Seminars in Cardiothoracic and Vascular Anesthesia最新文献

英文中文

Challenging Paradigms and Trusting Evidence: New Approaches to Perioperative Care. 挑战范式和信任证据:围手术期护理的新方法。

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-12-01 DOI: 10.1177/10892532221138170

Meghan Prin, Nathan Clendenen, Hillary Lum, Miklos D Kertai, Benjamin A Abrams

the novel perspectives on the complexities of clinical perioperative care are impera-tive. This issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) emphasizes this ethos. Two original research studies evaluate methods to reduce the quantity of anesthetic and opioid medications needed for surgery, and a comprehensive two-part review evaluates the evidence for “ prehabilitation ” before cardiac surgery. This issue is rounded out by two systematic reviews on the use of TEE in liver transplantation, and two case reports describing the challenging management of intracardiac masses. This literature will guide readers towards a more patient-centered approach with less dependence on polypharmacy and, hopefully, optimize outcomes for cardiac surgery. This approach is all the more relevant as the population ages; surgical populations are aging faster than the general population and phrases like “ potentially inappropriate medications ” and “ deprescribing ” entered the perioperative lexicon. we the the are visible on the horizon and the of famed to The you know, the less you

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引用次数: 0

Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory Analysis. 主动脉瓣置换术前后左心室扭转力学的可行性研究及探索性分析。

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-09-01 DOI: 10.1177/10892532221114791

Kan Zhang, Nikhil Kumar, Andrej Alfirevic, Shiva Sale, Jing You, Andrew Bauer, Andra E Duncan

Introduction. We examined whether intraoperative assessment of left ventricular (LV) twist mechanics is feasible with transesophageal echocardiography (TEE). We then explored whether twist mechanics were altered by hemodynamic conditions or patient comorbidities. Methods. In this sub-analysis of clinical trial data, transgastric short-axis echocardiographic images of the LV base and apex were collected in patients having aortic valve replacement (AVR) at baseline and end of surgery. Transvalvular gradients and LV systolic and diastolic function were assessed using two-dimensional (2D) and Doppler echocardiography. 2D speckle-tracking echocardiography was used for off-line analysis of LV twist, twisting rate, and untwisting rate. We examined the intraoperative change in twist mechanics before and after AVR. LV twist mechanics were also explored by diabetic status, need for coronary artery bypass grafting (CABG), and use of epinephrine/norepinephrine. Results. Of 40 patients, 16 patients had acceptable TEE images for off-line LV twist analysis. Baseline median [Q1, Q3] LV twist was 12 [7, 16]°, twisting rate was 72 [41, 97]°/sec, and untwisting rate was -91 [-154, -56]°/s. Median [Q1, Q3] change in LV twist at end of surgery was -2 [-5, 3]°, twisting rate was 7 [-33, 31]°/s, and untwisting rate was 0 [-11, 43]°/s. No difference was noted between diabetic and non-diabetic patients or AVR and AVR-CABG patients. Conclusion. LV twist was augmented in patients with aortic stenosis, though twist indices were not affected by reduced afterload, diabetes, or coronary artery disease. Intraoperative assessment of twist mechanics may provide unique information on LV systolic and diastolic function, though fewer than 50% of TEE examinations successfully assessed twist. Clinical Trial Registry. This work is a sub-analysis of a clinical trial, registered on ClinicalTrials.gov on August 19, 2010 (NCT01187329), Andra Duncan, Principal Investigator.

