Journal of Cardiothoracic and Vascular Anesthesia via MedWorm.com

Cardiac Calendar—2012 to 2013

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

Fifty-Eighth Annual Meeting of Indian Association of Cardiovascular and Thoracic Surgeons. Kolkata, India. February 10-12, 2012. Contact: http://www.iacts2012.com. Cardiothoracic Symposium 2012. Iguazu Falls, Argentina. March 19-21, 2012. Contact: ctsymposium2012@mci-group.com. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Advances in the Management of Carotid Artery Disease: Focus on Recent Evidence and Guidelines

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilatera...

Case 1—2012 A Perfect Storm: Fatality Resulting From Metoclopramide Unmasking A Pheochromocytoma and Its Management

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

A PHEOCHROMOCYTOMA IS AN UNCOMMON catecholamine-secreting neuroendocrine tumor with typical symptoms of paroxysmal headache, palpitations, and severe hypertension. Pheochromocytomas can be associated with labile hemodynamics. However, hemodynamic shock is infrequent, occurring in approximately 2%. Before 1960, mortality in patients with pheochromocytoma was >50%. Currently, the mortality is (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2011

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

There have been rapid advances in oral anticoagulation. The oral factor Xa inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran recently have been rigorously evaluated. These novel anticoagulants will usher in a new paradigm for perioperative anticoagulation. Perioperative blood conservation in cardiac surgery recently has been highlighted in the updated guidelines by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. These recommendations reflect a comprehensive evaluation of the recent evidence to optimize transfusion practice. Transcatheter mitral valve repair continues to mature. Transcatheter aortic valve implantation for aortic stenosis has entered the clinical mainstream, with randomized trials showing its superiori...

Hands-on…Handoff

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

ALL CARDIAC ANESTHESIOLOGISTS have been confronted by suboptimal intensive care unit (ICU) patient handoffs. Simply put, handoffs are a risky business. The protocols involved in this area have been identified as one of the weakest links in patient management. The often-cited Institute of Medicine report Crossing the Quality Chasm asserts that patient handoffs provide opportunity for error. The report notes, “In a safe environment, information is not lost, inaccessible, or forgotten in transitions.” Improved system design can enhance the ability of providers to (1) communicate more effectively, (2) create efficient means of transferring monitors, and (3) reduce the total number of steps in the process. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Guide for Authors

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Articles to Appear in Future Issues

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Editorial Board

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Masthead

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Subject Index

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Author Index

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Guest Reviewers for 2011 Manuscripts

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

The Editor-in-Chief and the members of the Journal's Editorial Board would like to thank the following guest reviewers for their expertise in reviewing manuscripts during the past year. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Use of Transesophageal Echocardiography for Diagnosing a Malfunctioning Newly Implanted Prosthetic Mitral Valve

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

I read with interest the letter by Dr A. Goel et al in which they described a case of a patient in whom there was a stuck leaflet of a bioprosthetic mitral valve. This was detected while preparing to wean from cardiopulmonary bypass (CPB) with the aid of transesophageal echocardiography (TEE). The patient was returned to full CPB, and the stuck valve was fixed. I commend the authors on their successful management and on their interesting presentation, and I would like to add additional information. Although not referenced in the report, the intraoperative detection of a stuck valve was first reported in 1995. In that case, the mitral valve had been replaced with a St Jude prosthetic valve (St Jude Medical, St Paul, MN). The prosthetic valve appeared normal during an examination with TEE wh...

Retractions Lead to Revision of Review Article “Contemporary Fluid Management in Cardiac Anesthesia”

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

Numerous articles authored by Dr Joachim Boldt were retracted from international journals on anesthesia and intensive care medicine because of missing institutional review board approvals. Therefore, we believe our recent publication needed to be updated to re-evaluate conclusions that might have been influenced by the retracted data. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Postinfarction Ventricular Septal Defects: Surgical or Percutaneous Closure—Between a Rock and a Hard Place

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

To comment on this case and the clinical decisions made, please go to: (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Education of Anesthesia Residents and Cardiothoracic Fellows: Can They Work Together?

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

THE ACCREDITATION of the cardiothoracic anesthesia fellowship has encouraged an exponential increase in the number of applicants seeking cardiothoracic anesthesia fellowships. This has created discontent among residents, who perceive and rightly so that fellows are competing for the major, complicated cases and depriving residents of opportunities to enhance their skills. This problem may be caused in part by instances in which fellows supervise instead of handling their own cases. These are tricky waters to navigate, for it is still crucial for our fellows to supervise and teach residents because a key goal of the fellowship is to train future educators. I believe this imperative extends across all subspecialties. It is our job as leaders and educators to balance the needs of both residen...

Guide for Authors

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

The Journal of Cardiothoracic and Vascular Anesthesia will consider for publication suitable articles on all topics related to anesthesia for cardiac, vascular, and thoracic surgery. The scope of this Journal is broad and seeks to consolidate all material pertinent to cardiothoracic anesthesiology, including topics from critical care medicine, pharmacology, monitoring, perfusion technology, internal medicine, surgery, and transplantation. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Articles to Appear in Future Issues

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights for 2011 P.A. Patel, H. Ramakrishna, M. Andritsos, T. Wyckoff, H. Riha, and J.G.T. Augoustides; Philadelphia, PA (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Editorial Board

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Masthead

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 01 Dec 2011 00:53:10 +0100

Journal of Cardiothoracic and Vascular Anesthesia (ISSN 1053-0770) is published bimonthly by Elsevier, 360 Park Avenue South, New York, NY 10010-1710. Periodicals postage paid at New York, NY and additional mailing offices. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Increased Chest Tube Drainage Is Independently Associated With Adverse Outcome After Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions: Postoperative hemorrhage (drainage loss) exceeding 200 mL/h in 1 hour or 2 mL/kg for 2 consecutive hours occurring within 6 hours after cardiac surgery is associated with higher 30-day mortality and other postoperative complications. Further research is needed to validate these results. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Noncardiac Surgery in the Prone Position in Patients With Ventricular Assist Devices

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 18 Nov 2011 05:00:00 +0100

After a literature review and PubMed search using the key words “prone,” “ventricular assist device,” “noncardiac surgery,” and “position,” we report the first case of surgery in the prone position in a patient with a ventricular assist device (VAD). A 72-year-old woman with a previously implanted Heartmate II (Thoratec Corporation, Pleasanton, CA) Left Ventricular Assist Device presented to the authors' institution with an expanding right frontoparietal hematoma and left-sided hemiplegia. As such, the patient proceeded to the operating room for a right parietal craniotomy for decompression of an intracerebral hematoma. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

A Randomized, Double-Blind Trial Comparing Continuous Thoracic Epidural Bupivacaine With and Without Opioid in Contrast to a Continuous Paravertebral Infusion of Bupivacaine for Post-thoracotomy Pain

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 18 Nov 2011 05:00:00 +0100

Conclusions: The current study provided data that fill gaps in the current literature in 3 important areas. First, this study found that thoracic epidural analgesia (TEA) with bupivacaine and a hydrophilic opioid, hydromorphone, may provide enhanced analgesia over TEA or continuous paravertebral infusion (CPI) with bupivacaine alone. Second, in the bupivacaine-alone group, the increased basal rates required to achieve analgesia resulted in hypotension more frequently than in the bupivacaine/hydromorphone combination group, underscoring the benefit of the synergistic activity. Finally, in agreement with previous retrospective studies, the current data suggest that CPI of local anesthetic appears to provide acceptable analgesia for post-thoracotomy pain. (Source: Journal of Cardiothoracic a...

Thoracic Epidural or Paravertebral Catheter for Analgesia After Lung Resection: Is the Outcome Different?

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 17 Nov 2011 05:00:00 +0100

Conclusions: Paravertebral catheter analgesia with morphine patient-controlled analgesia seems as effective as thoracic epidural for reducing the risk of postoperative complications. The authors additionally found that paravertebral catheter use is associated with a shorter hospital stay and may be a better form of analgesia for fast-track thoracic surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Anesthesia for Interventional Cardiology

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 07 Nov 2011 05:00:00 +0100

This article reviews the common implantation and electrophysiology (EP) procedures undertaken in cardiac catheterization laboratories. An outline of the procedures undertaken and their major periprocedural complications are addressed along with recommendations for their anesthetic management. The first section covers closure of intracardiac shunts, closure of patent ductus arteriosus (PDA), left atrial appendage (LAA) occlusion devices, transcatheter valves, and the implantation and removal of pacemaker and rhythm management devices. The second section covers EP procedures and anesthetic management issues in patients with congenital heart disease (CHD). It also covers the anesthetic implications of ionizing radiation and practice in a remote location. (Source: Journal of Cardiothoracic and...

