 22% to 25% of individual lectures. When all sessions were combined, there was a statistically significant difference in the expected versus observed proportion of women in speaking slots.