介绍。我们研究了术中使用经食管超声心动图(TEE)评估左心室(LV)扭转力学是否可行。然后，我们探讨了扭转力学是否会因血流动力学条件或患者合并症而改变。方法。在临床试验数据的亚分析中，收集了主动脉瓣置换术(AVR)患者在基线和手术结束时的左室基底和心尖的经胃短轴超声心动图图像。通过二维(2D)和多普勒超声心动图评估经瓣梯度和左室收缩和舒张功能。采用二维斑点跟踪超声心动图离线分析左室扭、扭率、解扭率。我们检查了术中AVR前后扭转力学的变化。还探讨了左室扭转力学与糖尿病状态、冠状动脉旁路移植术(CABG)的需要以及肾上腺素/去甲肾上腺素的使用。结果。在40例患者中，16例患者的TEE图像可用于离线左室扭转分析。基线中位数[Q1, Q3] LV扭转为12[7,16]°，扭转速率为72[41,97]°/秒，解扭速率为-91[-154，-56]°/秒。手术结束时左室扭转的中位[Q1, Q3]变化为-2[- 5,3]°，扭转速率为7[- 33,31]°/s，解扭转速率为0[- 11,43]°/s。糖尿病和非糖尿病患者、AVR和AVR- cabg患者之间无差异。结论。主动脉瓣狭窄患者左室扭转增加，但扭转指数不受后负荷减少、糖尿病或冠状动脉疾病的影响。术中评估扭转力学可以提供左室收缩和舒张功能的独特信息，尽管只有不到50%的TEE检查成功评估了扭转。临床试验注册。这项工作是临床试验的子分析，于2010年8月19日在ClinicalTrials.gov上注册(NCT01187329)， Andra Duncan，首席研究员。

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引用次数: 2

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia. 2021年回顾:值得注意的心胸麻醉文献。

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-06-01 DOI: 10.1177/10892532221100660

Aaron Smoroda, David Douin, Joseph Morabito, Matthew Lyman, Meghan Prin, Bryan Ahlgren, Andrew Young, Elijah Christensen, Benjamin A Abrams, Nathaen Weitzel, Nathan Clendenen

In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: "cardiac anesthesiology and outcomes" (n = 177), "cardiothoracic anesthesiology" (n = 34), "cardiac anesthesia," and "clinical outcomes" (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

2021年，与心脏麻醉学相关的临床科学继续取得进展，但由于持续的大流行和临床研究中断，进展速度较慢。大多数进展都是渐进式的，并解决了与我们的领域相关的持久问题。为了确定本综述的文章，我们使用之前报道的方法完成了一项结构化的综述(1)。具体来说，我们使用的搜索词是:“心脏麻醉学和结局”(n = 177)、“心胸麻醉学”(n = 34)、“心脏麻醉”和“临床结局”(n = 42)，筛选了PubMed的临床试验和2021年。我们还回顾了来自最著名的临床期刊的临床试验，以确定用于叙述性回顾的其他研究。然后，我们选择了最值得注意的出版物纳入本综述并确定了关键主题。

引用次数: 2

2021––Forging Ahead Into the Endemic While Struggling Against the New Challenges Facing Health Care Providers 2021年——在应对卫生保健提供者面临的新挑战的同时，继续推进流行病

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-31 DOI: 10.1177/10892532221104162

Cara E. Crouch, Benjamin A. Abrams, M. Kertai, N. Weitzel

This issue of Seminars in Cardiothoracic and Vascular Anesthesia is our annual noteworthy review issue where we recruit experts in multiple perioperative fields to hand pick the key themes and articles from the previous publication year. This year’s authors have done fantastic work collating the best literature in their chosen fields with topics in transplant, Cardiac ICU, cardiac anesthesia topics of hyperoxia, transfusion, and of course cardiac surgery. We hope that you enjoy this issue. 2021 began for much of the medical community with hope for a conclusion to the unprecedented COVID-19 pandemic. Sadly, a shift was made to the endemic phase of this process and COVID-19 continues to have an impact on both clinical practice and ongoing research. The medical and scientific community is moving forward through this phase and advancing our understanding of the complex interaction between SARS-Cov-2 and host, and the underlying pathophysiology of long haul COVID-19 symptoms. Centers across Asia, Australia, Europe, North America, and South America experienced a 50–70% reduction in cardiac surgery volume with a 53% reduction in cardiac surgery cases in the United States during the last 2 years of the pandemic. Despite the ongoing pandemic, transplantations had a record year in the United States with 41,354 organ transplants performed in 2021, a 5.9% increase from 2020. This included new annual records for kidney transplants (24,669), liver transplants (9,236), and heart transplants (3,817); although, lung transplants decreased slightly (2,524) from the year prior (Figure 1). In this setting, the medical community also has faced its largest challenge providing care as the workforce numbers have been reduced nationwide, significantly impacting the medical system in all phases of perioperative care. Cardiothoracic Anesthesiology

