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The Important Thing Is Not to Stop Questioning. 重要的是不要停止质疑。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-29 DOI: 10.1177/10892532241279627
Daniel Haines, Ryan Grell, Jiapeng Huang, Benjamin Abrams, Miklos D Kertai
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引用次数: 0
Perioperative and Anesthetic Considerations in Vascular Rings and Slings. 血管环和吊索的围手术期和麻醉注意事项。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-20 DOI: 10.1177/10892532241234404
Michael Wadle, Denise Joffe, Carl Backer, Faith Ross

Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.

血管环是一种日益普遍和多样化的先天性畸形,主动脉弓及其主要分支会环绕并收缩食管和气管。根据病变类型、相关并发症和邻近结构受损情况,围手术期的处理方法也大不相同。已有多篇综述文章从外科角度描述了血管环的范围和相关问题。本综述旨在从麻醉提供者的角度讨论此类病变的围手术期影响和建议。
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引用次数: 0
Management of Anticoagulation and Antifibrinolytics in Catastrophic Antiphospholipid Syndrome. 灾难性抗磷脂综合征的抗凝和抗纤溶药物管理。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-05 DOI: 10.1177/10892532241249782
Jee Ha Park, Nazia Siddiqui, William K Hrebec, Trevor J Szymanski, Santiago Uribe-Marquez, Kyle G Miletic, Sandeep Krishnan

Antiphospholipid syndrome (APS) is an autoimmune disorder that presents with hypercoagulability and results in a lab artifact of prolonged PTT. The most severe form is catastrophic antiphospholipid antibody syndrome (CAPS), which manifests as rapidly progressing thromboses in multiple organ systems leading to multi-organ ischemia. The mainstay management CAPS is anticoagulation and systemic corticosteroids. Antifibrinolytic agents have previously been thought to be relatively contraindicated in CAPS due to the pro-thrombotic nature of the disease; the complex coagulation profile of CAPS can make it difficult to assess the risks and benefits of antifibrinolytic therapy. Also, should a patient with CAPS require cardiopulmonary bypass (CPB) for surgery, it poses a unique challenge in providing appropriate anticoagulation in the setting of prolonged ACT. We present a case of a 32-year-old postpartum female with CAPS requiring heart transplant who safely received intraoperative antifibrinolytic therapy and was successfully anticoagulated during CPB after perioperative plasmapheresis.

抗磷脂抗体综合征(APS)是一种自身免疫性疾病,表现为高凝状态,并导致 PTT 延长的实验室假象。最严重的形式是灾难性抗磷脂抗体综合征(CAPS),表现为多个器官系统迅速形成血栓,导致多器官缺血。治疗 CAPS 的主要方法是抗凝和全身使用皮质类固醇。由于 CAPS 具有促血栓形成的性质,抗纤维蛋白溶解剂以前一直被认为是 CAPS 的相对禁忌药物;CAPS 复杂的凝血谱可能会导致难以评估抗纤维蛋白溶解剂治疗的风险和益处。此外,如果 CAPS 患者需要使用心肺旁路术(CPB)进行手术,那么在延长 ACT 的情况下提供适当的抗凝治疗将是一项独特的挑战。我们介绍了一例需要进行心脏移植的 32 岁产后女性 CAPS 患者,她在术中安全地接受了抗纤维蛋白溶解治疗,并在围手术期进行血浆置换后成功地在 CPB 期间进行了抗凝治疗。
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引用次数: 0
Anesthetic Management of a Jehovah's Witness Patient for Coronary Artery Bypass Grafting With Antiphospholipid Antibody Syndrome and Renal Transplant. 对一名患有抗磷脂抗体综合征和肾移植的耶和华见证会患者进行冠状动脉旁路移植术的麻醉管理。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-24 DOI: 10.1177/10892532241236117
Katherine Greco, Dirk Varelmann, Jonah Patel

Anesthesia for cardiac surgical patients with antiphospholipid antibody syndrome (APLS) presents challenges with monitoring anticoagulation during cardiopulmonary bypass. Additionally, this condition is associated with other autoimmune diseases and comorbidities that need to be considered in caring for these patients, and there is minimal evidence for specific strategies during cardiac surgery. Separately, Jehovah's Witness (JW) patients typically do not consent to receiving blood products, presenting an additional challenge for resuscitation during cardiac surgery and especially in the context of APLS. We present our approach to the anesthetic management of a JW patient with systemic lupus erythematosus (SLE) complicated by APLS, thrombocytopenia, and renal failure with history of renal transplant who presented for coronary artery bypass surgery. Management strategies we recommend include administration of antifibrinolytics after heparinization to mitigate bleeding risk and interdisciplinary management with the perfusion, intensive care, surgical, and nephrology teams.

