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    Comparison of Post-Liver Transplantation Outcomes in Portopulmonary Hypertension and Pulmonary Venous Hypertension: A Single-Center Experience.
    Transplant Proc 2017 Mar;49(2):338-343
    Emory University School of Medicine, Department of Medicine, Atlanta, Georgia, USA. Electronic address:
    Background: In potential liver transplant candidates, pulmonary vascular diseases, including portopulmonary hypertension (PoPH) and pulmonary venous hypertension (PVH), can be associated with high morbidity and mortality. Although there are clear guidelines regarding management and transplant listing criteria for patients with PoPH, the listing criteria for PVH are not well defined.

    Objective: The aim of this study was to describe and compare the perioperative and postoperative morbidity and mortality associated with PoPH and PVH in patients undergoing liver transplantation. Read More

    Noteworthy Literature Published in 2016 for Thoracic Organ Transplantation Anesthesiologists.
    Semin Cardiothorac Vasc Anesth 2017 Mar;21(1):45-57
    1 University of Pittsburgh, Pittsburgh, PA, USA.
    This article is first in the series to review the published literature on perioperative issues in patients undergoing thoracic solid organ transplantations. We present recent literature from 2016 on preoperative considerations, organ preservation, intraoperative anesthesia management, surgical techniques, postoperative complications, and the impact of perioperative management on short- and long-term outcomes that are pertinent to thoracic transplantation anesthesiologists. Read More

    Pediatric Perioperative Stress Responses and Anesthesia.
    Transl Perioper Pain Med 2017 ;2(1):1-12
    Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, Boston, USA; Harvard Medical School, Boston, USA.
    Surgical stress responses cause an array of endocrinological, metabolic and immunological changes in patients. The landmark studies in the 1980s showed that adequate anesthesia dramatically improved the outcomes of pediatric surgical patients by attenuating stress hormonal responses, pointing out the harm of 'inadequate' anesthesia. Subsequent studies questioned the role of administering very high-dose anesthetics to further attenuate stress responses. Read More

    Why Anesthesiologists Must Incorporate Focused Cardiac Ultrasound Into Daily Practice.
    Anesth Analg 2017 Mar;124(3):761-765
    From the *Department of Perioperative Medicine and Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama; and †Department of Anesthesiology, University of Utah, Salt Lake City, Utah.
    The size, availability, cost, and quality of modern ultrasound devices have, for the first time in modern medicine, enabled point-of-care ultrasound by the noncardiologist physician. The appropriate application of focused cardiac ultrasound (FoCUS) by anesthesiologists has the potential to alter management and affect outcomes for a wide range of patients. In this article, the indications, benefits, and limitations of FoCUS are described. Read More

    [Treatment Strategy and Results of Carotid Endarterectomy in Chronic Renal Failure Patients].
    No Shinkei Geka 2017 Feb;45(2):127-132
    Department of Neurosurgery, Nakamura Memorial Hospital.
    Introduction: The number of patients receiving chronic dialysis treatment in Japan currently exceeds 300,000 people. Few reports have described carotid endarterectomy(CEA)for chronic renal failure patients because of the unacceptable rate of perioperative stroke and other morbidities. A strategy for and treatment results of CEA for chronic renal failure patients in our hospital are described herein. Read More

    Chronic Trigemino-Cardiac Reflex: An Underestimated Truth.
    Front Neurol 2017 30;8:22. Epub 2017 Jan 30.
    Department of Research, University of Southampton , Southampton , UK.
    The trigemino-cardiac reflex (TCR) is a brainstem reflex that manifests as adverse cardiorespiratory events upon the stimulation of sensory branches of the fifth cranial nerve. This reflex is mainly investigated in different neurosurgical procedures and intervention. This reflex is commonly considered as an acute and mild physiological response. Read More

