Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Mar 2010
Comparative StudyPostoperative recovery advantages in patients undergoing thyroid and parathyroid surgery under regional anesthesia.
Thyroid or parathyroid surgery may be performed using general anesthesia or regional anesthesia. Ninety-five (95) patients underwent thyroid or parathyroid surgery using general anesthesia (n=64) or bilateral superficial cervical plexus block with sedation (n=31) and completed a postoperative questionnaire regarding the perioperative experience. Patients undergoing parathyroid surgery under regional anesthesia (n=24) were more likely to experience better energy levels (p=0.012) and earlier return to work (p=0.045) postoperatively. Overall, 96% of patients undergoing either type of surgery with either type of anesthetic reported satisfaction with the anesthetic.
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Semin Cardiothorac Vasc Anesth · Mar 2010
Use of paravertebral blockade to facilitate early extubation after minimally invasive cardiac surgery.
We retrospectively reviewed the first 14 patients who received preoperative paravertebral blockade prior to minimally invasive cardiac surgical procedures. The use of paravertebral blockade along with an anesthetic technique designed to facilitate rapid recovery allowed early extubation in the operating room or intensive care unit in all but one patient. Extubated patients leaving the operating room were comfortable. No postoperative respiratory complications occurred.
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Semin Cardiothorac Vasc Anesth · Mar 2010
ReviewCentral nervous system protection in cardiac surgery.
Neurological dysfunction and stroke following cardiac surgery and thoracic surgery requiring hypothermic circulatory arrest is a well-defined problem. The original studies in CABG patients identified risk factors, such as prior stroke and lower educational level. There is older evidence suggesting that higher perfusion pressures during cardiopulmonary bypass are helpful. ⋯ The subset of patients having thoracic aortic surgery requiring periods of aortic discontinuity are particularly problematic. A cerebral protection strategy should be determined, and this may include hypothermic circulatory arrest, selective cerebral perfusion, or retrograde cerebral perfusion. All of these techniques have been associated with good surgical outcomes, but there is little information on cognitive outcomes of thoracic aortic surgery.
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Semin Cardiothorac Vasc Anesth · Mar 2010
Case ReportsA case of difficulty predicting neurological deficit during thoracoabdominal aortic surgery.
Perioperative spinal cord injury associated with thoracoabdominal aorta (TAAA) surgery is a devastating complication. With variable results, the intraoperative use of neurophysiologic monitoring has been employed for the diagnosis and prevention of spinal cord ischemia. ⋯ However, postoperatively these changes in evoked potentials never manifested in neurologic injury. We examine the utility of neurophysiologic monitoring as it pertains to TAAA surgery.
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Semin Cardiothorac Vasc Anesth · Mar 2010
Anesthesia management of a patient with a ventricular assist device for noncardiac surgery.
Congestive heart failure represents a severe health condition with unfavourable long-term prognosis despite all the progress in pharmacological therapy of heart failure. Another therapeutic option is represented by mechanical cardiac support devices. Ventricular assist devices (VAD) constitute largest subgroup of these devices. ⋯ In all the patients supported with VAD, transesophageal echocardiography is extremely useful method for monitoring the function of VAD itself, and in the case of univentricular VAD for monitoring the function of nonsupported cardiac ventricle. The most important issue in hemodynamic management of the patients with VAD is avoiding hypovolemia because it can cause inadequate VAD output with resulting low cardiac output and hypotension. All the patients with VAD need some degree of anticoagulation, and for noncardiac surgery the question of interrupting or decreasing the level of anticoagulation should be discussed among members of the caring team.