Thoracic Paravertebral Block for Video-Assisted Thoracoscopic Surgery: Single Injection Versus Multiple Injections

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 07 Nov 2011 05:00:00 +0100

Conclusions: The two techniques provided comparable postoperative analgesia. However, single-injection PVB may represent an advantage over multiple-injection PVB in patients undergoing VATS, with greater patient satisfaction associated with a shorter procedure and the likelihood of decreased complications. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Reasons Elevated B-Type Natriuretic Peptide Levels Are Associated With Adverse Outcome in Patients Undergoing Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 17 Oct 2011 04:00:00 +0100

We read with interest the recent article by Nozohoor et al who studied a total of 407 consecutive patients undergoing cardiac surgery and found that elevated B-type natriuretic peptide (BNP) levels were associated with adverse postoperative outcome (prolonged ventilation and inotropic support) and were predictive of impaired late survival. However, they did not point out why elevated BNP was associated with adverse outcome in patients undergoing cardiac surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Iatrogenic Acute Aortic Dissection During Cardioplegic Cannula Insertion Detected by Transesophageal Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 17 Oct 2011 04:00:00 +0100

Iatrogenic acute aortic dissection (IAAD) is a rare but potentially lethal complication. Fortunately, the reported incidence of IAAD is low (approximately 0.16% to 0.35%), perhaps because of underreporting or underdetection (small or posteriorly located, precluding visual detection). The authors report a case of IAAD with an intimal tear in the posterior wall of the ascending aorta during cardioplegic cannula insertion detected intraoperatively by transesophageal echocardiography (TEE). (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Update on Blood Conservation for Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 17 Oct 2011 04:00:00 +0100

PATIENTS UNDERGOING CARDIAC SURGERY are at risk of excessive bleeding, leading to increased usage of allogeneic blood and hemostatic blood products. Although this patient population represents a relatively small proportion of surgical patients, cardiac surgery consumes about 20% of the available blood supply in the United States, with similar numbers reported worldwide. The potential for beneficial effects of transfusing blood to maintain tissue oxygen perfusion and prevent organ ischemia may be greatest in patients with cardiovascular disease. Indeed, life-threatening hemorrhage, an absolute indication for blood transfusion, may be relatively frequent in these patients, with repeat surgery for bleeding occurring in up to 5% of patients. In addition, the risks of preexisting anemia and acu...

Cardiothoracic Anesthesiology Fellowship: Challenges of Training and a Novel Approach to Resident Education

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 17 Oct 2011 04:00:00 +0100

THE FEBRUARY 2011 issue of the Journal of Cardiothoracic and Vascular Anesthesia (JCVA) had an editorial by Dr Dalia A. Banks introducing a new Journal section for fellows, the “Cardiac Anesthesia Fellows Education (CAFE)”. This section provides an ideal opportunity for fellows to pursue their academic interests. Dr Banks highlighted many important issues pertaining to CTA (cardiothoracic anesthesiology) fellows and their transition to clinician/educators. As Dr Banks mentions in her editorial, educational opportunities are an important facet of the fellowship experience. Here, a novel approach to intraoperative resident education is presented. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Sudden Intraoperative Hypertension During Endovascular Abdominal Aortic Repair as a First Sign of Massive Fatal Atheroembolism

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 10 Oct 2011 04:00:00 +0100

We report here the case of an 80-year-old man who, while undergoing EVAR, developed unexplained severe hypertension and died of multiple-organ failure on the second postoperative day. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Cardiac Calendar—2012 to 2013

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 10 Oct 2011 04:00:00 +0100

Thirtieth Annual Symposium Clinical Update in Anesthesiology, Surgery and Perioperative Medicine with International Faculty and Industrial Exhibits. San Juan, Puerto Rico. January 15-21, 2012. Contact: http://www.clinicalupdateinanesthesiology.org, e-mail: marc.stone@mountsinai.org. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Advances in Anticoagulation: Focus on Dabigatran, an Oral Direct Thrombin Inhibitor

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 10 Oct 2011 04:00:00 +0100

Dabigatran is an oral direct thrombin inhibitor with a rapid onset. Patients on dabigatran do not require coagulation monitoring. Recent prospective randomized trials have shown the efficacy of dabigatran for the prevention of venous thromboembolism after knee or hip arthroplasty and for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Because dabigatran is cleared principally by the kidneys, dosage adjustments are required in the setting of renal dysfunction. There currently is no reversal agent for dabigatran although hemodialysis can facilitate its rapid removal in life-threatening circumstances. The management of severe bleeding associated with dabigatran also may include the administration of a procoagulant, such as recombinant activated factor VII. B...

RETRACTION: De Hert SG, Lorsomradee S, vanden Eede H, Cromheecke S, Van der Linden PJ. A Randomized Trial Evaluating Different Modalities of Levosimendan Administration in Cardiac Surgery Patients With Myocardial Dysfunction. J Cardiothorac Vasc Anesth 2008;22:699-705

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

It was brought to the attention of Dr. De Hert that some of the outcome data on postoperative mortality in this paper are very similar to those reported in an earlier paper by Dr. De Hert, based on an earlier study, and published in Anesthesia and Analgesia, Volume 104:766-773 (2007). Upon further investigation Dr. De Hert and his co-authors determined that some of the data from the first study were inadvertently included in Groups A and C of the second study, published in Journal of Cardiothoracic and Vascular Anesthesia. Dr. De Hert has therefore requested that his JCVA paper be withdrawn. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Cardiac Calendar—2011 to 2012

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

Twenty-Fifth Annual Meeting of the European Association for Cardiothoracic Surgery. Lisbon, Portugal. October 1-5, 2011. Contact: www.eacts.org. Eighteenth International Congress of the Czech Society of Anesthesiology and Critical Care Medicine. Prague, Czech Republic. October 6-8, 2011. Contact: www.csarim2011.cz; e-mail: csarim2011@guarant.cz. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Integrating Outcome Benefit Into Anesthetic Design: The Promise of Steroids and Statins

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

Steroids and statins may facilitate the integration of anesthetic design with clinical outcome. Although steroids clearly benefit adult cardiac surgical patents, the evidence is weaker in pediatric cardiac surgery. Current large randomized trials of steroids likely will determine the future role of steroids in adult cardiac surgery. In the intensive care unit, steroid therapy is indicated in septic shock that is refractory to fluid and pressor therapy. Recent data, however, indicate that liberal steroid therapy for sepsis may have adverse outcome consequences. A 2nd concern in the intensive care unit is acute adrenal suppression secondary to bolus etomidate therapy because it may be deleterious in patients with septic shock. Possible clinical solutions include alternative induction agents,...

Con: Extubation in the Operating Room Following Pediatric Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

EXTUBATION IN THE OPERATING ROOM after surgery for correction of congenital heart defects in children, even in selected cohorts, has no proven benefit to patients or families, is associated with disguised resource consumption, and has never been demonstrated conclusively to shorten the duration of intensive care unit (ICU) or hospital stay. Furthermore, although extubation in the ICU after a short (2- to 6-hour) period of stabilization is appropriate in selected patients, the routine application of early extubation after pediatric cardiac surgery cannot be justified. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Pro: Early Extubation Following Surgery for Congenital Heart Disease

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

EARLY EXTUBATION in adult patients undergoing cardiac surgery has been shown to be safe and to decrease resource use. Despite several large studies showing that this practice can be extended to pediatric patients undergoing surgery for congenital heart disease (CHD), there is still a significant amount of controversy. Some centers attempt extubation as soon as possible, whereas others routinely sedate patients after surgery. A quick literature search shows that early extubation in children undergoing surgery for CHD had been introduced in the late 1970s. Several large studies and case series have since proved that early extubation can be performed safely in simple and complex surgical cases for all age groups, including neonates. The term “early extubation” typically is applied when pa...