    Practical guidelines on e-cigarettes for practitioners and others health professionals. A French 2016 expert's statement.
    Rev Mal Respir 2017 Feb 9. Epub 2017 Feb 9.
    Département de pneumologie, CHU d'Angers, 4, rue Larrey, 49000 Angers, France.
    A group of 11 French medical experts has developed guidelines through a Delphi progressive consensus about smoking management at the e-cigarette era. The lack of scientific data about e-cigarettes led the experts to set out recommendations, mainly based on clinical practice while waiting for scientific validations. The validated smoking cessation treatments keep the first place in the prevention and the treatment of tobacco-induced damages. Read More

    Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist's perspective.
    Korean J Anesthesiol 2017 Feb 26;70(1):3-12. Epub 2017 Jan 26.
    Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea.
    Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Read More

    Perioperative anesthetic management for renal cell carcinoma with vena caval thrombus extending into the right atrium: case series.
    J Clin Anesth 2017 Feb 17;36:39-46. Epub 2016 Nov 17.
    Department of Anesthesia, Indiana University School of Medicine, Fesler Hall Room 204, 1130 West Michigan St, Indianapolis, IN, 46202-5115.
    Renal cell carcinoma has a tendency for vascular invasion and may extend into the inferior vena cava and even into the right-sided cardiac chambers. It has been reported that nephrectomy with thrombectomy can provide immediate palliation of symptoms with 5-year survival rates of up to 72% in the absence of nodal or distant metastasis. The location of the tumor dictates the anesthetic and surgical approach, as extension into the heart often necessitates cardiac surgical involvement. Read More

    Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial.
    PLoS One 2017 9;12(2):e0170757. Epub 2017 Feb 9.
    Section of Anaesthetics, Pain Management and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom.
    Background: Delirium is a frequent complication after cardiac surgery and its occurrence is associated with poor outcomes. The purpose of this study was to investigate the impact of perioperative dexmedetomidine administration on the incidence of delirium in elderly patients after cardiac surgery.

    Methods: This randomized, double-blinded, and placebo-controlled trial was conducted in two tertiary hospitals in Beijing between December 1, 2014 and July 19, 2015. Read More

    Successful Management of a Patient With Possible Mast Cell Activation Syndrome Undergoing Pulmonary Embolectomy: A Case Report.
    A A Case Rep 2017 Feb 8. Epub 2017 Feb 8.
    From the Departments of *Anesthesiology and †Critical Care, Emory University, Atlanta, Georgia.
    We report the successful perioperative management of a patient with presumed mastocytosis undergoing pulmonary embolectomy. Postoperatively the patient went into vasodilatory shock, which was partly attributed to mast cell mediator release. H1- and H2-antagonists, steroids, and a single dose of methylene blue were given with improvement of hemodynamics. Read More

    Hemodynamic profile and behavioral characteristics during induction of anesthesia in pediatric patients with attention deficit hyperactivity disorder.
    Paediatr Anaesth 2017 Feb 8. Epub 2017 Feb 8.
    Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
    Aim: There is no consensus regarding the administration of stimulant drugs preoperatively, particularly in pediatric patients diagnosed with ADHD. The primary objective of the current study was to assess differences in blood pressure and heart rate before and after induction of anesthesia between patients on chronic amphetamine or methylphenidate therapy who receive their normal dose preoperatively compared to patients in whom the prescribed medication was withheld. Secondary objectives were to assess the anxiety level during the induction of anesthesia and the effect of premedication with midazolam. Read More

    Electroencephalographic characteristics of status epilepticus after cardiac arrest.
    Clin Neurophysiol 2017 Jan 21. Epub 2017 Jan 21.
    Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
    Objective: To describe the electrophysiological characteristics and pathophysiological significance of electrographic status epilepticus (ESE) after cardiac arrest and specifically compare patients with unequivocal ESE to patients with rhythmic or periodic borderline patterns defined as possible ESE.

