Transesophageal Echocardiography-Guided Extracorporeal Membrane Oxygenation Cannulation in COVID-19 PatientsA paucity of data supports the use of transesophageal echocardiography (TEE) for bedside extracorporeal membrane oxygenation (ECMO) cannulation. Concerns have been raised about performing TEEs in patients with COVID-19. The authors describe the use and safety of TEE guidance for ECMO cannulation for COVID-19.
Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized StudyThe 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.
Aortic Valve Repair Using HAART 300 Geometric Annuloplasty Ring: A Review and Echocardiographic Case SeriesAortic valve repair (AVr) aims to preserve the native aortic leaflets and restore normal valve function. In doing so, AVr is a more technically challenging approach than traditional aortic valve replacement. Some of the complexity of repair techniques can be attributed to the unique structure of the functional aortic annulus (FAA), which, unlike the well-defined mitral annulus, is comprised of virtual and functional components. Though stabilizing the ventriculo-aortic junction (VAJ), a component of the FAA, is considered beneficial for patients with chronic aortic insufficiency (AI), the ideal AVr technique remains a subject of much debate.
Prospective Observational Trial of a Nonocclusive Dilatation Balloon in the Management of Tracheal StenosisTRACHEAL STENOSIS is a debilitating condition that is difficult to treat, requires multidisciplinary management, and yet often presents with severe respiratory compromise requiring urgent intervention. Emergency tracheostomy may be life-saving but impacts future definitive management by tracheal resection and reconstruction (TRR).1,2 Although considered the gold standard for the management of tracheal stenosis, TRR requires a high level of resources and still is associated with a significant rate of failure and restenosis.
Assessing Skill Acquisition in Anesthesiology Interns Practicing Central Venous Catheter Placement Through Advancements in Motion AnalysisThe study authors hypothesized that a combination of previously used (path length, translational motions, and time) and novel (rotational sum) motion metrics could be used to analyze learning curves of anesthesiology interns (postgraduate year 1) practicing central venous catheter placement in the simulation setting. They also explored the feasibility of using segmented motion recordings to inform deliberate practice.
An Approach to Standard Perioperative Transthoracic Echocardiography Practice for Anesthesiologists—Perioperative Transthoracic Echocardiography ProtocolsThe use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists’ training and practice. While a special “certification in Critical Care Echocardiography” was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists.
Mitral Valve Cleft-like Indentations in Hypertrophic Obstructive Cardiomyopathy: Insights From Intraoperative Three-Dimensional Transesophageal EchocardiographyCleft-like indentations (CLIs) of the mitral valve (MV) are best assessed with three-dimensional (3D) transesophageal echocardiography (TEE). The present study examined the prevalence, characteristics, and surgical effect of MV CLIs in patients with hypertrophic cardiomyopathy (HCM).
Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach ProposalDespite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. However, there is a lack of consensus on the formal role of ultrasound during evaluation of perioperative hypoxia or hypotension.
Syringe-Free, Long-Axis in-Plane Versus Short-Axis Classic out-of-Plane Approach for Ultrasound-Guided Internal Jugular Vein Catheter Placement in Critically Ill Children: A Prospective Randomized StudyAlthough pediatric central venous catheterization is performed using ultrasound guidance, it is still a challenge. This study aimed to investigate the efficacy of the syringe-free, long-axis in-plane approach and compared the short-axis classic out-of-plane approach for ultrasound-guided central venous catheter placement in critically ill pediatric patients.
Usefulness of Right Ventricular Longitudinal Shortening Fraction to Detect Right Ventricular Dysfunction in Acute Cor Pulmonale Related to COVID-19RIGHT VENTRICULAR (RV) dysfunction, evaluated by echocardiography, is not a rare complication of coronavirus disease 2019 (COVID-19) infection, with an estimated incidence of 27%.1 RV systolic function is classically assessed with transthoracic echocardiography (TTE) by RV-fractional area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), or S′ tricuspid systolic (RV-S′) wave velocity obtained by tissue-Doppler imaging.2 More recently, two-dimensional speckle-tracking echocardiography (2D-STE), a semi-automated angle-independent method, has been developed to evaluate the RV systolic function.
Continuous Noninvasive Arterial Pressure Monitoring for Transcatheter Aortic Valve ReplacementThe objective of the present study, which was conducted in patients undergoing transcatheter aortic valve replacement, was to compare continuous noninvasive arterial pressure measured with the ClearSight device (Edwards Lifesciences, Irvine, CA) with invasive radial artery pressure used as the reference method. The authors hypothesized that the ClearSight device is an accurate, precise, safe, and efficient method for arterial blood pressure measurement comparable with an invasive radial arterial line.
Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac SurgerySystemic intravenous administration of opioids is the main treatment strategy for intraoperative and postoperative pain management in patients undergoing cardiac surgery with sternotomy. However, using lower doses of opioids may achieve the well-established benefits of the fast-track approach, with minimal opioid-related side effects. Postoperative pain is coupled with a long stay in the intensive care unit. Although neuraxial anesthesia has some benefits, its use remains controversial due to the potential development of epidural hematoma after anticoagulation for cardiopulmonary bypass and coagulopathy after cardiac surgery.
Pneumonia: Hiding in Plain (Film) SightHerein, a case describing how point-of-care lung ultrasound was used to identify the source of progressive multiorgan failure when a chest x-ray and other routine tests failed to provide a conclusive answer is presented. The discussion after the case focuses on the following: (1) the relative strengths and weaknesses of chest x-ray versus lung ultrasound in screening for lung disease and (2) suggestions of how lung ultrasound practice can be standardized within the field of anesthesiology.