CASE 5—2011Acute Respiratory Distress Syndrome in an Infant After Repair of Tetralogy of Fallot

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) carries a high mortality. Protective lung ventilation (low tidal volume [TV] and positive end-expiratory pressure [PEEP]), particularly low TV ventilation, is the only therapy that has been shown to decrease mortality in ARDS patients (from approximately 40% to 30%). ARDS and protective lung ventilation are usually associated with hypoxemia, hypercapnea, and increased pulmonary vascular resistance (PVR). These pathophysiologic changes can result in right ventricular (RV) dysfunction or aggravation of existing RV dysfunction. The authors discuss management issues of tetralogy of Fallot (TOF) in an infant who developed ARDS postoperatively after intracardiac repair. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Bench to Bedside: Dynamic Mitral Valve Assessment

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: This new software, despite its limitations, allows an improved perspective on MV geometry with implications for MV repair and surgical decision making. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Scholarly Productivity, Academic Success, and Beyond

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

IN THIS ISSUE of the Journal, Pagel and Hudetz examine the scholarly productivity of academic cardiac anesthesiologists in the United States. They use the h-index, a “bibliometric statistic” defined as the number (h) of an individual's publications that have been cited at least h times in the peer-reviewed literature. Not surprisingly, the h-index increased with academic rank. Thus, such a measurement is certainly one indication of academic success, incorporating the quality and appeal of an individual's scientific output. Hence, the investigators are to be congratulated for quantifying the current status of such success among cardiac anesthesiologists practicing in academic health care centers in the United States. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Guide for Authors

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

Articles to Appear in Future Issues

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

Volatile Agents for Cardiac Protection in Noncardiac Surgery: A Randomized Controlled Study A. Zangrillo, V. Testa, V. Aldrovandi, A. Tuoro, G. Casiraghi, F. Cavenago, M. Messina, E. Bignami, and G. Landoni, MD; Milan, Italy (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Editorial Board

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Masthead

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

A Word of Caution Regarding Transesophageal Echocardiography and Penetrating Chest Trauma

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

In their recent Case Conferenence, Stein et al described the use of transesophageal echocardiography (TEE) to assist in the diagnosis and management of a stab wound to the left chest. I would like to proffer a word of caution regarding the use of TEE in a patient who recently had sustained a penetrating chest injury. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Coronary Artery Disease, Acute Myocardial Infarction, and a Newly Developing Ventricular Septal Defect: Surgical Repair or Percutaneous Closure?

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

For further information and follow-up discussion of the E-Challenge, please go to: (Source: Journal of Cardiothoracic and Vascular Anesthesia)

CASE 7—2011: Perioperative Challenges of Valvular Replacement in Patients After Mediastinal Radiation Therapy

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

MEDIASTINAL RADIATION THERAPY can induce a wide spectrum of cardiovascular pathology, and the potential perioperative risks for patients after radiation therapy who require valvular surgery remain underappreciated. These patients frequently present with symptoms consistent with a deterioration in cardiac function despite optimal medical management, and surgical intervention becomes an option to extend and improve quality of life. Interestingly, some of these patients may appear to have normal left ventricular function based on preoperative workup, which may be deceiving to the unfamiliar practitioner when developing an intraoperative management plan. The authors retrospectively reviewed their experience with this delicate subset of patients to collectively identify intraoperative challenge...

Poststernotomy Pain: A Clinical Review

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

POORLY CONTROLLED PAIN is associated with sympathetic nervous system activation and an increased hormonal stress response. This response may contribute to multiple adverse postoperative events, including myocardial ischemia, cardiac arrhythmias, hypercoagulability, pulmonary complications, and increased rates of delirium and wound infection. In a systematic review of trials that examined postoperative pain and patient outcomes, better pain control was associated with lower rates of cardiovascular complications, pneumonia, and postoperative hypercoagulability. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Comparison of the Analgesic Effects of Continuous Extrapleural Block and Continuous Epidural Block After Video-Assisted Thoracoscopic Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

Conclusions: Although this study did not show the superiority of continuous extrapleural block relative to continuous epidural in VATS patients, the results suggest that both methods provided effective analgesia with a relatively small dose of rescue morphine. Although the analgesic effects of these techniques were comparable, extrapleural block has the advantage of safety and precise placement of the catheter and can be considered an alternative to epidural block in VATS patients. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Cardioprotection by Volatile Anesthetics: What About Noncardiac Surgery?

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

OVER THE LAST TWO decades, many experimental studies have shown that volatile anesthetics provide protection against the consequences of myocardial ischemia-reperfusion (IR) injury. These studies involved the intentional application of reversible or irreversible myocardial ischemia mainly in young and healthy hearts. However, translating these predominantly beneficial findings to the clinical setting has proven to be disappointing. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Milrinone and Mortality in Adult Cardiac Surgery: A Meta-analysis

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 26 Sep 2011 04:00:00 +0100

Conclusions: This analysis suggests that milrinone might increase mortality in adult patients undergoing cardiac surgery. The effect was seen only in patients having an active inotropic drug for comparison and not in the placebo subgroup. Therefore, the question remains whether milrinone increased mortality or if the control inotropic drugs were more protective. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Reply to Dr Herzlinger

Journal of Cardiothoracic and Vascular Anesthesia — Tue, 20 Sep 2011 04:00:00 +0100

We appreciate the opportunity to respond to Dr Herzlinger's letter. Since our case report, overheating of the FMS 2000 Rapid Infuser continues to occur during liver transplantations at UCLA, and the number and frequency of the incidents are increasing. In the first few months of 2011 (up to June 9), we had an additional 23 cases of overheating. In addition to input from the manufacturer, we have consulted hospital bioengineers, the hospital facility operations director, the blood bank director and staff, other practitioners, and independent investigators. We have examined our practice, blood preparation, pressure and backflow of the device, hospital electrical system (through several weeks of power quality studies), and the possibility of electromagnetic interference from other equipment....

Association Between Postoperative Acute Kidney Injury and Duration of Cardiopulmonary Bypass: A Meta-Analysis

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

Conclusions: Longer CPB times are associated with a higher risk of developing AKI-CPB, which, in turn, has a significant effect on overall mortality as reported by the individual studies. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Combined Central Venous Oxygen Saturation and Lactate as Markers of Occult Hypoperfusion and Outcome Following Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

Objective: To assess the association between postoperative central venous oxygen saturation (ScvO2) and arterial lactate with outcome after cardiac surgery. Design: Prospective observational study. Setting: University-affiliated tertiary care hospital. Participants: Patients after coronary artery bypass and/or valve surgery. Interventions: None. Measurements and Main Results: Postoperative ScvO2 and arterial lactate were obtained on arrival to the intensive care unit (ICU). ScvO2 and lactate were drawn again at 8 and 24 hours, respectively, after ICU admission. Moderate global tissue hypoxia (GTH) was defined as ScvO2 (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Overheating and Rupture of FMS 2000 Rapid Infuser

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

The case report by Xia et al described a case in which our rapid infusion/warmer, the FMS 2000 Rapid Infuser (Belmont Instrument Corporation, Billerica, MA), detected an above-temperature situation, alarmed, and stopped the infusion. A portion of the heat exchanger, part of our sterile single-use disposable set, appeared to have become very hot, and a portion of the housing appeared to have softened. As discussed below, the very hot portion of our heat exchanger involves fluid trapped in the heat exchanger, which cannot reach the patient. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

CASE 6—2011: Aortic Valve Replacement in a Patient With Aortic Stenosis, Dilated Cardiomyopathy, and Renal Dysfunction

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

AORTIC VALVE REPLACEMENT in patients with severe aortic stenosis (AS), dilated cardiomyopathy, and congestive heart failure usually is associated with a poor perioperative outcome. A poor outcome may be secondary to existing myocardial and/or multiorgan dysfunction, perioperative hemodynamic instability, inadequate myocardial protection, and to the detrimental effects of the cardiopulmonary bypass (CPB) related systemic inflammatory response. Aortic valve replacement in a patient with severe AS, dilated cardiomyopathy, congestive heart failure, and renal dysfunction is described, and the potential role of anesthetic management in successful outcome is discussed. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Pulse-Pressure Variation Predicts Fluid Responsiveness During Heart Displacement for Off-Pump Coronary Artery Bypass Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

Conclusions: Pulse-pressure variation successfully predicted fluid responsiveness and would be useful in guiding fluid management during heart displacement for off-pump coronary artery bypass surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Detection of Right Ventricular Insufficiency and Guidance of Volume Therapy Are Facilitated by Simultaneous Monitoring of Static and Functional Preload Parameters

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

Conclusions: Increases of CVP and SVV or PPV are suspicious for RVF. However, SVV and PPV fail to predict volume responsiveness in RVF. Changes in SVV and PPV during a volume-loading maneuver can be used to assess volume responsiveness. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Relationship Between Plethysmographic Waveform Changes and Hemodynamic Variables in Anesthetized, Mechanically Ventilated Patients Undergoing Continuous Cardiac Output Monitoring

