Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Dec 2024
ReviewPain Management in Open Abdominal Aortic Aneurysm Repair: Potential Alternatives to Epidural Anesthesia.
Despite significant advances in endovascular techniques, open abdominal aortic aneurysm (AAA) repair continues to play an important role in vascular surgery. Many studies have described the advantages of epidural anesthesia combined with general anesthesia over general anesthesia alone as an analgesic method for open AAA repair. Several recent guidelines have recommended epidural anesthesia as the first option for pain management in open AAA repair. ⋯ Although the efficacy and safety of ultrasound-guided nerve blocks, continuous local wound infiltration, and intravenous administration of lidocaine in open AAA repair have been evaluated in several studies, few studies have evaluated the efficacy of continuous nerve blocks compared with epidural anesthesia. In this article, the authors present a narrative review of pain management techniques used in open AAA repair, focusing on pain management techniques other than epidural anesthesia. Research gaps and the need for further studies on this topic are also discussed.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2024
Sex-Based Differences in Ruptured Abdominal Aortic Aneurysm Management and Outcomes: An Update.
This study aimed to evaluate sex-based differences in outcomes following ruptured abdominal aortic aneurysm (AAA) repair, focusing on mortality, morbidity, and postoperative complications. ⋯ Significant sex-based disparities were found in AAA repair outcomes. Men had higher comorbidity burdens while women presented at an older age with an increased time from symptom onset to repair. These findings support the need for sex-specific guidelines and interventions to improve outcomes for both women and men.
-
J. Cardiothorac. Vasc. Anesth. · Dec 2024
Crossing Boundaries: Utilizing Left-sided Impella for Right Ventricular Mechanical Support and Intraoperative Transesophageal Echocardiogram Considerations.
Right ventricular failure is a leading cause of mortality among patients with various etiologies of cardiogenic shock. This case series outlines an innovative approach to directly unloading the right ventricle with the Impella LD or 5.5 without crossing the tricuspid valve in cases requiring tricuspid valve repair or replacement. ⋯ Left-sided Impella can be used to support the right ventricle in patients who have undergone surgical tricuspid valve procedures. It provides direct right ventricular unloading, does not cross a newly replaced or repaired tricuspid valve, and allows early ambulation.