    Methods: Retrospective cohort study of consecutive patients treated with targeted temperature management and monitored with simplified continuous EEG. Patients with ESE were identified and electrographically characterised until 72h after ESE start using the standardised terminology of the American Clinical Neurophysiology Society. Read More

    Utilization and Effectiveness of Desmopressin Acetate After Cardiac Surgery Supplemented With Point-of-Care Hemostatic Testing: A Propensity-Score-Matched Analysis.
    J Cardiothorac Vasc Anesth 2016 Nov 17. Epub 2016 Nov 17.
    Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
    Objectives: To explore the utilization pattern and hemostatic effectiveness of desmopressin acetate (DDAVP) supplemented with point-of-care (POC) hemostatic testing in contemporary cardiac surgery.

    Design: Retrospective, observational study.

    Setting: Single quaternary care university hospital. Read More

    Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association.
    Circulation 2017 Feb 6. Epub 2017 Feb 6.
    Non-vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Read More

    Prophylactic Pulmonary Artery Reduction in a Young Female with Severe Pulmonary Hypertension from Complete Atrioventricular Septal Defect.
    Korean Circ J 2017 Jan 24;47(1):136-140. Epub 2016 Nov 24.
    Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea.
    Management of severely dilated pulmonary artery (PA) associated with severe pulmonary hypertension from congenital heart disease remains controversial, primarily due to its rare nature and concern for perioperative unpredictable complications. Herein, we report a 25 year-old female with a severely dilated PA (up to 73 mm), who was successfully treated by a PA graft replacement by creating a Y-shaped conduit using a 28 mm hemashield tube in the main PA and a 20 mm hemashield tube in both proximal parts of the branch PA. Read More

    Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery.
    Blood Purif 2017 Jan 31;43(4):298-308. Epub 2017 Jan 31.
    Research and Science Administration of Medical School Brandenburg (MHB), Brandenburg an der Havel, Germany.
    Purpose: The study aimed to investigate patients' characteristics, fluid and hemodynamic management, and outcomes according to the severity of cardiac surgery-associated acute kidney injury (CSA-AKI).

    Methods: In a single-center, prospective cohort study, we enrolled 282 adult cardiac surgical patients. In a secondary analysis, we assessed preoperative patients' characteristics, physiological variables, and medication for intra- and postoperative fluid and hemodynamic management and outcomes according to CSA-AKI stages by the Renal risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification. Read More

    Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program.
    Ann Emerg Med 2017 Jan 27. Epub 2017 Jan 27.
    Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
    Despite advances in the medical and surgical management of cardiovascular disease, greater than 350,000 patients experience out-of-hospital cardiac arrest in the United States annually, with only a 12% neurologically favorable survival rate. Of these patients, 23% have an initial shockable rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), a marker of high probability of acute coronary ischemia (80%) as the precipitating factor. However, few patients (22%) will experience return of spontaneous circulation and sufficient hemodynamic stability to undergo cardiac catheterization and revascularization. Read More

    Coagulation Management in Jersey Calves: An ex vivo Study.
    Eur Surg Res 2017 Jan 27;58(3-4):128-139. Epub 2017 Jan 27.
    Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany.
    Objective: Jersey calves are frequently used as an experimental animal model for in vivo testing of cardiac assist devices or orthopedic implants. In this ex vivo study, we analyzed the coagulation system of the Jersey calves and the potential of human-based coagulation management to circumvent perioperative bleeding complications during surgery. Experimental Procedure: Blood from 7 Jersey calves was subjected to standard laboratory tests and thromboelastometry analysis. Read More

    Trigeminocardiac reflex in cerebrovascular surgery: a review and an attempt of a predictive analysis.
    Expert Rev Cardiovasc Ther 2017 Feb 4:1-7. Epub 2017 Feb 4.
    a Department of Research , University of Southampton , Southampton , UK.
    Introduction: Trigemino-cardiac reflex (TCR) is a well-established neurogenic reflex that is primarily observed in many neurosurgical procedures, especially skull base surgery. Few management strategies have been highlighted in the literature; however, controversies still exist related to this topic. Areas covered: The authors present for the first time the results of a multivariable analysis to predict the TCR during cerebrovascular surgery. Read More

    Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome.
    Semin Cardiothorac Vasc Anesth 2017 Jan 1:1089253216687857. Epub 2017 Jan 1.
    2 Cleveland Clinic, Cleveland, OH, USA.
    The first stage of surgical treatment for hypoplastic left heart syndrome (HLHS) includes the creation of artificial systemic-to-pulmonary connections to provide pulmonary blood flow. The modified Blalock-Taussig (mBT) shunt has been the technique of choice for this procedure; however, a right ventricle-pulmonary artery (RV-PA) shunt has been introduced into clinical practice with encouraging but still conflicting outcomes when compared with the mBT shunt. The aim of this study is to explore mathematical modeling as a tool for describing physical profiles that could assist the surgical team in predicting complications related to stenosis and malfunction of grafts in an attempt to find correlations with clinical outcomes from clinical studies that compared both surgical techniques and to assist the anesthesiologist in making decisions to manage patients with this complex cardiac anatomy. Read More

    Delayed Anaphylaxis to Mammalian Meat Following Tick Exposure and Its Impact on Anesthetic Management for Cardiac Surgery: A Case Report.
    A A Case Rep 2017 Jan 23. Epub 2017 Jan 23.
    From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia.
    Hypersensitivity reactions to mammalian meat following tick exposure are increasing in prevalence and provide a unique challenge to anesthesiologists. The reactions, including anaphylaxis, are delayed and therefore may not be easily recognized and treated. The risk is especially high in cardiac surgery, where several potential triggers, including biological valves as well as heparin, are used frequently. Read More

    Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults.
    Eur J Cardiothorac Surg 2017 Jan 22. Epub 2017 Jan 22.
    Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
    Objectives: Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients.

    Methods: We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Read More

    Patient management in aortic arch surgery†.
    Eur J Cardiothorac Surg 2017 Jan;51(suppl 1):i4-i14
    Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
    SummaryAortic arch surgery requires complex patient management beyond the manual replacement of the diseased vessel. These procedures include (i) a thorough and pathologically adjusted preoperative evaluation, (ii) initiation and control of cardiopulmonary bypass, (iii) cerebral protection strategies and (iv) techniques to protect the abdominal end organs during prolonged operations. Due to the complexity of aortic arch procedures, multimodal real-time surveillance is required during all stages of the operation. Read More

    The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial.
    Lancet 2017 Feb 18;389(10070):701-708. Epub 2017 Jan 18.
    Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia; Children's Lung Health, Telethon Kids Institute, Perth, WA, Australia. Electronic address:
    Background: Perioperative respiratory adverse events (PRAE) are the most common critical incidents in paediatric anaesthesia and occur more often in infants. Use of laryngeal mask airways (LMAs) is associated with reduced PRAE compared with endotracheal tubes in older children (>1 year). We aimed to evaluate the effect of these devices on the incidence of PRAE in infants. Read More

    Surgical Considerations in Total Anomalous Pulmonary Venous Connection.
    Semin Cardiothorac Vasc Anesth 2017 Jan 1:1089253216688535. Epub 2017 Jan 1.
    2 Seattle Children's Hospital, Seattle, WA, USA.
    Total anomalous pulmonary venous connection (TAPVC) is predominantly a neonatal congenital cardiac diagnosis in which the pulmonary veins fail to return to the left atrium. The presence or absence of obstruction defines the clinical presentation, and in the setting of obstructed pulmonary veins, this diagnosis represents a true surgical emergency. Improvements in perioperative care and refinement of surgical techniques continue to allow for improved survival and decreased morbidity. Read More

