Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Pulmonary Artery Pseudoaneurysm Due to Pulmonary Artery Catheter Placement: A New Minimally Invasive Approach to Solve a Life-threatening Complication 肺动脉导管置入术导致的肺动脉假性动脉瘤：解决危及生命并发症的微创新方法。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-01-01 DOI: 10.1053/j.jvca.2024.10.017

Roberta Russo MD , Alessandro Calzolari MD , Valentina Salice MD , Camilla Micieli MD , Claudia Castiglioni MD , Mattia Gomarasca MD , Federico Mondin MD , Bedrana Moro Salihovic MD , Francesca Orsenigo MD , Davide Negroni MD , Carmelo Migliorisi MD , Matteo Lucchelli MD , Giovanni Mistraletti MD

This article discusses a pulmonary artery pseudoaneurysm (PAP) formation following pulmonary artery catheter (PAC) placement for cardiac surgery. The patient, an 82-year-old female with a history of hypertension and chronic heart failure, underwent elective mitral and tricuspid valve surgery. After surgery, bleeding was observed in the endotracheal tube, indicating a potential complication. Fiberoptic bronchoscopy revealed bleeding mainly in the right bronchus. Subsequent computed tomography pulmonary angiogram (CTPA) confirmed the presence of a small pseudoaneurysm in a branch of the pulmonary artery. Prompt collaboration between anesthesiologists, cardiac surgeons, and interventional radiologists led to the successful embolization of the pseudoaneurysm with a minimally invasive approach by using the PAC as a guide catheter to reach the PAP.

The article outlines the potential causes of PAP formation, clinical presentation, and management strategies. While conservative, surgical, and interventional approaches are discussed, the preferred treatment is coil embolization due to its effectiveness and minimal invasiveness. The authors emphasize the importance of rapid diagnosis, multidisciplinary collaboration, and the feasibility of using the pulmonary artery route for embolization to rapidly reach the lesion to stabilize. Overall, the case demonstrates the successful resolution of a life-threatening complication through timely intervention and coordinated teamwork.

本文讨论了心脏手术肺动脉导管（PAC）置入后形成的肺动脉假性动脉瘤（PAP）。患者是一名 82 岁的女性，有高血压和慢性心力衰竭病史，接受了二尖瓣和三尖瓣择期手术。术后观察到气管导管出血，表明可能出现并发症。纤维支气管镜检查发现出血主要发生在右支气管。随后进行的计算机断层扫描肺血管造影（CTPA）证实，肺动脉分支存在一个小的假性动脉瘤。麻醉科医生、心脏外科医生和介入放射科医生迅速合作，采用微创方法，利用 PAC 作为到达 PAP 的导引导管，成功栓塞了假性动脉瘤。文章概述了 PAP 形成的潜在原因、临床表现和处理策略。文章讨论了保守治疗、手术治疗和介入治疗方法，但线圈栓塞因其有效性和微创性而成为首选治疗方法。作者强调了快速诊断、多学科协作的重要性，以及使用肺动脉栓塞途径快速到达病灶以稳定病情的可行性。总之，该病例展示了通过及时干预和团队协作成功解决危及生命的并发症的过程。

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引用次数: 0

Transesophageal Echocardiographic Assessment of Incomplete Aortic Cross-Clamp 经食管超声心动图评估不完全主动脉瓣关闭不全。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-01-01 DOI: 10.1053/j.jvca.2024.10.024

Yasuhiro Suda MD, Miho Takemitsu MD, Hiroshi Makino MD, PhD

引用次数: 0

Comparison of Inhalational and Intravenous Anesthesia Induction on Electroencephalogram and Cerebral Perfusion in Children With Congenital Heart Disease: A Secondary Analysis of a Randomized Controlled Trial 先天性心脏病患儿吸入和静脉麻醉诱导对脑电图和脑灌注的影响比较：随机对照试验的二次分析。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-01-01 DOI: 10.1053/j.jvca.2024.10.025

Ding Han MM , Siyuan Xie MM , Shoudong Pan MD , Yangchuan Ou MM

Objectives

The effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction.

Design

A randomized controlled trial.

Setting

Operating room in 2 tertiary hospitals.

Participants

A cohort of 116 pediatrics patients undergoing cardiac surgery.

Measurements and Main Results

The patients were randomly assigned to either the intravenous group (n = 58) or the inhalational group (n = 58). The inhalational group received anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, whereas the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison with the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (p < 0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (p < 0.05 for all).

