Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Sep 2020
ReviewExpert Consensus Systems of Care Proposal to Optimize Care for Patients With Valvular Heart Disease Review of the 2019 Document for the Cardiac Anesthesiologist.
Valvular heart disease requiring intervention is increasing in prevalence in the adult population. With advancement in transcatheter and surgical procedures for valvular heart disease, optimization of patient selection, availability of resources and personnel, appropriate training and certification, and optimal periprocedural management rely on clinical evaluation, accurate echocardiographic interpretation, and understanding of valvular pathophysiology by the cardiac anesthesiologist. ⋯ The authors propose a protocol with guidelines and performance metrics to create tiered-level valve centers. This review focuses and expands on aspects discussed in Nishimura et al.'s Expert Consensus Systems of Care Document that are relevant to the cardiac anesthesiologist in the periprocedural setting.
-
J. Cardiothorac. Vasc. Anesth. · Sep 2020
Randomized Controlled Trial Observational StudyThe Optimal Length of Insertion for Central Venous Catheters Via the Right Internal Jugular Vein in Pediatric Cardiac Surgical Patients.
The primary objective was to identify the best among 4 techniques that could predict the length of central venous catheter insertion through the right internal jugular vein, which, in turn, would ensure the ideal placement of the catheter tip in pediatric cardiac surgical patients. The techniques evaluated were those based on operator experience, topography/landmark methods, and one that relied on a patient's height-related formula. Based on the outcome of the study, the possibility of arriving at a formula was investigated that would predict with reasonable certainty the ideal length of catheter to be inserted for the correct catheter placement through the right internal jugular vein in pediatric cardiac surgical patients belonging to the authors' geographic area. ⋯ A landmark-based topographic method in which the length of insertion of the catheter was determined by the distance from the skin puncture site to the second intercostal space for achieving correct placement of the catheter tip was found to be more reliable compared with other techniques. Height-based formula has the disadvantage of being affected by the skin puncture site. Assuming that a skin puncture at the midpoint between the right mastoid process and clavicular insertion of sternocleidomastoid muscle insertion is ensured, a new formula based on height has been proposed.