对患有抗磷脂抗体综合征(APLS)的心脏手术患者进行麻醉时,需要在心肺旁路过程中监测抗凝情况。此外,这种情况还与其他自身免疫性疾病和合并症有关,在护理这些患者时需要考虑到这些因素,而目前关于心脏手术期间特定策略的证据极少。另外,耶和华见证会(JW)患者通常不同意接受血液制品,这给心脏手术期间的复苏带来了额外的挑战,尤其是在 APLS 的情况下。我们介绍了我们对一名患有系统性红斑狼疮(SLE)并发 APLS、血小板减少症和肾功能衰竭并有肾移植史的 JW 患者进行麻醉管理的方法,该患者前来接受冠状动脉搭桥手术。我们建议的管理策略包括在肝素化后使用抗纤维蛋白溶解剂以降低出血风险,以及与灌注、重症监护、外科和肾内科团队进行跨学科管理。
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引用次数: 0
A Review of Pediatric Cardiomyopathy. 小儿心肌病回顾。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-06 DOI: 10.1177/10892532241250241
Jenna S Schauer, Borah Hong

Though pediatric cardiomyopathy is rare in children, there is significant associated morbidity and mortality. Etiology varies from inborn errors of metabolism to familial genetic mutations and myocyte injury. Major classes include dilated, hypertrophic, restrictive, and non-compaction. Diagnosis generally involves a combination of clinical history and echocardiography. The use of cross-sectional imaging is gaining popularity. Management varies between subtype and may involve a combination of medical and surgical interventions depending on clinical status.

虽然小儿心肌病在儿童中很少见,但其发病率和死亡率却很高。病因多种多样,包括先天性代谢错误、家族遗传突变和心肌细胞损伤。主要类型包括扩张型、肥厚型、限制型和非充盈型。诊断通常需要结合临床病史和超声心动图。横断面成像技术的使用越来越普及。不同亚型的治疗方法也不尽相同,根据临床状况,可能需要结合药物和手术治疗。
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引用次数: 0
A Multi-Country Survey on the Availability of Intraoperative Use of Echocardiography for Noncardiac Surgery. 关于非心脏手术术中使用超声心动图可用性的多国调查。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-06 DOI: 10.1177/10892532241256020
Mohamed M El Tahan, Davy C Cheng, Laszlo Szegedi, Jannicke Mellin-Olsen, Marko Zdravkovic, Eric Benedet Lineburger, Daniela Filipescu, Luigi Tritapepe, Fabio Guarracino, Caetano Nigro Neto, Paula Camona Garcia, Miguel Ángel Rodenas Monteagudo, Manuel Gil Granell, Rosario Vicente Guillén, Philippe Gaudard, Ahmed Abdulmomen, Abdelazeem Ali Eldawlatly, Serban-Ion Bubenek-Turconi, Radu Stoica, Marc Licker, Gabor Erdoes, Eckhard Mauermann, Mikhail Kirov, Vladimir Lomivorotov, Vera Saldien, Mona Momeni, Jiapeng Huang

Background: This survey aimed to explore the availability and accessibility of echocardiography during noncardiac surgery worldwide.

Methods: An internet-based 45-item survey was sent, followed by reminders from August 30, 2021, to August 20, 2022.

