Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Jul 2022
ReviewThree-Dimensional Transesophageal Echocardiography Simulator: New Learning Tool for Advanced Imaging Techniques.
The use of intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) has grown exponentially in recent years. Three-dimensional TEE technology has evolved to allow for real-time display of 3D images and, thus, has become the standard of care for the evaluation of cardiac anatomy and function. Its use has provided a new dimension of clinical insight when managing patients for cardiac surgery or structural heart interventions. ⋯ This training is essential, as the skill set involved in acquiring 3D data sets differs from that of two-dimensional (2D) TEE and requires users to be able to appreciate how 3D anatomic display differs from that of tomographic cross-sectional 2D imaging. This added skill set requires mental reconstruction and spatial reorientation to appreciate the added elevational dimension in frustum-based imaging and is best achieved in a simulation environment rather than the busy operating room. In this review article, the authors evaluate the functionality of a 3D TEE simulator and how simulators such as this can establish preclinical proficiency in novices in the expanding area of advanced 3D TEE imaging.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2022
Meta AnalysisRole of Hypothermia in Adult Cardiac Surgery Patients: A Systematic Review and Meta-analysis.
To review studies that assessed systemic hypothermia as an organ protection strategy in adults undergoing cardiac surgery with cardiopulmonary bypass. ⋯ The existing evidence for an organ-protective effect of hypothermia in adult cardiac surgery is of low quality and inconsistent.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2022
ReviewContrast-Enhanced Echocardiography Application in Patients Supported by Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review.
Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention increasingly used to support patients with severe respiratory and cardiac dysfunction. Echocardiography is an important tool, aiding implantation and monitoring during ECMO therapy, but often its use is limited by poor acoustic windows. ⋯ In this article the authors review the literature addressing the use of contrast-enhanced echocardiography (CEE) in ECMO-supported patients. The authors discuss the role of CEE in guiding implantation of ECMO, cardiac assessment and diagnosis of complications during ECMO therapy, as well as the safety of ultrasound-enhancing agents in this cohort of patients.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2022
ReviewPerioperative Presentations of Kounis Syndrome: A Systematic Literature Review.
Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting coronary arteries, resulting in coronary vasospasm in the context of an allergic manifestation. This article reviews the literature regarding perioperative presentations of the syndrome. A systematic search in MEDLINE and Embase databases was performed for case reports through June 16, 2021, on Kounis syndrome triggered by medications administered in the perioperative setting. ⋯ Coronary vasospasm is often less frequently recognized as a form of allergic manifestation in the perioperative setting. Many potential triggers, such as antibiotics and neuromuscular blocking agents, are routinely administered during surgery. Awareness of this condition, early diagnosis, and effective management of this condition can lead to good outcomes.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2022
ReviewIntraoperative Hypotension-Physiologic Basis and Future Directions.
Intraoperative hypotension (IOH) is a major concern to the anesthesiologist. Its appropriate identification and management require an understanding of the physiology of blood pressure regulation, prudent blood pressure monitoring, and treatment. Even short durations of low mean arterial pressure have been associated with adverse postoperative clinical outcomes. ⋯ This new technology has the potential to reduce duration or even prevent IOH. In the authors' opinion, it is an example of how human-machine interaction will contribute to future advances in medicine. Additional studies should evaluate the effects of its use on postoperative outcomes.