    Perioperative Care of the Patient With the Total Artificial Heart.
    Anesth Analg 2017 Jan 19. Epub 2017 Jan 19.
    From the *Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California; and †Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
    Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. Read More

    Transcatheter aortic valve implantation: new hope in the management of valvular heart disease.
    Postgrad Med J 2017 Jan 19. Epub 2017 Jan 19.
    Frimley Health NHS Foundation Trust, London, UK.
    Severe calcific aortic stenosis is relatively common, and unless treated with valve replacement it carries an adverse prognosis. A large number of patients, however, are denied surgery due to their advanced age or coexistent medical conditions that increase perioperative cardiovascular risks. Transcatheter aortic valve implantation (TAVI), a technique in which a bioprosthetic valve is inserted via a catheter and implanted within the diseased native aortic valve, is a new therapeutic modality for treatment of older patients with severe symptomatic aortic stenosis and other comorbidities, who have an inherently high surgical risk. Read More

    The Effect of Epidural Levobupivacaine and Fentanyl on Stress Response and Pain Management in Patients Undergoing Percutaneous Nephrolithotomy.
    West Indian Med J 2016 Mar 14. Epub 2016 Mar 14.
    Ataturk University School of Medicine, Department of Anesthesiology and Reanimation 25100, Yakutiye/Erzurum/Turkey.
    Objective: The perioperative stress response of patients who were scheduled to have percutaneous nephrolithotomy under epidural anaesthesia with opioids and local anaesthetics has not been investigated in detail yet. Our hypothesis is that the stress response following percutaneous nephrolithotomy can be lessened by epidural analgesia.

    Methods: A total of 48 patients, between 18-65 years of age and ASA I-II, for whom elective percutaneous nephrolithotomy was planned, were randomly divided into two groups namely: Group GA (n = 24): general anaesthesia by sevoflurane and fentanyl and postoperative intravenous PCA; Group GE (n = 24): epidural anaesthesia and general anaesthesia together with postoperative epidural analgesia (0. Read More

    Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia.
    Tex Heart Inst J 2016 Dec 1;43(6):496-502. Epub 2016 Dec 1.
    Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Read More

    Perioperative management of a large, late presenting phaeochromocytoma.
    BMJ Case Rep 2017 Jan 18;2017. Epub 2017 Jan 18.
    North Shore Hospital, Auckland, New Zealand.
    A 77-year-old man presenting to the emergency department with an acute coronary syndrome was later found to have a phaeochromocytoma. The lateness of this presentation was likely due to the protective α blocking effects of long-term terazosin therapy for his prostatism. α blockers such as terazosin are a well-recognised medical therapy in the perioperative optimisation of phaeochromocytoma because they treat the adrenergic effects of catecholamine release from the tumour such as hypertension. Read More

    Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX).
    Br J Anaesth 2017 Feb;118(2):190-199
    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
    Background: In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes.

    Methods: Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II.

    Results: Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8. Read More

    Delivery of anesthesia for children with Mucopolysaccharidosis Type III (Sanfilippo syndrome): a review of 86 anesthetics.
    Paediatr Anaesth 2017 Jan 18. Epub 2017 Jan 18.
    Department of Anaesthesia, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
    Background: Sanfilippo syndrome (MPS III) is rare, with 97 cases in the United Kingdom between 1988 and 1998. Mucopolysaccharide infiltration of tissues in mucopolysaccharidosis (MPS) causes multi-systemic pathology including difficult airways and cardiac disease. Published anesthesia case reviews of Sanfilippo syndrome have included limited numbers of patients to date. Read More

