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Intraoperative Transesophageal Echocardiographic Detection of a Gerbode Defect in a Patient Referred for Aortic Valve Endocarditis: A Case Report 一例主动脉瓣心内膜炎患者术中经食管超声心动图检测Gerbode缺陷
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-04-12 DOI: 10.1177/10892532221080920
Rohesh J. Fernando, Sean D. Johnson, K. Richardson
This clinical challenge discusses a case in which a patient was referred for aortic valve repair or replacement due to severe aortic regurgitation from infective endocarditis. In addition to discovering a previously unknown tricuspid valve vegetation, the intraoperative echocardiographic evaluation was instrumental in revealing an undiagnosed Gerbode defect. The flow through this Gerbode defect was previously mistaken for tricuspid regurgitation, and the patient was misdiagnosed as exhibiting severe pulmonary hypertension. This case highlights the importance of reviewing preoperative echocardiographic imaging, as well as diligence in completing a thorough intraoperative transesophageal echocardiographic exam prior to cardiopulmonary bypass. In addition, while flow typically occurs in Gerbode defects during systole, this case demonstrates that flow can also occur during diastole, which was most likely due to the severe aortic regurgitation. Fortunately, the patient was able to undergo successful treatment for the unexpected sequalae of the infective endocarditis, including repair of the Gerbode defect, tricuspid valve repair, and aortic valve and root replacement. Importantly, the incorrect diagnosis of severe pulmonary hypertension was removed.
这项临床挑战讨论了一例患者因感染性心内膜炎导致严重主动脉瓣反流而被转诊进行主动脉瓣修复或置换的病例。除了发现以前未知的三尖瓣植被外,术中超声心动图评估也有助于揭示未诊断的Gerbode缺陷。通过Gerbode缺损的血流先前被误认为是三尖瓣反流,患者被误诊为表现出严重的肺动脉高压。该病例强调了回顾术前超声心动图成像的重要性,以及在体外循环前认真完成彻底的术中经食管超声心动图检查的重要性。此外,虽然血流通常发生在收缩期的Gerbode缺陷中,但本例表明,血流也可能发生在舒张期,这很可能是由于严重的主动脉瓣反流。幸运的是,患者能够成功治疗意外的感染性心内膜炎,包括Gerbode缺损修复、三尖瓣修复、主动脉瓣和根部置换。重要的是,排除了严重肺动脉高压的错误诊断。
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引用次数: 2
Tracheal Bronchus With Difficult Lung Isolation: A Case Report 气管支气管伴肺部分离困难1例报告
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-28 DOI: 10.1177/10892532211069243
Daniel A Friedlander, Rabi Panigrahi, Dhamodaran Palaniappan
Tracheal bronchus (TB) occurs in 0.1–3% of the population as an accessory bronchus that originates in the trachea, typically supplying the right upper lobe. The presence of a TB can pose unique airway challenges, particularly during procedures that require lung isolation. Here, we describe a case of TB with difficult lung isolation. Careful examination with fiberoptic bronchoscopy permitted double lumen tube positioning without obstruction of the TB. A second case is presented where the presence of TB did not affect anesthetic management. Implications of TB for airway management and strategies for successful one-lung ventilation are discussed.
气管支气管(TB)作为起源于气管的副支气管,在0.1-3%的人群中发生,通常供应右上叶。结核病的存在可能会对气道造成独特的挑战,尤其是在需要肺部隔离的手术中。在这里,我们描述了一个肺结核病例,肺隔离困难。经纤维支气管镜仔细检查,双腔管定位无肺结核梗阻。第二个案例是肺结核的存在并没有影响麻醉管理。讨论了肺结核对气道管理的影响以及成功单肺通气的策略。
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引用次数: 2
Transesophageal Echocardiographic Assessment of the Repaired Mitral Valve: A Proposed Decision Pathway. 经食管超声心动图评估修复的二尖瓣:一种建议的决策途径。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-09-02 DOI: 10.1177/10892532211036655
Jose Liza Reshmi, G Gopan, Praveen Kerala Varma, Madathil Thushara, Vanga Babu Sudheer, Rajesh Gopalakrishnan Madavathazhathil, Aveek Jayant