Results: 1189 responses were received from 62 countries. Nearly seventy-one percent of respondents had intraoperatively used transesophageal or transthoracic echocardiography (TEE and TTE, respectively) for monitoring or examination. The unavailability of echocardiography machines (30.3%), lack of trained personnel (30.2%), and absence of clinical indications (22.6%) were the top 3 reasons for not using intraoperative echocardiography in noncardiac surgery. About 61.5% of participants had access to at least one echocardiography machine. About 41% had access to at least 1 TEE probe, and 62.2% had access to at least 1 TTE probe. Seventy-four percent of centers had a procedure to request intraoperative echocardiography if needed for noncardiac cases. Intraoperative echocardiography service was immediately available in 58% of centers.

Conclusions: Echocardiography machines and skilled echocardiographers are still unavailable at many centers worldwide. National societies should aim to train a critical mass of certified TEE/TTE anesthesiologists and provide all anesthesiologists access to perioperative TEE/TTE machines in anesthesiology departments, considering the increasing number of older and sicker surgical patients scheduled for noncardiac surgery.

背景:这项调查旨在了解全球非心脏手术中超声心动图的可用性和可及性:本调查旨在了解全球非心脏手术中超声心动图的可用性和可及性:方法:在互联网上发送一份包含 45 个项目的调查问卷,并在 2021 年 8 月 30 日至 2022 年 8 月 20 日期间发送提醒邮件:结果:共收到来自 62 个国家的 1189 份回复。近 71% 的受访者在术中使用过经食道或经胸超声心动图(分别为 TEE 和 TTE)进行监测或检查。没有超声心动图机(30.3%)、缺乏训练有素的人员(30.2%)和没有临床指征(22.6%)是非心脏手术中未使用术中超声心动图的三大原因。约 61.5% 的参与者可使用至少一台超声心动图机。约 41% 的参与者可使用至少一台 TEE 探头,62.2% 的参与者可使用至少一台 TTE 探头。74%的中心设有程序,可在非心脏病病例需要时申请术中超声心动图检查。58%的中心可立即提供术中超声心动图服务:结论:全球许多中心仍未配备超声心动图机和熟练的超声心动图技师。考虑到计划进行非心脏手术的高龄和重症手术患者人数不断增加,各国学会应致力于培训足够数量的经认证的 TEE/TTE 麻醉师,并在麻醉科为所有麻醉师提供围术期 TEE/TTE 机器。
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引用次数: 0
Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair. 使用 Pleth 变异指数作为 MitraClip 期间左心房压力变化的无创动态指标:经导管二尖瓣修复术。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 10.1177/10892532241260535
Ashwin Vaidyanathan, Jayakar Guruswamy, Abhishek Saluja, Marvin Eng, Trevor Szymanski

Background: Transcatheter edge-to-edge repair (TEER) with MitraClip is a safe and effective alternative to surgical mitral valve repair/replacement in patients with high operative risk. Pleth Variability Index (PVI) is a non-invasive, dynamic index based on analysis of the respiratory variations in the plethysmographic waveform recorded transcutaneously by the pulse oximeter.

Objectives: The objective of the study was to evaluate if the hemodynamic effect of improved left-sided output after successful transcatheter mitral valve repair would lead to a significant change in PVI, and if it would correlate with the decrease in left atrial pressure (LAP).

Design: Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).

Setting: Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.

Participants: The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.

Measurements and main results: Of 30 patients, all components of the LAP (a wave, v wave, and mean) decreased significantly after successful MitraClip placement (P < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (P = .275). No significant correlation between change in PVI and change in LAP was observed (P = .235).

Conclusions: In patients with severe mitral regurgitation, successful MitraClip resulted in a significant reduction in LAP without a significant change in PVI. A larger sample size may provide more insight on the utility of using PVI as an indicator of LAP change in patients with mitral regurgitation.