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 16 Sep 2011 04:00:00 +0100

Conclusions: This study was unable to reproduce the results of prior studies. Only stroke volume and photoplethysmographic width were correlated in this study; however, the correlation and concordance (based on analysis of a 4-quadrant plot) were too weak to be clinically useful. Future studies in patients undergoing low-to-moderate risk surgery may result in improved correlations and clinical utility. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Evaluation of Tricuspid and Pulmonary Valves Using Epicardial and Transesophageal Echocardiography—A Comparative Study

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 05 Sep 2011 04:00:00 +0100

Conclusions: There was good agreement for Doppler measurements across TVs; however, measurements across PVs were significantly higher with EE versus TEE. TV Doppler measurements were difficult to acquire even for surgeons experienced in epiaortic scanning. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Pilot Implementation of a Perioperative Protocol to Guide Operating Room–to–Intensive Care Unit Patient Handoffs

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 05 Sep 2011 04:00:00 +0100

Conclusions: A standardized handoff protocol that guides the transfer of care from the OR team to the CSICU team can reduce the risk of missed information and improve satisfaction among perioperative providers. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Volatile Agents for Cardiac Protection in Noncardiac Surgery: A Randomized Controlled Study

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 29 Aug 2011 04:00:00 +0100

Conclusions: In the authors' experience, patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics. Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Anesthesia for Thoracic Surgery: A Survey of UK Practice

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 26 Aug 2011 04:00:00 +0100

Conclusions: The authors hope this survey both provides interest and serves as a useful resource reflecting the current practice of thoracic anesthesia. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Preconditioning With Repeated Hyperbaric Oxygen Induces Myocardial and Cerebral Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized, Controlled Clinical Trial

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 26 Aug 2011 04:00:00 +0100

Conclusions: Preconditioning with HBO resulted in both cerebral and cardiac protective effects as determined by biochemical markers of neuronal and myocardial injury and clinical outcomes in patients undergoing on-pump coronary artery bypass graft surgery. No protective effects were noted in off-pump coronary artery bypass graft surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Feasibility of Measuring Renal Blood Flow Using Transesophageal Echocardiography in Pediatric Patients Undergoing Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 25 Aug 2011 04:00:00 +0100

Objective: To evaluate the feasibility of measuring renal blood flow (RBF) using transesophageal echocardiography (TEE) in pediatric patients undergoing cardiac surgery. Design: A prospective noninterventional study. Setting: A university hospital. Participants: Twenty-three pediatric patients who underwent surgical repair for complex congenital heart defects were included in this study. Intervention: None. Measurements and Main Results: The authors evaluated the accuracy of using TEE to visualize the left renal artery by comparing TEE images with preoperative computed tomography angiographic images. RBF was measured during the cardiopulmonary bypass (CPB) period. TEE images and Doppler studies from all subjects were interpreted by 2 blinded independent assessors. Inter- and int...

Extracorporeal Membrane Oxygenation: A New Way to Study Toxic Drugs in Chronic Diseases

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 22 Aug 2011 04:00:00 +0100

We wish to propose a new research approach and treatment method for cancer, a leading cause of death all over the world. Clinically expensive chemotherapy absorbs an enormous part of research resources. Certain anticancer drugs, techniques, and strategies are never tested on humans because of their acute pulmonary and/or cardiac toxicity and, therefore, never reach the market. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Reply to Drs Giroti and Kiran

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 22 Aug 2011 04:00:00 +0100

We are grateful to Drs Giroti and Kiran for his their pertinent comments regarding our study. As it was pointed out, there are several factors that can contribute to postoperative cognitive dysfunction. The first one is atheroma either on the aorta or in the carotid artery. At the Montreal Heart Institute, we routinely use transesophageal echocardiography in all patients undergoing cardiac surgery as we have published previously. Examination of the aorta is also done routinely, and if abnormal, it will be followed by epiaortic scanning. Preoperative but not intraoperative Doppler examination of elderly patients is also performed. None of our patients developed stroke postoperatively. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Cryoablation of Atrial Fibrillation in Cardiac Surgery: Outcomes and Myocardial Injury Biomarkers

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 22 Aug 2011 04:00:00 +0100

Conclusions: Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Interaction Between Dexmedetomidine and α-Adrenergic Receptors: Emphasis on Vascular Actions

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 22 Aug 2011 04:00:00 +0100

Dexmedetomidine (DEX) is a new methylol derivative with high affinity to α2-adrenergic receptors. It causes analgesia and sympatholysis, and has sedative, anxiolytic, and hypnotic effects. The use of DEX and its affinity to α2-adrenergic receptors in the body should not only be limited to sedation and anesthesia, because α2-adrenergic receptors are scattered throughout the body. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Comparison of Transthoracic and Transesophageal 2-Dimensional Speckle Tracking Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

Conclusions: Transesophageal 2D strain imaging is a reproducible method to measure ventricular function and has a good agreement with TTE 2D strain imaging. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

A Comparative Evaluation of Transesophageal and Transthoracic Echocardiography for Measurement of Left Ventricular Systolic Strain Using Speckle Tracking

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

Conclusions: Strain measured by speckle tracking in TEE correlated moderately with TTE for global strain and poorly for regional strain. This may be explained by differences in scanning frequency and other imaging factors. Nevertheless, because of the high degree of reproducibility, it may be a useful tool to quantify intraoperative changes in ventricular function with TEE. However, equivalence between TTE and TEE cannot be assumed, and limits of comparability should be recognized. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Factors Affecting Neurocognitive Outcome After Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

With great interest we read the article by de Tournay-Jette et al, which evaluated the relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction (POCD) in elderly patients after coronary artery bypass graft surgery. It is true that most previous studies have evaluated the relationship between the near infrared spectroscopy value and POCD but in a relatively younger population, which itself has less cognitive dysfunction as compared with an elderly population. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Effects of Thoracic Epidural Anesthesia on Flow and Endothelium of Internal Thoracic Artery in Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

Conclusions: The results of this study indicated that TEA increased ITA free blood flow significantly via increased VEGF, i-NOS, and adenosine-A2B receptor expressions. Therefore, the use of TEA as an adjunct to GA might be considered as an alternative to vasoactive agents for increasing ITA flow in CABG surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Use of Recombinant Activated Factor VII for Controlling Refractory Postoperative Bleeding in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

Conclusions: Recombinant activated factor VII treatment reduced blood loss and transfusion requirements and prevented re-exploration in the majority (83.8%) of pediatric cardiac surgery patients. High doses were required to discontinue bleeding promptly in neonates, the majority of whom had hypoplastic left-heart syndrome. No treatment-related thrombotic events were observed. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Transesophageal Echocardiographic Short-Axis Views of the Left Atrial Appendage

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

Left atrial appendage (LAA) thrombus has a known association with embolic events, but diagnosis with echocardiography has proved to be an ongoing challenge. The correct diagnosis is important for decisions on surgical or percutaneous closure and anticoagulation. Although 3-dimensional transesophageal echocardiography has been shown to be more geometrically accurate for LAA assessment than 2-dimensional transesophageal echocardiography, should the diagnosis be suspected intraoperatively and no 3-dimensional machine is available, multiple 2-dimensional orthogonal views of LAA lesions should improve the diagnostic yield. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Aortic Stenosis and Mitral Regurgitation: Not as Simple as It Looks

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

To comment on this case and the clinical decisions made, please go to: (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Fate of Mitral Regurgitation After Aortic Valve Replacement for Aortic Stenosis

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 12 Aug 2011 04:00:00 +0100

For further information and follow-up discussion of the E-Challenge, please go to: (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Remifentanil in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 08 Aug 2011 04:00:00 +0100

Conclusions: Remifentanil reduces cardiac troponin release, time of mechanical ventilation, and length of hospital stay in patients undergoing cardiac surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Anesthesia and Perioperative Management of Patients Who Undergo Transfemoral Transcatheter Aortic Valve Implantation: An Observational Study of General Versus Local/Regional Anesthesia in 125 Consecutive Patients

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

Conclusions: This observational study suggests that LRA was associated with less intraoperative hemodynamic instability and significant shortening of the procedure and hospital stay. Changes in the anesthetic technique adapted to changes in TAVI interventional techniques and did not increase the rate of postoperative complications. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Erratum