Conclusions

The administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared with the use of intravenous medications for anesthesia induction.

Trial registration

Chinese Clinical Trial Registry (ChiCTR1800015946).

目的：麻醉剂对先天性心脏病患儿脑电图和脑灌注的影响仍未得到充分研究。为此，我们对吸入麻醉诱导和静脉麻醉诱导进行了比较：随机对照试验：地点：两家三级医院的手术室：116名接受心脏手术的儿科患者：患者被随机分配到静脉组（58 人）或吸入组（58 人）。吸入组使用4%至6%的七氟醚和哌库铵0.2毫克/千克进行麻醉诱导，而静脉组则使用咪达唑仑0.2毫克/千克、哌库铵0.2毫克/千克和舒芬太尼1微克/千克进行麻醉诱导。气管插管十分钟后，测量以下参数：频谱边缘频率、爆发抑制事件、患者状态指数、大脑中动脉血流速度、脑氧饱和度和血液动力学参数。与静脉注射组相比，吸入组的 95% 光谱边缘频率、猝发抑制事件比率、大脑中动脉血流速度和脑氧饱和度均有显著增加（P 均＜0.05），收缩压、舒张压、心脏指数和收缩期上冲最大斜率均有下降（P 均＜0.05）：结论：与使用静脉药物进行麻醉诱导相比，使用七氟醚进行麻醉诱导可获得更多的爆发抑制，同时还能显示出更优越的脑灌注效果：试验注册：中国临床试验注册中心（ChiCTR1800015946）。

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引用次数: 0

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IF 2.3 4区医学 Q2 ANESTHESIOLOGY

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引用次数: 0

Pro: Is the Radial Artery the Ideal Location for Invasive Blood Pressure Monitoring In Cardiac Surgery? 专业人士：桡动脉是心脏手术中进行有创血压监测的理想位置吗？

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Isolated Chylous Ascites After Arterial Switch Surgery in a Newborn: Peritoneal Dialysis and Right Ventricular Pressure as Potential Contributing Factors 新生儿动脉转换手术后出现孤立性乳糜腹水：腹膜透析和右心室压力是潜在诱因。

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引用次数: 0

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients: Executive Summary. A Report From the Society of Cardiovascular Anesthesiologists 心脏外科患者术后疼痛管理实践指南：执行摘要。心血管麻醉医师学会报告。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-01-01 DOI: 10.1053/j.jvca.2024.10.015

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Cardiac surgery is associated with significant postoperative pain that can affect patients’ recovery and quality of life. Optimal analgesia after cardiac surgery can be challenging due to patients’ coexisting morbidities and frequently observed adverse effects when opioids are used to treat postoperative pain. In this current era of enhanced recovery and fast track extubation, multimodal analgesia is increasingly being utilized for pain management after cardiac surgery. Regional analgesia is an integral part of multimodal analgesia and has garnered more attention since the development of fascial plane blocks. There is considerable variability among individuals, institutions, and practices in the analgesic approaches used to treat postoperative pain in cardiac surgical patients because of lack of consensus or guidelines. This practice advisory was developed with the overall goal of identifying opportunities for improving postoperative pain relief and pain-related outcomes after cardiac surgery and guiding perioperative providers through the provision of clinically relevant evidence-based recommendations.

心脏手术会带来明显的术后疼痛，影响患者的康复和生活质量。由于患者同时患有多种疾病，而且在使用阿片类药物治疗术后疼痛时经常会观察到不良反应，因此心脏手术后的最佳镇痛方法具有挑战性。在当前加强恢复和快速拔管的时代，心脏手术后疼痛管理中多模式镇痛的使用正在不断扩大。区域镇痛是多模式镇痛不可或缺的一部分，自筋膜平面阻滞问世以来，区域镇痛受到越来越多的关注。由于缺乏共识或指南，在治疗心脏手术患者术后疼痛的镇痛方法方面，个人、机构和实践之间存在差异。制定本实践建议的总体目标是确定改善心脏手术术后疼痛缓解和疼痛相关预后的机会，并通过提供临床相关的循证建议来指导围手术期提供者。

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引用次数: 0

Echocardiographic Evaluation During Biventricular Assist Device Insertion With Transatrial Cannulation in a Patient With Shone's Complex 超声心动图评价BiVAD插入经房导管对肖尼综合症患者的影响

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

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引用次数: 0

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