AANA journal
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Eisenmenger syndrome is an insidious disease entity. This disease is characterized by an unrepaired congenital heart defect and left-to-right cardiac shunting. After many years of increased blood flow through the pulmonary system as a result of the shunting, damage to the pulmonary vessels occurs, culminating in severe pulmonary hypertension. ⋯ Because of the great strides in medical care, more patients with Eisenmenger syndrome require anesthesia. Maintaining the patient's systemic vascular resistance at the preoperative level is of paramount importance. Choosing the best anesthesia technique is difficult, at best.
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Review Case Reports
Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: a case report.
The use of bispectral index (BIS) for monitoring neuronal function under general anesthesia has been expanding in practice. However, the meanings of the values are not always clear and have been shown to be altered by such drugs as ketamine, ephedrine, and physostigmine. ⋯ The patient reported no intraoperative recall despite BIS values in the high 70s. This case reinforces that BIS values require interpretation and can only be relevant to the circumstances of the individual case.
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Perioperative beta blockade has been proven to significantly reduce the incidence of myocardial ischemia and myocardial infarction and of long-term overall mortality related to cardiac events after various surgeries in patients at intermediate or high risk for such events. The major physiologic effects of beta blockers result in a positive balance of myocardial oxygen supply and demand. Although the optimal time frame for initiation of treatment is not clear from the available data, it has been shown that beta blocker therapy is effective when started at least 1 week before the scheduled surgery and continued throughout the postoperative period. The current recommendations for perioperative beta blockade for patients at intermediate and high risk for a perioperative cardiac event are to use a beta1 blocking agent, begin therapy several weeks before a planned operation, titrate the dose to achieve a heart rate of 60 to 70 beats per minute, and taper the dose of the beta blocker after the postoperative period.
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The purpose of this article is to describe the benefits of using the Universal Oxygen Connector. Until now, an oxygen hose was only able to connect to a 22-mm fitting, such as those found on humidifiers used in the recovery room, and oxygen tubing was only able to connect to a Christmas tree type adapter. The Universal Oxygen Connector, manufactured and sold by International Medical, Inc (Burnsville, Minn), was developed to allow the practitioner to attach either a 22-mm oxygen hose, oxygen tubing, or a 15-mm oxygen adapter to the same connector. ⋯ As such, oxygen should be administered during transport from the operating room to the recovery room, in the recovery room, and at times during transport to the patient room and in the patient room. Oxygen also should be administered whenever a patient receiving oxygen is transported. Use of the Universal Oxygen Connector decreases material waste, decreases hospital costs, saves time and effort and, most importantly, promotes patient safety by providing a versatile system for oxygen delivery.
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Review Case Reports
Off-pump coronary artery bypass grafting: a case report.
It is easy to take for granted the seemingly effortless way cardiovascular surgeons are able to bypass atherosclerotic coronary arteries. The process used today was developed over many years of rigorous study, experimentation, success, and failure. Early cardiac surgery was performed blindly, through small incisions, on a beating heart. ⋯ A case report of a 72-year-old female who underwent OPCAB is outlined. Included is a discussion of some of the benefits and potential complications of CABG and OPCAB. Anesthetic considerations for OPCAB procedures also are presented.