Role of Ultrasound-Guided Evaluation of Dyspnea in the Coronavirus Disease 2019 PandemicTHE NOVEL coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic termed as “coronavirus disease 2019 (COVID-19)”, causing an unprecedented pressure on healthcare systems. Clinical care for COVID-19 patients varies widely in different parts of the world, with rapid evolution in diagnostic and therapeutic management. New insights into clinical imaging techniques are being acquired rapidly to reduce infection risk and maximize resource utilization. Previously, ultrasonography was established as an effective and inexpensive alternative imaging modality for the identification and monitoring of pneumonia and acute respiratory distress syndrome (ARDS).
A Rare Cause of a Left Atrial MassIntramyocardial hematomas are a rare complication of myocardial infarctions. Normally restricted to the left ventricle, in certain scenarios, such as after a percutaneous coronary intervention, intramyocardial hematomas also can occur in the left atrium. Herein, the case of a 74-year-old man who presented to the authors’ institution with a large inferior wall myocardial infarction refractory to multiple pressor therapy and thus necessitated venoarterial extracorporeal membrane oxygenation support is described.
Cardiopulmonary Resuscitation in Intensive Care Unit Patients With Coronavirus Disease 2019Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2–associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment.
Prediction of Pleural Adhesions by Lung Ultrasonography: An Observational StudyVIDEO-assisted thoracoscopic surgery (VATS) has gained widespread acceptance because of advantages such as minimal wounds, reduced pain, and enhanced recovery.1 However, the presence of pleural adhesions is one of the major obstacles in VATS, which disturbs lung collapse, adds the risk of lung injury from a trocar or scope, and causes conversion to open surgery in severe cases. Pleural adhesions also increase the operating time, bleeding, and postoperative pain from accompanying adhesiolysis.2 Therefore, if pleural adhesions can be detected before surgery, it may allow anesthesiologists to help surgeons insert the trocar or scope safely, to prepare for a prolonged surgery or the possibility of open conversion, and to consider more active pain management, such as multimodal analgesia including nerve block.
The Year in Perioperative Echocardiography: Selected Highlights From 2019This article is the fourth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board, for the opportunity to continue this series. In most cases, these were research articles that were targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but in some cases, these articles targetted the use of perioperative echocardiography in general.
Extraluminal Placement of the Bronchial Blocker in Infants Undergoing Thoracoscopic Surgery: A Randomized Controlled StudyThe purpose of the present study was to evaluate the efficacy of extraluminal use of the bronchial blocker (BB) for one-lung ventilation (OLV) in infants undergoing thoracoscopic surgery.
Echocardiography-Guided Dual-Lumen Venovenous Extracorporeal Membrane Oxygenation Cannula Placement in the ICU—A Retrospective ReviewThe most effective method of image guidance for venovenous extracorporeal membrane oxygenation is not known. The authors’ objectives were to define the frequency of successful initial cannulation using echocardiographic guidance in the intensive care unit, as well as to determine the frequency of subsequent adjustments. Additional aims were to illustrate cannula malposition problems and to describe features associated with difficult cannulation.
Retrosternal Clots After Fontan Surgery by Systematic Evaluation With Transthoracic UltrasoundBleeding is a common, serious, and often subtle complication after total cavopulmonary connection surgery. The aim of the present study was to assess the incidence of retrosternal clots after surgery, which were searched for systematically with transthoracic ultrasound.
A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular Velocities in TEEA novel speckle-tracking-based option for measuring tricuspid annular velocities in the midesophageal 4-chamber view (ME4C) was compared with velocities measured by tissue Doppler in the apical-4 chamber view (AP4C). Because this method was based on a modified speckle-tracking-based measurement of tricuspid annular plane systolic excursion (TAPSE), the authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by M-mode in the AP4C. The authors hypothesized that velocities measured by speckle tracking in transesophageal echocardiography (TEE) would be similar, correlate, and agree with those measured by tissue Doppler in transthoracic echocardiography (TTE).
Incorporating Perioperative Point-of-Care Ultrasound as Part of the Anesthesia Residency CurriculumThe purposes of this study were to establish whether implementing a curriculum of perioperative point-of-care ultrasound (POCUS) of the heart and lungs for current in-training anesthesia residents during their required month of cardiac anesthesia was feasible and whether an evaluation tool would demonstrate improvement in the residents’ baseline knowledge of POCUS.
The Year in Perioperative Echocardiography: Selected Highlights from 2018This article is the third of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series. In most cases, these will be research articles targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but in some cases, these articles will target the use of perioperative echocardiography in general.
Anesthetic Management of Total Thoracoscopic Left Atrial Maze Procedure for Chronic Atrial Fibrillation—A Single-Institution ExperienceATRIAL FIBRILLATION (AF) is an increasingly common health problem with a prevalence of 1% to 2% that is expected to double within 20 years.1,2 As an independent risk factor for death and stroke, patients with AF have a 5-fold higher risk for those adverse outcomes compared to the general population.3 The goal of treatment is to interrupt the re-entrant circuits causing AF. Pharmacologic cardioversion is successful in only 35% to 75% of cases,4 leaving many to rely on transcatheter radiofrequency (RF) ablation or surgical treatment.