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

RETRACTION: Mengistu AM, Mayer J, Boldt J, Röhm KD, Suttner SW. Usefulness of Monitoring Platelet Function by Multiple Electrode Aggregometry in Primary Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth 2011;25:42-47. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Endoscopically Assisted Transesophageal Echocardiographic Probe Insertion

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

A 53-year-old man was scheduled to undergo an aortic arch replacement and native aortic valve resuspension for aortic aneurysm and severe aortic regurgitation. The patient originally had a transesophageal echocardiographic (TEE) examination by a cardiologist under sedation to establish the diagnosis and had a documented easy TEE probe passage.The patient had not had any history of dysphagia, upper gastrointestinal bleeding, or esophageal abnormalities nor was he receiving steroid therapy. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Enemy of Good …

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

“Striving to better, oft we mar what's well.”—William Shakespeare: King Lear; Act 1“Have no fear of perfection—you'll never reach it.”—Salvador Dali“The new prosthetic valve looks perfect, but your loved one did not survive.”—Your surgeon“You don't have to talk to the family, I [surgeon] do.”—Your surgeon (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Guide for Authors

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

Articles to Appear in Future Issues

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

Scholarly Productivity of United States Academic Cardiothoracic Anesthesiologists: Influence of Fellowship Accreditation and Transesophageal Echocardiographic Credentials on h-Index and Other Citation Bibliometrics (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Editorial Board

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Masthead

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

Multimodal Brain Monitoring Reduces Major Neurologic Complications in Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 29 Jul 2011 04:00:00 +0100

Conclusions: This preliminary study suggests that multimodal brain monitoring can reduce the incidence of neurologic complications as well as hospital costs associated with post–cardiac surgery patient care. Furthermore, intraoperative brain monitoring provides useful information about brain functioning, blood flow velocity, and metabolism, which may guide the anesthesiologist during surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Intraoperative Detection of a Stuck Bioprosthetic Mitral Valve Leaflet Causing Severe Mitral Regurgitation

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 29 Jul 2011 04:00:00 +0100

We present a case of mitral valve replacement in which the use of TEE led to an early diagnosis of a stuck leaflet and prevented a potential fatal complication. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

β-Blockers to Optimize Peripheral Oxygenation During Extracorporeal Membrane Oxygenation: A Case Series

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 18 Jul 2011 04:00:00 +0100

Conclusions: In selected septic, tachycardic patients with a high cardiac output, veno-venous ECMO, led to improvement of peripheral oxygenation with the addition of a short-acting β-blocker infusion. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

High-Dose Insulin Administration Improves Left Ventricular Function After Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 15 Jul 2011 04:00:00 +0100

Conclusions: Intraoperative GIN therapy improves global and systolic left ventricular function after CABG surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 11 Jul 2011 04:00:00 +0100

Conclusion: Hypoactive delirium itself is a strong predictor for a longer ICU stay and a prolonged period of mechanical ventilation. Some of the risk factors related to the intraoperative and postoperative setting are suitable for preventive action. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Pheochromocytoma Detected During Anesthesia Induction

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 11 Jul 2011 04:00:00 +0100

We present a case of hemodynamic instability during anesthesia induction in which the surgical procedure was aborted because of suspected undiagnosed pheochromocytoma. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Anesthetic Management of Patients Undergoing Aortic Valve Bypass (Apicoaortic Conduit) Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 04 Jul 2011 04:00:00 +0100

AORTIC VALVE BYPASS (AVB) surgery is the creation of a valved conduit from the apex of the left ventricle (LV) to the descending aorta in patients with left ventricular outflow tract obstruction (). In adults, the outflow tract obstruction usually is caused by aortic valve (AV) stenosis. The typical patient is elderly and presents with a pre-existing medical condition that significantly increases perioperative risk for morbidity and mortality with conventional AV replacement (AVR). AVB usually can be accomplished without cardiopulmonary bypass (CPB), one of the major excess risk factors in conventional AVR. Other significant factors that increase the risk for adverse outcomes are advanced aortic atherosclerosis with calcification (“porcelain aorta”), previous sternotomy, prior intratho...

Predictive Value of the Additive and Logistic EuroSCOREs in Patients Undergoing Aortic Valve Replacement

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 04 Jul 2011 04:00:00 +0100

Conclusions: Although the additive and the logistic EuroSCOREs had good discriminatory power, they were not able to predict the actual operative mortality accurately. Both EuroSCOREs overestimated the operative mortality, especially in low-risk patients. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Transthoracic Echocardiography: Training Options for Practicing Physicians

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 04 Jul 2011 04:00:00 +0100

The recent article regarding emerging technology spoke of the benefits of perioperative echocardiography. We enthusiastically agree with the authors from Harvard Medical School that transthoracic echocardiography (TTE) has incredible clinical utility. It has the potential to positively impact anesthetic decision making and improve patient care. The benefits are well documented and applicable throughout the entire perioperative period for high-risk surgeries, high-risk patients, and individuals who suffer from unexpected hemodynamic compromise. As most anesthesiologists experience on a daily basis, the cardiovascular system of patients can be extraordinarily dynamic and is affected by anesthetics, fluid management, surgical manipulation, and blood loss. Patients' intracardiac pressures, sys...

The Management and Outcome of Documented Intraoperative Heart Rate–Related Electrocardiographic Changes

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 04 Jul 2011 04:00:00 +0100

Conclusions: This incidence of reported REC was much lower than the previously reported incidence of ischemia-related ECG changes, suggesting that the largest proportion of events go unnoticed. In many patients, subsequent cardiology workup did not confirm the existence of clinically significant CAD. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Anesthesia Preparation Time Is Not Affected by the Experience Level of the Resident Involved During His/Her First Month of Adult Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 27 Jun 2011 04:00:00 +0100

Conclusions: These findings suggest that operating room efficiency as measured by the anesthesia preparation time may not be affected by the level of the resident on his/her 1st month of adult cardiac anesthesia. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

TEE for Estimating Pleural Effusion Volumes

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 20 Jun 2011 04:00:00 +0100

We read with interest the article by Howard et al describing the use of transesophageal echocardiography to estimate the volume of chronic pleural effusions caused by heart failure. The maximal cross-sectional area (CSAmax) in centimeters squared of the pleural effusion seen on transesophageal echocardiography was recorded. CSAmax was then compared with the actual volume (V) of fluid in milliliters subsequently drained at surgery. Based on 28 data points obtained from 23 patients, the authors conclude that the volume of fluid can be estimated from the following formula: V = 4.5·CSAmax3/2. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

A Comparison of Cardiac Output by Thoracic Impedance and Direct Fick in Children With Congenital Heart Disease Undergoing Diagnostic Cardiac Catheterization

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 20 Jun 2011 04:00:00 +0100

Conclusions: Compared with measurements made by direct Fick, CO measured using the Physioflow device was unreliable in anesthetized children with congenital heart disease. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Con: Methylene Blue Should Not Be Used Routinely for Vasoplegia Perioperatively

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 20 Jun 2011 04:00:00 +0100

VASOPLEGIA OR VASOPLEGIC SYNDROME (VS) is an ill-defined clinical state often characterized by low systemic blood pressure, low systemic vascular resistance, high or normal cardiac output, and increased requirement for intravenous fluid and vasopressor administration. It is a form of vasodilatory shock in which a lack of vascular tone leads to the inability to achieve an adequate perfusion pressure. This clinical scenario is often witnessed in cardiac surgery as a consequence of cardiopulmonary bypass (CPB) triggering a systemic inflammatory response. The incidence of VS after cardiac surgery is quite variable, ranging from 5% to 25% to as high as 42% in patients undergoing insertion of a left ventricular assist device for end-stage heart failure. VS has also been described in some patient...