这一期的《心胸血管麻醉研讨会》是我们值得关注的年度综述，我们招募了多个围手术期领域的专家，从前一年的出版物中手工挑选关键主题和文章。今年的作者们做了出色的工作，整理了他们选择的领域的最佳文献，主题包括移植，心脏ICU，心脏麻醉的高氧，输血，当然还有心脏手术。我们希望你喜欢这个问题。对大部分医学界来说，2021年是希望结束前所未有的COVID-19大流行的一年。可悲的是，这一进程已经转向流行阶段，COVID-19继续对临床实践和正在进行的研究产生影响。医学界和科学界正在通过这一阶段向前迈进，并加深我们对SARS-Cov-2与宿主之间复杂相互作用以及长期COVID-19症状的潜在病理生理学的理解。亚洲、澳大利亚、欧洲、北美和南美的中心在大流行的最后两年里心脏手术量减少了50-70%，美国心脏手术病例减少了53%。尽管疫情持续，但2021年美国的器官移植数量达到创纪录的41354例，比2020年增长了5.9%。这包括肾脏移植(24669例)、肝脏移植(9236例)和心脏移植(3817例)的年度新记录;尽管如此，肺移植比前一年略有下降(2524例)(图1)。在这种情况下，医疗社区也面临着提供护理的最大挑战，因为全国范围内的劳动力数量已经减少，严重影响了围手术期护理的各个阶段的医疗系统。心胸麻醉学

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引用次数: 0

Rotational Thromboelastometry Values After On-Pump Cardiac Surgery – A Retrospective Cohort Study 无泵心脏手术后旋转血栓弹性测量值-一项回顾性队列研究

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-26 DOI: 10.1177/10892532221088216

Maria S Gauger, P. Kaufmann, Firmin Kamber, J. Quitt, D. Berdajs, D. Bolliger, E. Mauermann

Background Viscoelastic coagulation monitoring is recommended for coagulation management after cardiac surgery, but optimum target values are poorly defined. Aims To determine “to-be-expected” values in rotational thromboelastometry (ROTEM) after heparin reversal, to correlate ROTEM parameters with fibrinogen levels and platelet count, and to estimate the effect of hemoglobin levels on these measurements. Methods We retrospectively analyzed 571 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass from 12/2018 to 08/2020. ROTEM and conventional laboratory measurements were performed 5 to 10 minutes after protamine administration. Results Clotting times in EXTEM, INTEM, and FIBTEM were significantly prolonged (72.6%, 96.1%, and 31.8% above reference ranges, respectively). Clot firmness parameters in EXTEM and INTEM were relevantly reduced (7.9% to 14.4% and 9.1% to 32.3% below the reference ranges, respectively). There was an excellent linear correlation of FIBTEM amplitude after 10 min (A10) and of maximal clot firmness (MCF) with fibrinogen concentrations (r = .81 and .80). Areas under receiver operating characteristic (AUROC) for identifying hypofibrinogenemia <1.5 g/L were between .80 and .87. No effect of hematocrit was observed. We also found a linear correlation of EXTEM, INTEM, and EXTEM-FIBTEM at both A10 and MCF with platelet counts (.32 to .68). The AUROCs for identifying thrombocytopenia (<100,000/μL) were .79 to .84, and were greater for A10 than for MCF measurements (P=.074, .001, and <.001, respectively). Conclusions “To-be-expected” ROTEM values after CPB are different from the published reference ranges. ROTEM parameters might allow for reliable estimation of fibrinogen level and platelet count without being influenced by hematocrit.