The indications for mitral valve repair extend across the entire spectrum of degenerative mitral valve disease, ranging from fibroelastic degeneration to Barlow's disease. Collaboration between the surgeon and anesthesiologist is essential for ensuring optimal results. Echocardiographic assessment of the repair can be challenging but is essential to the success of the procedure, as even mild residual mitral regurgitation can portend poor patient outcomes. In addition to determining the severity of residual regurgitation, the anesthesiologist must elucidate the mechanism of disease in order to inform appropriate re-intervention measures. Finally, there are unique complications of mitral valve surgery for the anesthesiologist to understand and assess by echocardiography. This review describes a systematic pathway for a comprehensive intraoperative assessment of the mitral valve following surgical repair.

二尖瓣修复的适应症涵盖了退行性二尖瓣疾病的整个范围,从纤维弹性变性到Barlow病。外科医生和麻醉师之间的合作对于确保最佳结果至关重要。超声心动图对修复的评估可能具有挑战性,但对手术的成功至关重要,因为即使是轻微的二尖瓣残余返流也可能预示着不良的患者预后。除了确定残余反流的严重程度外,麻醉师还必须阐明疾病的机制,以便告知适当的再干预措施。最后,二尖瓣手术有一些独特的并发症,麻醉医师需要通过超声心动图来了解和评估。这篇综述描述了手术修复后二尖瓣术中综合评估的系统途径。
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引用次数: 4
Anesthetic Considerations in Pediatric Patients With Acute Decompensated Heart Failure. 急性失代偿性心力衰竭患儿的麻醉考虑。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-11-03 DOI: 10.1177/10892532211044977
Roby Sebastian, Sana Ullah, Pablo Motta, Bibhuti Das, Luis Zabala

Acute decompensated heart failure (ADHF) in pediatrics is a significant cause for morbidity and mortality in children. Congenital heart disease and cardiomyopathy are the leading etiologies of ADHF. It is common for these children to undergo diagnostic, therapeutic, or surgical procedure under anesthesia, which may be associated with significant morbidity and mortality. The importance of preanesthetic multidisciplinary planning with all involved teams, including anesthesia, cardiology, intensive care, perfusion, and cardiac surgery, cannot be emphasized enough. In order to safely manage these patients, it is imperative for the anesthesiologist to understand the complex pathophysiological interactions between cardiopulmonary systems and anesthesia during these procedures. This review discusses the etiology, pathophysiology, clinical manifestations, and perioperative management of these patients.

儿科急性失代偿性心力衰竭(ADHF)是儿童发病率和死亡率的重要原因。先天性心脏病和心肌病是ADHF的主要病因。这些儿童在麻醉下接受诊断、治疗或手术是常见的,这可能与显著的发病率和死亡率有关。麻醉前多学科规划与所有相关团队的重要性,包括麻醉、心脏病学、重症监护、灌注和心脏外科,再怎么强调也不为过。为了安全地管理这些患者,麻醉师必须了解在这些过程中心肺系统和麻醉之间复杂的病理生理相互作用。本文就其病因、病理生理、临床表现及围手术期处理进行综述。
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引用次数: 1
Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study. 心脏手术中血小板功能障碍:何时是评估的最佳时机?观察性单中心研究。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2022-02-13 DOI: 10.1177/10892532211064041
Elisabetta Auci, Igor Vendramin, Federico Barbariol, Ilaria Riccardi, Andrea Gigante, Antonio Baroselli, Tiziana Bove, Flavio Bassi, Luigi Vetrugno, Ugolino Livi

