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Temporary Epicardial Pacing After Cardiac Surgery
Temporary epicardial pacing frequently is employed after cardiac surgery, and can have a significant impact on a patient's hemodynamics, arrhythmias, and valvulopathies. Given that anesthesiologists often are involved intimately in the initial programming and subsequent management of epicardial pacing in the operating room and intensive care unit, it is important for practitioners to have a detailed understanding of the modes, modifiable intervals, and potential complications that can occur after cardiac surgery.Acute Cardiointestinal Syndrome Resulting From Postoperative Acute Biventricular Heart Failure
ACUTELY DECOMPENSATED HEART FAILURE (HF), if left untreated, causes organ hypoperfusion that can progress to irreversible and life-threatening multiorgan dysfunction. Cardiointestinal syndrome (CIS) is the result of both persistent venous congestion and hypoperfusion of the intestines as a result of biventricular HF.1 These mechanisms contribute to perturbations in normal intestine function that ultimately result in intestinal bacteria product translocation into the bloodstream.2 This translocation causes inflammatory cytokine production and sepsis, which depress myocardial function and eventually lead to biventricular heart failure, multiorgan failure, and death.Ultrasound-Enhancing Agent Enables Transthoracic Echocardiography in Patients With Delayed Sternal Closure
DELAYED STERNAL CLOSURE (DSC) is a technique adopted to manage unstable patients after cardiac surgery, including low-cardiac-output state (LCOS), intractable bleeding, and arrhythmia.1 This cohort of patients may have extensive devices within the thorax, including metal retractors, vacuum- assisted closure systems, swabs, drains, and central venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulae, rendering cardiac visualization very challenging. Transesophageal echocardiography (TEE) is the main tool to assess cardiac function in these patients.Intraoperative and Early Postoperative Management of Patients Undergoing Minimally Invasive Left Ventricular Assist Device Implantation
Minimally invasive approaches for left ventricular assist device (LVAD) implantation have grown in popularity and have many potential advantages, including less bleeding, shorter recovery time, and improved postoperative right ventricular function compared with traditional implantation. Centrifugal flow LVADs are easily implanted via a minimally invasive approach. In this article, the authors review intraoperive considerations for minimally invasive LVAD implantation and hemodynamic management principles for patients with centrifugal flow LVADs.Intraoperative Transesophageal Echocardiographic Findings in Surgical Resection of a Giant Right Atrial Diverticulum That Severely Compressed the Right Ventricle
A RIGHT ATRIAL (RA) diverticulum is a rare congenital malformation characterized by extraordinary cardiac enlargement that is often incidentally diagnosed by cardiac imaging.1–5 The etiology and optimal treatment of an RA diverticulum remain unclear because patients cases are asymptomatic. Although surgical resection is indicated for symptomatic patients, there have been no reports of intraoperative transesophageal echocardiography (TEE) of an RA diverticulum.Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic Review and Meta-Analysis
To identify the normal baseline preoperative range of cerebral tissue oxygen saturation (SctO2) derived using near-infrared spectroscopy (NIRS) and the efficacy of perioperative interventions designed to modulate SctO2 in cardiac surgical patients.Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT)
The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery.Left Atrium Dissection: A Rare Cardiac Surgery Complication
LEFT ATRIAL DISSECTION is a rare complication of cardiac surgeries and usually is associated with mitral valve procedures. Typically, a false chamber is created through a tear of the mitral valve annulus extending into the left atrial wall. Transesophageal echocardiography (TEE) is used for diagnosis. The authors present a case of left atrial dissection that occurred after an ascending and transverse aortic arch aneurysm repair that was managed successfully conservatively.Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a Systematic Review in Post-Cardiac Surgical Patients
LOSS OF HEMODYNAMIC coherence1 between macrocirculatory oxygen parameters and the peripheral microvasculature frequently is seen in critically ill patients,2 including postoperative cardiac surgery patients. Hemodynamic stabilization by volume expansion and pharmacologic cardiovascular support may correct systemic hemodynamic variables but not oxygenation and perfusion of the microcirculation.1,3 Persistent microcirculatory abnormalities are associated with adverse patient outcomes.4 Consequently, there is interest in minimally invasive methods to assess the microvasculature in addition to established systemic hemodynamic monitoring in patients admitted to intensive care units (ICUs).Cardiovascular Collapse in the Pregnant Patient, Rescue Transesophageal Echocardiography and Open Heart Surgery
ANESTHESIOLOGISTS with a practice in obstetrics must be acutely aware of the differential diagnosis of maternal cardiovascular collapse during pregnancy. The overall risk of maternal death is 6.5 in 100,000 deliveries and typically occurs in the third trimester.1 Deaths in the first and second trimesters are rare. The most common etiologies include pre-eclampsia (16%), amniotic fluid embolism (AFE) (14%), hemorrhage (12%), cardiac disease (11%), and pulmonary thromboembolism (9%). Less common etiologies include infection, medication error, and ectopic pregnancy.A Pharmacokinetic Model for Protamine Dosing After Cardiopulmonary Bypass
This study investigated postoperative hemostasis of patients subjected to conventional protamine dosing compared with protamine dosing based on a pharmacokinetic (PK) model following cardiopulmonary bypass.Predictive Value of Intraoperative Thromboelastometry for the Risk of Perioperative Excessive Blood Loss in Infants and Children Undergoing Congenital Cardiac Surgery: A Retrospective Analysis