背景:对于手术风险较高的患者,使用MitraClip进行经导管边缘到边缘修补术(TEER)是手术二尖瓣修补/置换术的一种安全有效的替代方法。脉搏血氧饱和度变异指数(Pleth Variability Index,PVI)是一种非侵入性的动态指数,基于脉搏血氧饱和度仪经皮记录的脉搏血氧饱和度波形的呼吸变化分析:该研究的目的是评估经导管二尖瓣修复术成功后左心室输出量的改善是否会导致 PVI 发生显著变化,以及是否与左心房压(LAP)的降低相关:前瞻性观察队列研究(ClinicalTrials.gov NCT03993938):美国密歇根州底特律市的一家学术医院,时间为 2019 年 10 月至 2021 年 2 月:作者纳入了成功接受 MitraClip 置入术的严重二尖瓣反流成年患者:在 30 名患者中,成功置入 MitraClip 后 LAP 的所有成分(a 波、v 波和平均值)均显著下降(P < .01)。夹片置入后,PVI 的中位数(IQR)从 21(11-35)升至 23(13-38);但这一变化无统计学意义(P = .275)。PVI的变化与LAP的变化之间无明显相关性(P = .235):结论:在严重二尖瓣反流患者中,成功的 MitraClip 可显著降低 LAP,而 PVI 无明显变化。更大的样本量可能会让人更深入地了解将 PVI 作为二尖瓣反流患者 LAP 变化指标的实用性。
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引用次数: 0
The Year in Review: Anesthesia for Congenital Heart Disease 2023. 年度回顾:2023 年先天性心脏病麻醉。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-01 DOI: 10.1177/10892532241244475
Michael Wadle, Leah Landsem, Gregory Latham, Faith Ross

This review highlights published literature in 2023 that is related to the anesthetic management of patients with congenital heart disease (CHD). Though not inclusive of all topics, 31 articles are discussed and four primary themes emerged: transfusion and hemostasis, outcomes and risk assessment, monitoring, and pharmacology.

本综述重点介绍了 2023 年发表的与先天性心脏病 (CHD) 患者麻醉管理相关的文献。虽然不包括所有主题,但讨论了 31 篇文章,并提出了四个主要主题:输血和止血、结果和风险评估、监测和药理学。
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引用次数: 0
Year in Review 2023: Noteworthy Literature in Cardiothoracic Transplantation. 2023 年回顾:心胸移植领域值得关注的文献。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-28 DOI: 10.1177/10892532241242973
Faiz Saleem, Hong Liang, Archer Kilbourne Martin

This review highlights key studies examining perioperative management of cardiothoracic transplantation published in 2023. Articles were manually screened after searching Scopus, PubMed, and Google Scholar databases for manuscripts related to cardiothoracic transplantation, which yielded 343 papers with 15 qualitatively selected as the most salient for readers. Overarching themes include differences in outcomes across the various etiologies of end-stage lung disease, novel developments to expand the donor pool, and multi-organ transplantation.

本综述重点介绍了2023年发表的有关心胸移植围手术期管理的主要研究。在Scopus、PubMed和Google Scholar数据库中搜索与心胸移植相关的手稿后,对文章进行了人工筛选,共获得343篇论文,其中15篇被定性为读者最感兴趣的论文。总的主题包括不同病因的终末期肺病治疗效果的差异、扩大供体库的新进展以及多器官移植。
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引用次数: 0
Year in Review 2023: Noteworthy Literature in Cardiothoracic Critical Care. 2023 年回顾:心胸重症监护领域值得关注的文献。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-26 DOI: 10.1177/10892532241249582
Sarah Alber, Kenji Tanabe, Andrew Hennigan, Hans Tregear, Samuel Gilliland

This article reviews noteworthy investigations and society recommendations published in 2023 relevant to the care of critically ill cardiothoracic surgical patients. We reviewed 3,214 articles to identify 18 publications that add to the existing literature across a variety of topics including resuscitation, nutrition, antibiotic management, extracorporeal membrane oxygenation (ECMO), neurologic care following cardiac arrest, coagulopathy and transfusion, steroids in pulmonary infections, and updated guidelines in the management of acute respiratory distress syndrome (ARDS).

本文回顾了 2023 年发表的与心胸外科重症患者护理相关的值得关注的研究和学会建议。我们查阅了 3,214 篇文章,确定了 18 篇对现有文献进行补充的出版物,涉及多个主题,包括复苏、营养、抗生素管理、体外膜氧合(ECMO)、心脏骤停后的神经护理、凝血病和输血、肺部感染中的类固醇以及急性呼吸窘迫综合征(ARDS)管理的最新指南。
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引用次数: 0
期刊
Seminars in Cardiothoracic and Vascular Anesthesia
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