Purpose. Cardiac surgery is characterized by a high risk of complications related to perioperative bleeding. Guidelines suggest the use of local algorithms based on perioperative point-of-care tests to assess and manage potential coagulation abnormalities. We investigated whether heparin reversal administration affects the adenosine-5-diphosphate (ADP) test values, thus identifying the earliest time point following cardio-pulmonary bypass that permits the promptest detection and treatment of potential platelet dysfunctions. Methods. This was a retrospective, single-center, observational study enrolling cardiac surgery patients requiring cardiac bypass. ADP-tests at 4 different time-points during surgery (T0: baseline, T1: at aortic de-clamping, T2: 10 minutes after protamine administration, and T3: at the end of surgery) were performed. Results. 63 patients undergoing elective cardiac surgery were studied. Baseline ADP-test values were almost constantly greater than intraoperative values, and end of surgery values were often greater than previous intraoperative values. The only difference that proved to be not statistically significant was between T1 and T2, with a clinically insignificant mean difference of -.2 U (95%CI of difference: -6.9 - 6.5 U). There was no correlation between the variation in ADP-test values pre- and post-protamine administration and the protamine-to-heparin ratio. Conclusion. The results of the present study support the hypothesis that the ADP-test could be performed early, at aortic de-clamping before protamine administration. This approach allows for the promptest assessment of a potential impairment in platelet function, and its timely correction.

目的。心脏外科手术的特点是与围手术期出血相关的并发症的高风险。指南建议使用基于围手术期护理点测试的局部算法来评估和管理潜在的凝血异常。我们研究了肝素逆转是否会影响腺苷-5-二磷酸(ADP)测试值,从而确定心肺旁路术后最早的时间点,以便及时发现和治疗潜在的血小板功能障碍。方法。这是一项回顾性、单中心、观察性研究,纳入了需要心脏搭桥手术的患者。在手术过程中4个不同时间点(T0:基线,T1:主动脉去夹,T2:鱼精蛋白给药后10分钟,T3:手术结束)进行adp测试。结果:对63例择期心脏手术患者进行了研究。基线adp测试值几乎总是大于术中值,手术结束值通常大于术中值。唯一证明无统计学意义的差异是T1和T2之间的差异,临床平均差异为- 0.2(95%CI: -6.9 ~ 6.5 U)。鱼精蛋白给药前后adp检测值的变化与鱼精蛋白与肝素比值无相关性。结论。本研究的结果支持adp测试可以在早期进行的假设,在鱼精蛋白给药之前进行主动脉脱模。这种方法可以及时评估血小板功能的潜在损害,并及时纠正。
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引用次数: 0
Mitral Regurgitation in Patients Undergoing Noncardiac Surgery. 非心脏手术患者的二尖瓣返流。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-09-01 DOI: 10.1177/10892532211042827
Ellen W Richter, Islam M Shehata, Hamdy M Elsayed-Awad, Matthew A Klopman, Sujatha P Bhandary

Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College of Cardiologists (ACC) and the American Heart Association (AHA) that inform decision-making for the anesthesiologist caring for a patient with MR undergoing noncardiac surgery. The pathophysiology and natural history of acute and chronic MR, staging of chronic primary and secondary MR, and considerations for timing of valvular corrective surgery are reviewed. These topics are then applied to a discussion of anesthetic management, including preoperative risk evaluation, anesthetic selection, hemodynamic goals, and intraoperative monitoring of the noncardiac surgical patient with MR.

二尖瓣反流(MR)是美国最常见的瓣膜性心脏病类型之一。严重MR(中度至重度或重度)患者接受非心脏手术围手术期心血管并发症的风险增加。MR可由多种原因引起,可分为两大类:原发性(瓣膜固有疾病)和继发性(通过影响左心室或二尖瓣环破坏正常瓣膜功能的疾病)。本文重点介绍了来自美国心脏病学会(ACC)和美国心脏协会(AHA)的最新指南,这些指南为麻醉医师治疗接受非心脏手术的MR患者提供了决策依据。本文回顾了急性和慢性MR的病理生理学和自然史,慢性原发性和继发性MR的分期,以及瓣膜矫正手术时机的考虑。然后将这些主题应用于麻醉管理的讨论,包括术前风险评估、麻醉剂选择、血流动力学目标和非心脏手术患者MR术中监测。
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引用次数: 2
Cefazolin-Induced Thrombocytopenia in a Patient with Polycythemia Vera Following Coronary Artery Bypass. 冠状动脉搭桥术后真性红细胞增多症患者头孢唑林诱导的血小板减少症。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-12-29 DOI: 10.1177/10892532211065234
Racha Boulos, Katja Turner, Samiya Saklayen, William Perez, Manoj H Iyer