Laboratory hemostatic variables and parameters of rotational thromboelastometry (ROTEM) were evaluated for their ability to predict perioperative excessive blood loss (PEBL) after congenital cardiac surgery.Incidental Finding of a Right Atrial Appendage Thrombus During Cardiac Surgery
RIGHT ATRIAL APPENDAGE (RAA) thrombi are encountered much less frequently than their left-sided counterparts. This difference is explained partly by dissimilarities in appendage anatomy and function. Atrial fibrillation (AF), right ventricular failure, and pulmonary hypertension are associated with RAA clots. Right atrial appendage thrombi remain a potential risk for serious embolic events and need to be addressed accordingly. The left atrial appendage (LAA) is studied routinely for the presence of thrombi in the setting of AF.Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial
Several studies have suggested that the cardioprotective effects of halogenated anesthetics in cardiac surgery result in reduced cardiac biomarker release compared with total intravenous anesthesia (TIVA). These findings came from relatively small randomized clinical trials and meta-analyses. The authors of this study hypothesized that the beneficial effects of volatile anesthetics translate into a reduced length of hospital stay after coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass.Intraoperative Anemia and Single Red Blood Cell Transfusion During Cardiac Surgery: An Assessment of Postoperative Outcome Including Patients Refusing Blood Transfusion
Increasing evidence suggests benefits from restrictive red blood cell transfusion (RBC) thresholds in major surgery and critically ill patients. However, these benefits are not obvious in cardiac surgery patients with intraoperative anemia. The authors examined the association between uncorrected hemoglobin (Hb) levels and selected postoperative outcomes as well as the effects of RBCs.Intraoperative Transesophageal Echocardiography for the Evaluation and Management of Diastolic Dysfunction in Patients Undergoing Cardiac Surgery: A Survey of Current Practice
To characterize existing practice patterns for intraoperative evaluation and grading of diastolic dysfunction in patients undergoing cardiac surgery.Risk Factors and Impact on Clinical Outcome of Multidrug-Resistant Acinetobacter Baumannii Acquisition in Cardiac Surgery Patients
Acinetobacter baumannii recently has emerged as an important nosocomial pathogen. The aim of this study was to assess the impact on mortality of multidrug-resistant A. baumannii (MDR-AB) infection/colonization in patients undergoing cardiac surgery and to investigate microbiologic characteristics, epidemiologic spread of this pathogen, and the relative containment measures.Rate of Major Anesthetic-Related Outcomes in the Intraoperative and Immediate Postoperative Period After Cardiac Surgery
To examine anesthesia-centered outcomes in a large cohort of patients undergoing coronary artery bypass grafting (CABG) or valvular heart surgery.Video Fluoroscopy for Positioning of Pulmonary Artery Catheters in Patients Undergoing Cardiac Surgery
To determine whether video fluoroscopy combined with traditional pressure waveform analyses facilitates optimal pulmonary artery catheter (PAC) flotation and final positioning compared with the traditional pressure waveform flotation technique alone.CASE 12—2015: Tropheryma Whipplei Endocarditis
A 50−60-YEAR-OLD MAN with ongoing alcohol and methamphetamine abuse and a suspected history of intravenous drug use presented to the emergency department with a 1-month history of bilateral leg pain. Physical examination was significant for a cold left foot and absent left dorsalis pedis and tibialis posterior pulses. Auscultation revealed a 4/6 crescendo-decrescendo systolic murmur heard loudest over the right upper sternal boarder, and a 3/6 diastolic decrescendo murmur heard loudest over the right lower sternal boarder.Air in the Moustache Can Choke the Left Ventricle
AORTIC ROOT PATHOLOGIES often require complex surgical repair techniques due to the involvement and manipulation of the coronary arteries. In 1981, Cabrol et al described a technique to reimplant the coronary arteries into the aortic conduit using a Dacron tube graft.1 In the 1980s and 1990s, the Cabrol technique and its modifications commonly were performed during aortic root surgery, but now are used less frequently due to the development of improved coronary ostial button mobilization techniques.Preliminary Experience With Combined Inhaled Milrinone and Prostacyclin in Cardiac Surgical Patients With Pulmonary Hypertension
To retrospectively evaluate the effects of combined inhaled prostacyclin and milrinone to reduce the severity of pulmonary hypertension when administered prior to cardiopulmonary bypass.Echocardiography-Based Hemodynamic Management in the Cardiac Surgical Intensive Care Unit
INTRAOPERATIVE TRANSESOPHAGEAL echocardiography (TEE) is well established within the cardiac operating room. Confirmation of the preoperative diagnosis is sought and additional relevant information is communicated to the surgeon. Following the procedure, the results of surgery are examined together with any complications, and information from echocardiography is used to optimize hemodynamic status. As the patient moves to the cardiac critical care unit and the TEE probe is removed, this information is no longer available.Impairment of Venous Drainage Due to Atrial Septal Aneurysm During Open-Heart Surgery
IT IS NOT UNCOMMON to encounter inadequate venous drainage during cardiopulmonary bypass. Some common causes include poor positioning and obstruction of the venous cannula, increased resistance due to the small diameter of the venous cannula, and kinks in the tubing that connects the venous cannula to the venous reservoir. We report a case of atrial septal aneurysm (ASA) impairing venous drainage from a 2-stage venous cannula in right atrium during a routine cardiac surgery case requiring cardiopulmonary bypass (CPB).Impact of the Anesthesiologist and Surgeon on Cardiac Surgical Outcomes
To determine the impact of anesthesiologists, surgeons, and their monthly caseload volume on mortality after cardiac surgery.