Pro: Methylene Blue as a Rescue Therapy for Vasoplegia After Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 20 Jun 2011 04:00:00 +0100

CARDIAC SURGERY may be complicated by an exaggerated systemic inflammatory response accompanied by loss of vascular smooth muscle tone and severe vasodilation (vascular paralysis or vasoplegia). Vasoplegia has been defined according to the following set of hemodynamic criteria: mean arterial pressure (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Target-Controlled Dosing of Remifentanil During Cardiac Surgery Reduces Postoperative Hyperalgesia

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 06 Jun 2011 04:00:00 +0100

Conclusions: The intraoperative decrease of opioid consumption when comparing the CI versus TCI mode of administration of remifentanil led to less OIH after cardiac surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Thoracicus Longus and Thoracodorsalis Nerve Block: A Supplemental Block for Thoracic Anesthesia Analgesia

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 06 Jun 2011 04:00:00 +0100

Ipsilateral post-thoracotomy shoulder pain has been reported in up to 85% of patients despite effective thoracic epidural analgesia. Although the effectiveness of several regional anesthesia techniques (eg, epidural, intrapleural, intercostal, paravertebral, and suprascapular phrenic nerve blocks) on such pain has been investigated, results have varied. Thus, the prevention and treatment of ipsilateral shoulder pain remain important challenges for anesthesiologists. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Decrease in Bispectral Index in a Patient Undergoing Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 06 Jun 2011 04:00:00 +0100

The bispectral index (BIS), a parameter derived from the electroencephalogram, is currently used to assess the depth of anesthesia. Severe hypoglycemia may induce a decrease in the electroencephalogram in either diabetic or nondiabetic patients. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Unexpected Detection of Internal Jugular Vein Thrombus During Ultrasound-Guided Central Venous Cannulation

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 06 Jun 2011 04:00:00 +0100

The use of 2-dimensional ultrasound (US) to facilitate central venous catheter (CVC) placement in the internal jugular vein (IJV) improves patient safety and reduces complications. Even after the recommendations by the National institute for Clinical Excellence (NICE) guidelines in 2002, US guidance is still not routinely used by all physicians when obtaining central venous access. A common cause of this could be lack of the US machine, the probe, and the experience with US. A case in which thrombus in the right jugular vein was found during US-guided CVC placement is presented. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Cardiac Calendar—2011 to 2012

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 06 Jun 2011 04:00:00 +0100

Third Joint Scandinavian Conference in Cardiothoracic Surgery. Tampere, Finland. August 18-29, 2011. Contact: e-mail: matti.tarkka@sydankeskns.fi. Australian Society of Anesthesiologists National Scientific Congress. Sydney, Australia. September 8-11, 2011. Contact: www.asa2011.com. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Should an Anesthesiologist Be Present on Site During Cardiologic Interventions?

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 03 Jun 2011 04:00:00 +0100

With great interest we read the article “Sedation and Analgesia in the Cardiac Electrophysiology Laboratory: A National Survey of Electrophysiologists Investigating the Who, How, and Why?” by Gaitan et al. The authors report that an anesthesiologist exclusively performed the conduction of deep sedation during electrophysiologic interventions in only 16% of cases. Furthermore, the authors suspected that patients were transitioned into deep sedation (or even general anesthesia) without supervision by an anesthesiologist. Difficulties with scheduling, an increased turnover time, and the attitude that the professional skills of an anesthesiologist were not considered to be necessary were the main reasons for not cooperating regularly with anesthesiologists. Finally, Gaitan et al concluded ...

Management of Tight Intraoperative Glycemic Control During Off-Pump Coronary Artery Bypass Surgery in Diabetic and Nondiabetic Patients

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 03 Jun 2011 04:00:00 +0100

Conclusions: In diabetics and nondiabetics undergoing off-pump coronary artery bypass surgery, tight perioperative glycemic control is feasible and efficient, with minimal risks for hypo- and hyperglycemia. In nondiabetics, starting insulin therapy from induction onwards results in more measurements within target, without affecting the mean BG. In diabetics, decreasing the sampling interval from 60 to 30 minutes results in more measurements within target and in a mean blood glucose within target at ICU arrival. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Use of an Inferior Epigastic Arterial Catheter in a Patient With Difficult Vascular Access

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 03 Jun 2011 04:00:00 +0100

We would like to report the cannulation of the inferior epigastric artery as an intraoperative arterial catheter site in a patient with difficult catheter placement. The patient was a 55-year-old man with a history of cirrhosis secondary to alcoholism, hepatorenal syndrome (resulting in end-stage renal disease), esophageal varices, heparin-induced thrombocytopenia, and shingles (with severe, diffuse skin excoriations) who presented for a combined cadaveric liver and kidney transplant. When the patient arrived in the operating room, he was noted to have multiple excoriations of the forearms and legs that were bandaged; in addition, there were also notable large bruises along his arms. Multiple attempts were made to place a radial arterial catheter. When this failed, there were several atte...

A Multimodal Approach to Address the Inflammation of Cardiopulmonary Bypass?

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 03 Jun 2011 04:00:00 +0100

In the February 2011 issue, the editorial by Beattie and Karkouti discussed the “dilemma” concerning the best antifibrinolytic drug to use in the postaprotinin era. Aprotinin not only has antifibrinolytic effects but also anti-inflammatory effects to address the unwanted inflammatory response to cardiopulmonary bypass (CPB). Aprotinin's ability to reduce blood loss after CPB better than the other antifibrinolytics likely relates, in part, to the attenuation of this CPB-induced inflammation. It seems that we are not just looking for the best antifibrinolytic to replace aprotinin but also the overall best drug or combination of drugs/techniques to help reduce inflammation and coagulopathy post-CPB. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The 12th International Congress of Cardiothoracic and Vascular Anesthesiologists, Beijing, China, September 22-25, 2010

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:41 +0100

THE 12TH INTERNATIONAL CONGRESS of Cardiothoracic and Vascular Anesthesiologists, organized by the Chinese Society of Anesthesiology and the Society of Cardiovascular Anesthesiologists (SCA), took place in the China National Conference Center, Beijing, People's Republic of China. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Con: A General Anesthesiologist With a Certain Skill Set Is Qualified to Provide Services in the Interventional Cardiology and Electrophysiology Laboratory

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:38 +0100

IN THE PAST DECADE, expansion of the anesthesia services provided in remote locations has been exponential. Interventional cardiology and electrophysiology (EP) laboratories have been in the forefront of the offsite locations where these services are provided. This expansion happened at the same time as a decrease in the volume of cases done in the operating rooms in some institutions was seen. Although increasingly there are examples of facilities in which cardiac surgery and cardiology occupy contiguous space with an integrated intensive care unit, the cardiology unit is typically remote from the operating room. Different models of anesthetic practice have been adopted by different hospitals. These models range from direct attending providers to staff anesthesiologists supervising certif...

Pro: A Cardiovascular Anesthesiologist Should Provide Services in the Catheterization and Electrophysiology Laboratory

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:38 +0100

THE GAMUT OF clinical practices in the realm of interventional cardiology has grown more in the past decade than perhaps any other field in medicine and continues to evolve. Significant recent advances have occurred in nonpharmacologic interventional techniques for the management of almost all cardiac arrhythmias and structural heart diseases, including valvular dysfunction, cardiomyopathy, and adult congenital heart lesions. Advances in technology and technical skills now allow increasingly complex procedures such as percutaneous valve replacements, arrhythmia ablation surgeries, and cardiac ventricular assist device insertions to be performed in even sicker patients using a catheter-based approach, thus obviating the need for open cardiothoracic surgery. Newer procedures continue to show...

It Is a Tough “ACT” to Follow

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:24 +0100

THIS IDIOMATIC EXPRESSION may well describe the evolution of monitoring heparin during cardiopulmonary bypass (CPB). Unfractionated heparin has been used to inhibit coagulation from the introduction of CPB in the 1950s to the present. The dose was originally based on pharmacokinetic data supplemented by visual observation of fibrin strands or frank clot formation in the CPB circuit. Laboratory tests reflecting the effect of relatively large doses of heparin required for CPB were not available. The endpoint of the only available point-of-care test (Lee-White coagulation time) was prolonged beyond the time for appropriate supplemental heparin administration. Two elements conspired to establish widespread test-based monitoring. The addition of an activator (diatomaceous earth) to shorten the ...

