- 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.
- 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.
- 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).
- 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.
- TOTALLY ENDOSCOPIC coronary artery bypass (TECAB) performed with robotic technology is an innovative procedure that allows coronary revascularization in the closed chest. Experience with TECAB surgery first was reported in 1999,1 and subsequent results have demonstrated the general application of this technique.2-4 Early and midterm patient outcomes are comparable to the conventional approach,2-6 but these initial cohorts of patients are still under observation for long-term outcomes.
- BASED LARGELY ON THE success of laparoscopic surgery in the 1990s, minimally invasive surgical approaches have gained widespread acceptance among many surgical specialties; cardiac surgery is no exception. In addition, the lay press and Internet are replete with reports of cardiac valve repair or replacement through small incisions with reportedly improved recovery times and cosmesis. Perhaps the most dramatic change to the surgical approach of valvular repair is with the use of robotic assistance (Fig 1).
- ANESTHESIOLOGISTS cannot concentrate solely on advances made within the specialty, but must also keep up with developments occurring within the field of surgery because the surgical management of the patients partly determines the anesthetic management. Mitral valve disease and its surgical therapy represent a very dynamic area within the field of cardiac surgery. Thanks to better understanding of the anatomy of the mitral valve apparatus, pathophysiology of underlying disease processes, and improvements in surgical technique, a shift has taken place clearly favoring mitral valve repair over mitral valve replacement for regurgitant lesions.