Cefazolin is an antibiotic that is commonly administered perioperatively to reduce the risk of surgical site infections. Cephalosporins have a well-established safety profile, but have been associated with thrombocytopenia and neutropenia due to their myelosuppressive effects. While this effect may be benign in healthy patients undergoing minor surgery, it can be detrimental in patients with underlying hematologic disorders presenting for open-heart surgery. Herein, we discuss the first case in the literature of cefazolin-induced thrombocytopenia and severe coagulopathy in a patient with polycythemia vera (PCV) during a coronary artery bypass-grafting surgery.

头孢唑林是一种抗生素,通常围手术期使用,以减少手术部位感染的风险。头孢菌素具有良好的安全性,但由于其骨髓抑制作用,与血小板减少症和中性粒细胞减少症有关。虽然这种影响在接受小手术的健康患者中可能是良性的,但在接受心脏直视手术的潜在血液疾病患者中可能是有害的。本文,我们讨论了文献中第一例头孢唑林诱导的真性红细胞增多症(PCV)患者在冠状动脉旁路移植术中发生的血小板减少症和严重凝血功能障碍。
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引用次数: 2
Recommendations From the Society for the Advancement of Transplant Anesthesiology Fellowship Committee: Core Competencies and Milestones for the Kidney/Pancreas Component of Abdominal Organ Transplant Anesthesia Fellowship. 来自移植麻醉学进步协会奖学金委员会的建议:腹部器官移植麻醉奖学金肾/胰腺部分的核心能力和里程碑。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-12-06 DOI: 10.1177/10892532211058574
Fouad G Souki, Ryan Chadha, Raymond Planinsic, Jeron Zerillo, Christine Nguyen-Buckley, Natalie Smith, M Susan Mandell, Tetsuro Sakai, Ramona Nicolau-Raducu

The Society for the Advancement of Transplant Anesthesia (SATA) is dedicated to improving patient care in all facets of transplant anesthesia. The anesthesia fellowship training recommendations for thoracic transplantation (heart and lungs) and part of the abdominal organ transplantation (liver) have been presented in previous publications. The SATA Fellowship Committee has completed the remaining component of abdominal transplant anesthesia (kidney/pancreas) and has assembled core competencies and milestones derived from expert consensus to guide the education and overall preparation of trainees providing care for kidney/pancreas transplant recipients. These recommendations provide a comprehensive approach to pre-operative evaluation, vascular access procedures, advanced hemodynamic monitoring, assessment of coagulation and metabolic abnormalities, operative techniques, and post-operative pain control. As such, this document supplements the current liver/hepatic transplant anesthesia fellowship training programs to include all aspects of "Abdominal Organ Transplant Anesthesia" recommended knowledge.

移植麻醉进步协会(SATA)致力于在移植麻醉的各个方面改善患者护理。在以前的出版物中已经提出了胸部移植(心脏和肺)和部分腹部器官移植(肝脏)的麻醉研究员培训建议。SATA奖学金委员会已经完成了腹部移植麻醉(肾/胰腺)的其余部分,并从专家共识中收集了核心能力和里程碑,以指导为肾/胰腺移植受者提供护理的受训者的教育和全面准备。这些建议为术前评估、血管通路程序、高级血流动力学监测、凝血和代谢异常评估、手术技术和术后疼痛控制提供了全面的方法。因此,本文件补充了当前肝/肝移植麻醉奖学金培训计划,包括“腹部器官移植麻醉”推荐知识的所有方面。
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引用次数: 1
The Anesthesiologist's Perspective and Experience in Global Congenital Cardiac Surgery: Results of a Survey of the Congenital Cardiac Anesthesia Society Membership. 全球先天性心脏手术麻醉医师的观点和经验:先天性心脏麻醉学会会员调查结果。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-11-06 DOI: 10.1177/10892532211047641
Richard M Hubbard, Lindsey B Buchbinder, Joseph D Tobias, Luis M Zabala, Gregory J Latham, Nischal K Gautam

