Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
Randomized Controlled Trial Multicenter StudyUse of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study.
The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. ⋯ The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
ReviewPerioperative Anesthetic Management of the Pregnant Patient With Congenital Heart Disease Undergoing Cardiac Intervention: A Systematic Review.
Maternal congenital heart disease is increasingly prevalent, and has been associated with a significantly increased risk of maternal, obstetric, and neonatal complications. For patients with CHD who require cardiac interventions during pregnancy, there is little evidence-based guidance with regard to optimal perioperative management. The periprocedural management of pregnant patients with congenital heart disease requires extensive planning and a multidisciplinary teams-based approach. Anesthesia providers must not only be facile in the management of adult congenital heart disease, but cognizant of the normal, but significant, physiologic changes of pregnancy.
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
ReviewAveir Leadless Pacemaker: Novel Technology With New Anesthetic Implications.
The Aveir VR Leadless Pacemaker (Abbott, Chicago, IL) recently was approved by the US Food and Drug Administration, and joined the Micra (Medtronic, Minneapolis, MN) transcatheter pacing system in the realm of nontransvenous cardiovascular implantable devices. The Aveir VR offers design improvements over its predecessor, the Nanostim (St. ⋯ There are recommendations for the perioperative management of conventional transvenous pacemakers, but leadless pacemakers add a new layer of consideration. Although there have been prior documented experiences with the Micra device, there are enough differences between the Aveir VR and the Micra that it is important to understand what makes the Aveir VR unique if an anesthesiologist were to come across one preoperatively.
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J. Cardiothorac. Vasc. Anesth. · Dec 2022
ReviewAngiotensin II - A Brief Review and Role in Severe SARS-COV-2 Sepsis.
The renin-angiotensin-aldosterone system (RAAS), whose major vasopressor effector is angiotensin II (ATII), has multiple activities and regulates sodium-water homeostasis and fluid and blood pressure homeostasis. RAAS plays a crucial role in cardiocirculatory shock because it counteracts hypotension and hypovolemia by activating different physiologic responses. Based on the encouraging results of the ATHOS-3 trial, the US Food and Drug Administration and the European Medicines Agency approved the use of ATII for catecholamine-resistant vasodilatory shock. ⋯ Beyond its vasopressor properties, ATII was hypothesized to have antiviral activity because it induces internalization and degradation of angiotensin-converting enzyme 2 receptors used by SARS-Cov-2 to infect cells. Overall, the use of ATII in patients with COVID-19 showed promising results because its administration was associated with the achievement and maintenance of target mean arterial pressure, increased PaO2/FIO2 ratio, and decreased FIO2. The aim of this narrative review is to summarize the available knowledge on the use of ATII in patients with COVID-19.