    The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review.
    Eur J Prev Cardiol 2017 Mar 17;24(4):409-425. Epub 2017 Jan 17.
    4 Department of Cardiology, University of Cagliari, Cagliari, Italy.
    Background One controversial issue in the relationship between oral care and cardiovascular diseases is how and whether to manage oral infections prior to cardiovascular surgery or other cardiovascular invasive procedures. Design We designed a systematic review to assess the information available on three main questions. Is there an agreement on the need for dental evaluation and treatment before cardiovascular interventions? Are consistent clinical recommendations or protocols available? Is dental treatment prior to cardiovascular interventions effective? Methods A systematic electronic search of MEDLINE, Scopus and Web of Science was performed from the database inceptions up to 31 April 2016. Read More

    Fluid management in cardiac surgery patients: pitfalls, challenges and solutions.
    Minerva Anestesiol 2017 Jan 17. Epub 2017 Jan 17.
    Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
    Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Read More

    The impact of liver disorders on perioperative management of reoperative cardiac surgery: a retrospective study in adult congenital heart disease patients.
    J Anesth 2017 Jan 16. Epub 2017 Jan 16.
    Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-0872, Japan.
    Purpose: We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients.

    Methods: This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery.

    Results: Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%). Read More

    Cardiac Pacemakers: Function, Troubleshooting, and Management: Part 1 of a 2-Part Series.
    J Am Coll Cardiol 2017 Jan;69(2):189-210
    Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address:
    Advances in cardiac surgery toward the mid-20th century created a need for an artificial means of stimulating the heart muscle. Initially developed as large external devices, technological advances resulted in miniaturization of electronic circuitry and eventually the development of totally implantable devices. These advances continue to date, with the recent introduction of leadless pacemakers. Read More

    General Anesthesia and Fabry Disease: A Case Report.
    A A Case Rep 2017 Jan 11. Epub 2017 Jan 11.
    From the *Department of Anesthesia and Intensive Care, Kantonsspital Schaffhausen, Schaffhausen, Switzerland; and †Clinic of Medicine/Endocrinology, UniversitätsSpital Zürich.
    Fabry disease is an inherited X-linked disorder characterized by the absence (in men) or deficiency (in women) in α-galactosidase A activity that causes a progressive accumulation of glycosphingolipids within lysosomes of cells of all the major organ systems. The subsequent organ damage that manifests in childhood and early adulthood presents a widely variable clinical picture of pain, hypertension, and cardiac, renal, nervous system, and lung dysfunction. We present 2 female patients with Fabry disease who required general anesthesia twice for gynecological and trauma surgery, respectively, and discuss their perioperative management based on new information in the medical literature. Read More

    The impact of a perceptual and adaptive learning module on transoesophageal echocardiography interpretation by anaesthesiology residents.
    Br J Anaesth 2016 Oct;117(4):477-481
    UCLA Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA.
    Background: The role of transoesophageal echocardiography (TOE) in anaesthetic practice is expanding. We evaluated the effect of a TOE perceptual and adaptive learning module (PALM) on first-yr anaesthesiology residents' performance, in diagnosing cardiac pathology by TOE.

    Methods: First-yr residents were assigned to a group (n = 12) that used a TOE PALM or a control group that did not (n = 12). Read More

    The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.
    Interact Cardiovasc Thorac Surg 2017 Jan 10. Epub 2017 Jan 10.
    Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
    Objectives: Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system.

    Methods: We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Read More

    Goldenhar syndrome: Cardiac anesthesiologist's perspective.
    Ann Card Anaesth 2017 Jan;20(Supplement):S61-S66
    Department of Cardiac Anaesthesia, Cardio thoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
    Goldenhar syndrome or oculo-auriculo-vertebral dysplasia was defined by Goldenhar in 1952 and redefined by Grolin et al. later. As the name denotes, children with this syndrome present with craniofacial and vertebral anomalies which increase the risk of airway compromise. Read More

    Pharmacological update: New drugs in cardiac practice: A critical appraisal.
    Ann Card Anaesth 2017 Jan;20(Supplement):S49-S56
    Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India.
    Cardiac practice involves the application of a range of pharmacological therapies. An anesthesiologist needs to keep pace with the rampant drug developments in the field of cardiovascular medicine for appropriate management in both perioperative and intensive care set-up, to strengthen his/her role as a perioperative physician in practice. The article reviews the changing trends and the future perspectives in major classes of cardiovascular medicine. Read More