Anesthesiologists are important components of volunteer teams which perform congenital cardiac surgery in low-resource settings throughout the world, but limited data exist to characterize the nature and breadth of their work. A survey of Congenital Cardiac Anesthesia Society (CCAS) members was conducted with the objective of understanding the type of voluntary care being provided, its geographic reach, the frequency of volunteer activities, and factors which may encourage or limit anesthesiologists' involvement in this work. The survey was completed by 108 participants. Respondents reported a total of 115 volunteer trips during the study period, including work in 41 countries on 5 continents. Frequent motivating factors to begin volunteering included invitations from charitable groups, encouragement from senior colleagues, and direct connections to individual locations. Discouraging factors included familial responsibilities, the need to use vacation time, and a lack of support from home institutions. The year 2020 saw a marked decrease in reported volunteer activity, and respondents reported multiple pandemic-related factors which might discourage future volunteer activities. The results of this study demonstrate the global reach of anesthesiologists in providing care for children having cardiac surgery. It also offers insights into the challenges faced by interested individuals, many of which are related to a lack of institutional support. These challenges have only mounted under the COVID-pandemic, leading to a dramatic downturn in volunteer activities. Finally, the survey reinforces the need for better coordination of volunteer activities to optimize clinical impact.

麻醉师是在世界各地资源匮乏的环境中进行先天性心脏手术的志愿者团队的重要组成部分,但现有的数据有限,无法表征他们工作的性质和广度。对先天性心脏麻醉学会(CCAS)成员进行了一项调查,目的是了解所提供的自愿护理的类型、地理范围、志愿活动的频率,以及可能鼓励或限制麻醉医师参与这项工作的因素。108名参与者完成了这项调查。受访者报告在研究期间共进行了115次志愿者旅行,包括在五大洲的41个国家工作。经常促使人们开始做志愿者的因素包括慈善团体的邀请、资深同事的鼓励以及与个人地点的直接联系。令人沮丧的因素包括家庭责任、需要利用假期以及缺乏家庭机构的支持。报告的2020年志愿活动显著减少,受访者报告了与大流行有关的多种因素,这些因素可能阻碍未来的志愿活动。这项研究的结果表明,麻醉师在提供照顾儿童心脏手术的全球影响力。它还为感兴趣的个人所面临的挑战提供了见解,其中许多挑战与缺乏机构支持有关。这些挑战在covid - 19大流行期间更加严峻,导致志愿者活动急剧减少。最后,该调查强调了更好地协调志愿者活动以优化临床影响的必要性。
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引用次数: 1
Face-To-Face Double-Lumen Tube Intubation With the Airtraq Video Laryngoscope for Emergency Thoracic Surgery: A Case Report. 急诊胸外科用Airtraq视频喉镜面对面双腔管插管1例。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2022-03-01 Epub Date: 2021-04-12 DOI: 10.1177/10892532211007664
Yacine Ynineb, Emilie Boglietto, Francis Bonnet, Christophe Quesnel, Marc Garnier

Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.

双腔插管通常用于胸外科手术,因为它可以实现快速有效的单肺通气。然而,它比单腔管插管更困难,特别是在急诊手术和/或低氧血症患者中。我们报告一例57岁的患者,在右上肺叶切除术后因术后气胸和胸膜肺炎而需要紧急翻修手术。由于支气管胸膜瘘需要快速肺隔离,因此进行了快速序列诱导和双腔管插管。此外,由于患者低氧血症且预充氧不完全,且在高流量供氧下仍难以忍受平卧位,因此采用面对面位插管。患者在22秒内成功插管,并立即分离右肺,使外科医生能够清洁胸膜腔。这是首例面对面双腔管插管的报道。使用Airtraq喉镜成功地避免了与这种插管相关的预期困难。虽然这种策略不能从这个病例中推荐,但该报告对未来评估Airtraq用于急诊胸外科双腔面对面插管的潜在优势的研究是令人鼓舞的。
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引用次数: 3
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Seminars in Cardiothoracic and Vascular Anesthesia
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