Guide for Authors

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:24 +0100

Articles to Appear in Future Issues

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:24 +0100

Early Complications and Immediate Postoperative Outcomes of Paravalvular Leaks After Valve Replacement Surgery M. Wąsowicz, M. Meineri, G. Djaiani, N. Mitsakakis, N. Hegazi, W. Xu, R. Katznelson, and J.M. Karski; Toronto, ON, Canada (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:24 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Editorial Board

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 28 May 2011 14:41:24 +0100

(Source: Journal of Cardiothoracic and Vascular Anesthesia)

Ultrasound Examination for the Diagnosis of Pneumonia Associated With Acinetobacter baumannii in a Cardiac Surgery Patient

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 27 May 2011 04:00:00 +0100

Ultrasound examination is a reliable noninvasive imaging method that is useful in the evaluation of lung pathology in the intensive care unit (ICU) setting. Pneumonia shows 4 patterns: lobar pneumonia, bronchopneumonia, interstitial pneumonia, and miliary pneumonia. Lobar pneumonia classically involves the entire lobe of the lung and consists of 4 stages (ie, congestion, red hepatization, gray hepatization, and resolution). The most common causes of bacterial pneumonia are Streptococcus pneumoniae, other gram-positive bacteria, and “atypical” bacteria. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Recent Advances in Chronic Thromboembolic Pulmonary Hypertension

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 27 May 2011 04:00:00 +0100

Surgical excellence in pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH) has begun to spread around the world. The perioperative mortality for this procedure is typically under 10%. The maximal benefit from PTE is derived in those patients who have a high proximal clot burden that is surgically accessible, as outlined by the Jamieson classification. Residual pulmonary hypertension after successful PTE is common and increasingly is managed with maintenance oral pulmonary vasodilator therapy such as endothelin antagonists, phosphodiesterase inhibitors, and/or prostaglandins. The role of pulmonary vasodilator therapy in CTEPH before PTE is limited and should not delay definitive surgical therapy. Although plain deep hypothermic circulatory arrest ...

Robot-Assisted Mitral Valve Repair

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 27 May 2011 04:00:00 +0100

BASED LARGELY ON THE success of laparoscopic surgery in the 1990s, minimally invasive surgical approaches have gained widespread acceptance among many surgical specialties; cardiac surgery is no exception. In addition, the lay press and Internet are replete with reports of cardiac valve repair or replacement through small incisions with reportedly improved recovery times and cosmesis. Perhaps the most dramatic change to the surgical approach of valvular repair is with the use of robotic assistance (). Many surgeons find that robotic assistance provides superior dexterity compared with thoracoscopic instruments. In addition, the dramatic and futuristic sounding nature of this approach leads many patients to seek out centers that offer robotic approaches to mitral surgery. Currently, a minor...

Pulmonary Hypertension and Right Ventricular Dysfunction: Physiology and Perioperative Management

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 27 May 2011 04:00:00 +0100

PULMONARY HYPERTENSION (PH) is a life-threatening disease with a complex pathophysiology that if undiagnosed culminates in progressive increases in the pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR), which inevitably lead to right ventricular (RV) failure and death. Unfortunately, significant delays in diagnosis and treatment occur because of nonspecific disease symptomatology, relative low incidence (2-5 persons/million/y in the United States), and general unfamiliarity with the disease. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Population Pharmacokinetics of Lidocaine Administered During and After Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 26 May 2011 04:00:00 +0100

Conclusions: A 2-compartment pharmacokinetic model best describes the plasma concentrations of a 48-hour lidocaine infusion in patients undergoing cardiac surgery with CPB. The inclusion of body weight as a covariate on clearance and central compartment improves the model. Lidocaine infusions should be dosed by body weight and decreased after 24 hours to avoid potential toxicity in long-term infusions. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Recombinant Activated Factor VII Increases Stroke in Cardiac Surgery: A Meta-analysis

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 19 May 2011 04:00:00 +0100

Conclusions: The administration of rFVIIa in cardiac surgery patients could result in a significant increase of stroke with a trend toward a reduction of the need for surgical re-exploration. The authors do not recommend routine use in cardiac surgery patients. rFVIIa may be considered with caution in patients with refractory life-threatening bleeding. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Effect of Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit on Cerebral Oxygenation

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 16 May 2011 04:00:00 +0100

Conclusions: The application of RAP to CPB limits the degree of hemodilution and improves cerebral oxygenation during CPB. The present findings suggest a potential benefit of RAP from a neurologic aspect. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Small-Dose Dexamethasone Improves Quality of Recovery Scores After Elective Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Study

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 12 May 2011 04:00:00 +0100

Conclusions: Patient-perceived postoperative QoR in cardiac surgical patients is enhanced significantly by small-dose dexamethasone treatment. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Scholarly Productivity of United States Academic Cardiothoracic Anesthesiologists: Influence of Fellowship Accreditation and Transesophageal Echocardiographic Credentials on h-Index and Other Citation Bibliometrics

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 05 May 2011 04:00:00 +0100

Conclusions: The results show that the h-index increases progressively with academic rank and is dependent on fellowship program accreditation status but not transesophageal echocardiographic credentials in United States academic cardiothoracic anesthesiologists. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Evaluation of a Previously Undescribed Transesophageal Echocardiographic View of the Main Pulmonary Artery

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 05 May 2011 04:00:00 +0100

Visualization of the pulmonary artery and pulmonary valve by transesophageal echocardiography is an important part of a comprehensive transesophageal echocardiographic (TEE) examination. We would like to describe a new 2-dimensional TEE esophageal view of the main pulmonary artery in the long axis. Technical details on attaining the view, its distinction from existing standard views, and its potential clinical applications and limitations are discussed. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Levosimendan Versus Intra-aortic Balloon Pump in High-Risk Cardiac Surgery Patients

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 05 May 2011 04:00:00 +0100

Conclusions: Patients receiving levosimendan had a shorter duration of intensive care stay than peers who received a preoperative IABP. The findings of this pilot study should be investigated further in a large randomized controlled study. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Comparison of 5 Different Remifentanil Strategies Against Myocardial Ischemia-Reperfusion Injury

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 25 Apr 2011 04:00:00 +0100

Conclusions: Preconditioning or postconditioning by remifentanil and the continuous infusion of remifentanil effectively reduce myocardial infarction, whereas reperfusion targeting ischemic targeting or reperfusion targeting remifentanil does not. Remifentanil preconditioning better preserves myocardial function, especially LVDP, than other remifentanil strategies. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Reply to Dr Muralidhar

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 25 Apr 2011 04:00:00 +0100

This communication is in response to the correspondence published in your esteemed Journal (February 2011 issue) titled “A Category I Indication for Transesophageal Echocardiography” by Muralidhar. We totally agree with the author that transesophageal echocardiography before percutaneous transvenous mitral commissurotomy is a class 1 indication for ruling out left atrial thrombus. We would just like to draw your attention to the fact that as per “2008 Focused Update Incorporated Into the American College of Cardiology/American Heart Association 2006 Guidelines for the Management of Patients With Valvular Heart Disease” section 3.2.4, class I indications for echocardiography in mitral stenosis: “Transesophageal echocardiography in MS should be performed to assess the presence or a...

Seizures After Adult Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 25 Apr 2011 04:00:00 +0100

We were interested to read the 2 articles on seizures after cardiac surgery published in a recent issue of the Journal of Cardiothoracic and Vascular Anesthesia. Apart from a handful of reports in relation to the possible side effects of tranexamic acid, contemporary data on the overall incidence, etiology, and prognosis of seizures after adult cardiac surgery are scarce. In view of this, we recently analyzed our own experience in 2,578 consecutive patients between April 2007 and December 2009. The overall incidence of seizures was 1% and differed according to procedure type (coronary artery bypass 0.1%, isolated valve 1%, valve with coronary artery bypass 3%, and complex aortic 5%: p < 0.001). Independent predictors for seizures identified in multivariate analysis included deep hypothermi...

Central Venous Catheter Insertion in Patients With Transvenous Pacemaker or Defibrillator Leads

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 25 Apr 2011 04:00:00 +0100

An increasing number of patients with an implanted pacemaker or defibrillator are being admitted into intensive care units and require the establishment of central venous access. Anesthesiologists often face the dilemma of choosing the most appropriate technique and insertion site of a central venous catheter (CVC) in such patients. Data indicate that the incidences of pacemaker-related thrombosis and bacterial infections associated with transvenous leads are 5.5% to 27% and 0.2% to 3%, respectively. Furthermore, most of these thrombi or infections remain asymptomatic. Therefore, the insertion of a CVC in these patients carries a theoretic risk of either thrombus dislodgment or dissemination of bacterial infection from the transvenous leads of the pacemaker or defibrillator to the blood st...