    Delirium after cardiac surgery: A pilot study from a single tertiary referral center.
    Ann Card Anaesth 2017 Jan-Mar;20(1):76-82
    Department of Anaesthesia, Postgraduate Institute for Medical Education and Research, Chandigarh, India.
    Background: Advances in cardiac surgery has shifted paradigm of management to perioperative psychological illnesses. Delirium is a state of altered consciousness with easy distraction of thoughts. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. Read More

    The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy: A retrospective trial.
    Medicine (Baltimore) 2017 Jan;96(1):e5815
    aDepartment of Anesthesiology, Liaocheng People's Hospital bDepartment of Anesthesiology cDepartment of General ward, women and children health of Dongchangfu District, Liaocheng, Shandong, China.
    Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1. Read More

    Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome.
    Clin Chem 2017 Jan 10;63(1):223-235. Epub 2016 Oct 10.
    Department of Medical Sciences and.
    Background: Increased cardiac troponin concentrations in acute coronary syndrome (ACS) identify patients with ongoing cardiomyocyte necrosis who are at increased risk. However, with the use of more precise assays, cardiac troponin increases are commonly noted in other cardiovascular conditions as well. This has generated interest in the use of cardiac troponin for prognostic assessment and clinical management of these patients. Read More

    Constrictive Pericarditis: A Practical Clinical Approach.
    Prog Cardiovasc Dis 2017 Jan - Feb;59(4):369-379. Epub 2017 Jan 4.
    Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address:
    Constrictive pericarditis (CP) represents a form of severe diastolic heart failure (HF), secondary to a noncompliant pericardium. The true prevalence of CP is unknown but it is observed in 0.2-0. Read More

    Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices.
    Anesthesiology 2017 Mar;126(3):450-460
    From the Department of Anesthesiology (M.R.M., S.S., S.K., M.D.C., E.S.J., M.C.E.) and Department of Cardiac Surgery (F.D.P.), University of Michigan Health System, University of Michigan, Ann Arbor, Michigan.
    Background: Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns.

    Methods: The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. Read More

    Organ transplantation and drug eluting stents: Perioperative challenges.
    World J Transplant 2016 Dec;6(4):620-631
    Aparna Dalal, Department of Anesthesiology, Icahn School of Medicine, New York, NY 10029, United States.
    Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Read More

    Clinical Databases and Registries in Congenital and Pediatric Cardiac Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide.
    World J Pediatr Congenit Heart Surg 2017 Jan;8(1):77-87
    2 Department of Pediatric Cardiology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
    The growth in large-scale data management capabilities and the successful care of patients with congenital heart defects have coincidentally paralleled each other for the last three decades, and participation in multicenter congenital heart disease databases and registries is now a fundamental component of cardiac care. This manuscript attempts for the first time to consolidate in one location all of the relevant databases worldwide, including target populations, specialties, Web sites, and participation information. Since at least 1,992 cardiac surgeons and cardiologists began leveraging this burgeoning technology to create multi-institutional data collections addressing a variety of specialties within this field. Read More

    Factors Influencing Neurodevelopment after Cardiac Surgery during Infancy.
    Front Pediatr 2016 15;4:137. Epub 2016 Dec 15.
    Pediatric Cardiology, University Hospital RWTH Aachen , Aachen , Germany.
    Short- and long-term neurodevelopmental (ND) disabilities with negative impact on psychosocial and academic performance, quality of life, and independence in adulthood are known to be the most common sequelae for surviving children after surgery for congenital heart disease (CHD). This article reviews influences and risk factors for ND impairment. For a long time, the search for independent risk factors was focused on the perioperative period and modalities of cardiopulmonary bypass (CPB). Read More

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