背景:粘弹性凝血监测被推荐用于心脏手术后的凝血管理，但最佳目标值尚未明确。目的确定肝素逆转后旋转血栓弹性测量(ROTEM)的“预期”值，将ROTEM参数与纤维蛋白原水平和血小板计数相关联，并估计血红蛋白水平对这些测量的影响。方法回顾性分析2018年12月至2020年8月连续571例接受心脏手术合并体外循环的成人患者。在鱼精蛋白给药后5至10分钟进行ROTEM和常规实验室测量。结果EXTEM、interm和FIBTEM的凝血时间明显延长(分别比参考范围延长72.6%、96.1%和31.8%)。EXTEM和INTEM的凝块硬度参数相应降低(分别比参考范围低7.9%至14.4%和9.1%至32.3%)。10 min后fitem振幅(A10)和最大凝块硬度(MCF)与纤维蛋白原浓度呈极好的线性相关(r = 0.81和0.80)。识别<1.5 g/L的低纤维蛋白原血症的受试者工作特征下面积(AUROC)在0.80 ~ 0.87之间。未观察到红细胞压积的影响。我们还发现A10和MCF的EXTEM、INTEM和EXTEM- fitem与血小板计数呈线性相关。32到0.68)。鉴定血小板减少症(<100,000/μL)的auroc为0.79 ~ 0.84,A10的auroc高于MCF (P=。074、0.001和<。001年,分别)。结论CPB后“预期”ROTEM值与已公布的参考范围存在差异。ROTEM参数可能允许可靠的估计纤维蛋白原水平和血小板计数，而不受红细胞压积的影响。

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引用次数: 2

Erector Spinae Plane Catheter Analgesia in Minimally Invasive Mitral Valve Surgery: A Retrospective Case–Control Study for Inclusion in an Enhanced Recovery Program 微创二尖瓣手术中的勃起棘平面导管镇痛：纳入强化恢复计划的回顾性病例对照研究

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-26 DOI: 10.1177/10892532221104420

Nicholas J Statzer, Andreas C Plackis, Austin A. Woolard, B. Allen, Kara K. Siegrist, Yaping Shi, M. Shotwell

Background. A retrospective case-control study was conducted to assess the feasibility of erector spinae plane (ESP) block as part of a multimodal enhanced recovery program for patients undergoing minimally invasive mitral valve replacement surgery. Methods. This retrospective analysis was conducted at a single center between January and August 2019. 61 patients were included; 23 received ESP and 38 did not. Erector spinae catheters (ESCs) were placed preoperatively, using a loading dose of 30 mL .5% ropivacaine, followed by an infusion of .2% ropivacaine at 10 mL/h throughout the study period. Primary outcome was 48-hour opioid consumption. Secondary outcomes included intraoperative morphine equivalents, extubation within 24 hours, reintubation, ICU length of stay and hospital length of stay and 30-day mortality. Results. Median [inter-quartile range] of the postoperative morphine milligram equivalents (MMEs) in the first 48 hours was 70[45-121] MMEs in the ESC) group, and 109[70–148] MMEs in the no ESC group (P-value = .16). No significant difference was observed in intraoperative morphine equivalents, extubation within 24 hours or ICU length of stay. The ESC group had shorter hospital length of stay (6.0 vs 7.0 days, P-value = .043). Conclusion. This study found a statistically insignificant, though potentially clinically significant reduction in postoperative opioid consumption. A reduced hospital length of stay as well as an acceptable safety profile was also observed in the ESC group. An adequately powered, prospective trial is warranted to accurately assess the potential role for ESP catheters for patients undergoing minimally invasive mitral valve surgery.

背景。我们进行了一项回顾性病例对照研究，以评估竖脊肌平面(ESP)阻滞作为微创二尖瓣置换术患者多模式增强恢复方案的可行性。方法。这项回顾性分析是在2019年1月至8月期间在一个中心进行的。纳入61例患者;23人接受ESP治疗，38人未接受ESP治疗。术前放置直立脊柱导管(ESCs)，加载剂量为30 mL 0.5%罗哌卡因，随后在整个研究期间以10 mL/h的速度输注0.2%罗哌卡因。主要终点为48小时阿片类药物消耗。次要结局包括术中吗啡当量、24小时内拔管、再插管、ICU住院时间和住院时间以及30天死亡率。结果。术后48小时吗啡毫克当量(MMEs)中位数[四分位数范围]:ESC组为70[45-121]MMEs，未ESC组为109[70 - 148]MMEs (p值= 0.16)。术中吗啡当量、24小时拔管时间和ICU住院时间均无显著差异。ESC组住院时间较短(6.0天vs 7.0天，p值= 0.043)。结论。该研究发现，尽管术后阿片类药物的消耗有潜在的临床意义，但统计学上不显著。在ESC组中还观察到住院时间缩短以及可接受的安全性概况。有必要进行一项充分有力的前瞻性试验，以准确评估ESP导管在微创二尖瓣手术患者中的潜在作用。

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引用次数: 4

The Year in Review: Anesthesia for Congenital Heart Disease 2021 年度回顾:麻醉治疗先天性心脏病2021

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-26 DOI: 10.1177/10892532221095038

Faith J. Ross, D. Joffe, Leah M Landsem, Gregory J. Latham

This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).