In reply to Dr Koning et al

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 25 Apr 2011 04:00:00 +0100

Koning et al are to be commended for acknowledging that microvascular perfusion is of paramount importance in cardiac anesthesia. In the prospective randomized observational study they comment on, it was found that pulsatile perfusion does not alter microvascular flow as compared with nonpulsatile flow during routine cardiac surgery using standard equipment. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

The Effects of Pulsatile Cardiopulmonary Bypass on Microcirculatory Perfusion: Perspectives From a Null-Result Study

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 25 Apr 2011 04:00:00 +0100

In their recent study, Elbers et al showed that pulsatile flow does not alter human microvascular perfusion during cardiopulmonary bypass (CPB). The authors are to be praised for focusing on direct visualization of the microcirculation during pulsatile CPB because previous studies suggest that the benefit of pulsatile over nonpulsatile CPB lies in the small vasculature. To our knowledge, this is also the first clinical study that describes the energy-equivalent pressure, a quantification of pulsatility. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Development, Current Status, and Anesthetic Management of the Implanted Artificial Heart

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 14 Apr 2011 04:00:00 +0100

CARDIOVASCULAR DISEASE (CVD) is now the leading cause of death worldwide, and heart failure accounts for a significant portion of this mortality. In the United States, the prevalence of heart failure is estimated at 5.8 million, about 670,000 new cases are diagnosed annually, and the current estimated direct and indirect cost for heart failure care is $39.2 billion. In the United States, the “baby boom” generation is now entering the age range when heart failure becomes much more common, and, worldwide, dietary and lifestyle changes have increased dramatically the prevalence of CVD. With these population prevalence changes, the proportion of CVD mortality attributable to end-stage heart failure will only continue to increase because the prospect for definitive therapies are absent. (So...

Aortic Stenosis and Acquired von Willebrand Disease: Lack of Association

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 14 Apr 2011 04:00:00 +0100

Conclusion: Contrary to previous reports, no correlation was found between AS and acquired von Willebrand disease type 2A. Further studies are needed to ascertain whether this lack of association is caused by a specific characteristic of the present population, the small sample size, or other factors. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Journal of Cardiothoracic and Vascular Anesthesia via MedWorm.com

Cardiac Calendar—2012 to 2013

Advances in the Management of Carotid Artery Disease: Focus on Recent Evidence and Guidelines

Case 1—2012 A Perfect Storm: Fatality Resulting From Metoclopramide Unmasking A Pheochromocytoma and Its Management

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2011

Hands-on…Handoff

Guide for Authors

Articles to Appear in Future Issues

Contents

Editorial Board

Masthead

Subject Index

Author Index

Guest Reviewers for 2011 Manuscripts

The Use of Transesophageal Echocardiography for Diagnosing a Malfunctioning Newly Implanted Prosthetic Mitral Valve

Retractions Lead to Revision of Review Article “Contemporary Fluid Management in Cardiac Anesthesia”

Postinfarction Ventricular Septal Defects: Surgical or Percutaneous Closure—Between a Rock and a Hard Place

The Education of Anesthesia Residents and Cardiothoracic Fellows: Can They Work Together?

Guide for Authors

Articles to Appear in Future Issues

Contents

Editorial Board

Masthead

Increased Chest Tube Drainage Is Independently Associated With Adverse Outcome After Cardiac Surgery

Noncardiac Surgery in the Prone Position in Patients With Ventricular Assist Devices

A Randomized, Double-Blind Trial Comparing Continuous Thoracic Epidural Bupivacaine With and Without Opioid in Contrast to a Continuous Paravertebral Infusion of Bupivacaine for Post-thoracotomy Pain

Thoracic Epidural or Paravertebral Catheter for Analgesia After Lung Resection: Is the Outcome Different?

Anesthesia for Interventional Cardiology

Thoracic Paravertebral Block for Video-Assisted Thoracoscopic Surgery: Single Injection Versus Multiple Injections

Reasons Elevated B-Type Natriuretic Peptide Levels Are Associated With Adverse Outcome in Patients Undergoing Cardiac Surgery

Iatrogenic Acute Aortic Dissection During Cardioplegic Cannula Insertion Detected by Transesophageal Echocardiography

Update on Blood Conservation for Cardiac Surgery

Cardiothoracic Anesthesiology Fellowship: Challenges of Training and a Novel Approach to Resident Education

Sudden Intraoperative Hypertension During Endovascular Abdominal Aortic Repair as a First Sign of Massive Fatal Atheroembolism

Cardiac Calendar—2012 to 2013

Advances in Anticoagulation: Focus on Dabigatran, an Oral Direct Thrombin Inhibitor

RETRACTION: De Hert SG, Lorsomradee S, vanden Eede H, Cromheecke S, Van der Linden PJ. A Randomized Trial Evaluating Different Modalities of Levosimendan Administration in Cardiac Surgery Patients With Myocardial Dysfunction. J Cardiothorac Vasc Anesth 2008;22:699-705

Cardiac Calendar—2011 to 2012

Integrating Outcome Benefit Into Anesthetic Design: The Promise of Steroids and Statins

Con: Extubation in the Operating Room Following Pediatric Cardiac Surgery

Pro: Early Extubation Following Surgery for Congenital Heart Disease

CASE 5—2011Acute Respiratory Distress Syndrome in an Infant After Repair of Tetralogy of Fallot

Bench to Bedside: Dynamic Mitral Valve Assessment

Scholarly Productivity, Academic Success, and Beyond

Guide for Authors

Articles to Appear in Future Issues

Contents

Editorial Board

Masthead

A Word of Caution Regarding Transesophageal Echocardiography and Penetrating Chest Trauma

Coronary Artery Disease, Acute Myocardial Infarction, and a Newly Developing Ventricular Septal Defect: Surgical Repair or Percutaneous Closure?

CASE 7—2011: Perioperative Challenges of Valvular Replacement in Patients After Mediastinal Radiation Therapy

Poststernotomy Pain: A Clinical Review

Comparison of the Analgesic Effects of Continuous Extrapleural Block and Continuous Epidural Block After Video-Assisted Thoracoscopic Surgery

Cardioprotection by Volatile Anesthetics: What About Noncardiac Surgery?

Milrinone and Mortality in Adult Cardiac Surgery: A Meta-analysis

Reply to Dr Herzlinger

Association Between Postoperative Acute Kidney Injury and Duration of Cardiopulmonary Bypass: A Meta-Analysis

Combined Central Venous Oxygen Saturation and Lactate as Markers of Occult Hypoperfusion and Outcome Following Cardiac Surgery

Overheating and Rupture of FMS 2000 Rapid Infuser

CASE 6—2011: Aortic Valve Replacement in a Patient With Aortic Stenosis, Dilated Cardiomyopathy, and Renal Dysfunction

Pulse-Pressure Variation Predicts Fluid Responsiveness During Heart Displacement for Off-Pump Coronary Artery Bypass Surgery

Detection of Right Ventricular Insufficiency and Guidance of Volume Therapy Are Facilitated by Simultaneous Monitoring of Static and Functional Preload Parameters

Relationship Between Plethysmographic Waveform Changes and Hemodynamic Variables in Anesthetized, Mechanically Ventilated Patients Undergoing Continuous Cardiac Output Monitoring

Evaluation of Tricuspid and Pulmonary Valves Using Epicardial and Transesophageal Echocardiography—A Comparative Study

Pilot Implementation of a Perioperative Protocol to Guide Operating Room–to–Intensive Care Unit Patient Handoffs

Volatile Agents for Cardiac Protection in Noncardiac Surgery: A Randomized Controlled Study

Anesthesia for Thoracic Surgery: A Survey of UK Practice

Preconditioning With Repeated Hyperbaric Oxygen Induces Myocardial and Cerebral Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized, Controlled Clinical Trial

Feasibility of Measuring Renal Blood Flow Using Transesophageal Echocardiography in Pediatric Patients Undergoing Cardiac Surgery

Extracorporeal Membrane Oxygenation: A New Way to Study Toxic Drugs in Chronic Diseases

Reply to Drs Giroti and Kiran

Cryoablation of Atrial Fibrillation in Cardiac Surgery: Outcomes and Myocardial Injury Biomarkers

Interaction Between Dexmedetomidine and α-Adrenergic Receptors: Emphasis on Vascular Actions

Comparison of Transthoracic and Transesophageal 2-Dimensional Speckle Tracking Echocardiography

A Comparative Evaluation of Transesophageal and Transthoracic Echocardiography for Measurement of Left Ventricular Systolic Strain Using Speckle Tracking

Factors Affecting Neurocognitive Outcome After Coronary Artery Bypass Graft Surgery

Effects of Thoracic Epidural Anesthesia on Flow and Endothelium of Internal Thoracic Artery in Coronary Artery Bypass Graft Surgery

Use of Recombinant Activated Factor VII for Controlling Refractory Postoperative Bleeding in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Transesophageal Echocardiographic Short-Axis Views of the Left Atrial Appendage