这篇综述的重点是2021日历年发表的文献，这些文献对照顾患有先天性心脏病的儿童和成人的麻醉师感兴趣。讨论了四个主要主题，包括新冠肺炎儿童的心血管疾病、主动脉瓣修复和置换、出血和凝血以及术后恢复增强（ERAS）。

引用次数: 2

Abdominal Organ Transplantation: Noteworthy Literature in 2021 腹部器官移植：2021年值得关注的文献

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-24 DOI: 10.1177/10892532221093955

Robert St Jules, Daniel Blech, N. Smith, T. Sakai

This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.

本综述重点介绍了与麻醉医师和重症监护医师护理腹部器官移植患者相关的值得注意的文献。在2021年，我们从1200多篇同行评议的胰腺移植、1400多篇肠移植和9000多篇肾移植的论文中筛选出了值得关注的论文。肝移植部分侧重于2021年发表的临床试验、系统综述和荟萃分析，并精选20篇论文。2019冠状病毒病和腹部器官移植在一个独立的章节。

引用次数: 1

Anesthetic Challenges in a Patient With TANGO2 Gene Deletion, DiGeorge Syndrome, and Tetralogy of Fallot: A Case Report TANGO2基因缺失、DiGeorge综合征和法洛四联症患者的麻醉挑战:一例报告

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-20 DOI: 10.1177/10892532221080946

Ivana Wrobleski, Nischal K. Gautam, Richard M. Hubbard

Mutations of the transport and Golgi organization 2 (TANGO2) genes are linked with both long-term neurological decline and acute metabolic crises during stress, leading to significant anesthetic risk. Crises are marked by rhabdomyolysis, lactic acidosis, seizures, cardiac dysfunction, and dysrhythmias. Much is unknown about optimal management of this condition, especially in the acute and critical care settings. The following report describes the anesthetic challenges of a patient with simultaneous TANGO2 gene deletion, DiGeorge Syndrome, and Tetralogy of Fallot, who presented for an interventional cardiac procedure with the goal of metabolic crisis-avoidance and facilitation of safe but expeditious recovery and discharge home.

运输和高尔基体组织2（TANGO2）基因的突变与长期神经系统衰退和应激期间的急性代谢危机有关，导致显著的麻醉风险。危象的特点是横纹肌溶解症、乳酸酸中毒、癫痫发作、心脏功能障碍和心律失常。这种情况的最佳管理还有很多未知之处，尤其是在急性和危重症护理环境中。以下报告描述了一名同时患有TANGO2基因缺失、DiGeorge综合征和法洛四联症的患者的麻醉挑战，该患者提出了一项介入性心脏手术，目的是避免代谢危机，促进安全但快速的康复和出院回家。

引用次数: 2

Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling 2021年值得注意的心脏文献:无新数据的冠状动脉指南变化，心脏死亡后心脏移植捐赠，Covid对全球心脏手术的影响，以及改善解剖重构的尝试

IF 1.4 Q3 ANESTHESIOLOGY

Seminars in Cardiothoracic and Vascular Anesthesia

Pub Date : 2022-05-19 DOI: 10.1177/10892532221101298

J. Hoffman, Kelly Higa, Yihan Lin, T. B. Reece, J. Cleveland, Muhammad Aftab, Jessica Y. Rove

Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.

心脏外科继续发展。去年引人注目的原因有很多。冠状动脉血运重建的指导方针引起了严重的分歧。新冠疫情继续在全球范围内影响护理工作。随着对器官采购和解剖护理的更好理解和更好的技术，器官采购和剥离护理取得了进展。

引用次数: 1

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