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Extracorporeal Membrane Oxygenation for the Treatment of Neonatal Respiratory FailureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This review discusses the use of extracorporeal membrane oxygenation (ECMO) for the treatment of respiratory failure in neonates. After briefly reviewing the early history of neonatal ECMO, the authors describe the respiratory diagnoses most often treated with ECMO and the manner in which affected neonates are deemed to have "failed" conventional therapies and thus require ECMO. After reviewing the most common indications for ECMO, factors that influence the timing of conversion to extracorporeal life support, as well as criteria that may exclude patients from receiving ECMO therapy, are described. At the conclusion of thi...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Carey, W. A., Colby, C. E. Tags: Articles Source Type: journals

Extracorporeal Life Support: Utilization, Cost, Controversy, and Ethics of Trying to Save LivesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Since the first successful application of extracorporeal membrane oxygenation (ECMO) in 1972, ECMO’s role in the management of respiratory and circulatory collapse continues to be refined and debated. Randomized clinical trials aimed at establishing efficacy and patient selection criteria have been fraught with ethical challenges. Growing concerns over rising health care costs require that careful evaluations of cost, utilization, and ethical issues surrounding heroic life-saving interventions such as ECMO are undertaken. Continued analyses of ECMO’s place in the medical management of respiratory and circulator...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Crow, S., Fischer, A. C., Schears, R. M. Tags: Articles Source Type: journals

ECMO Cannulation Controversies and ComplicationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Advances in extracorporeal life support have expanded indications for use extending beyond patients undergoing cardiac surgery. The approach to cannulation in patients requiring extracorporeal membrane oxygenation should be individualized and based on the specific clinical scenario in which the need arises. Adherence to proper techniques of vessel visualization, exposure, and cannulation along with accurate placement of cannulae will optimize flows and minimize complications in this setting. Patients in need of mechanical circulatory support require input from a multidisciplinary team approach with systematic clinical eval...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Stulak, J. M., Dearani, J. A., Burkhart, H. M., Barnes, R. D., Scott, P. D., Schears, G. J. Tags: Articles Source Type: journals

Anticoagulation and Coagulation Management for ECMOEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Advances in extracorporeal membrane oxygenation (ECMO) management have helped to reduce complications compared with its inception but they remain high. The principal causes of mortality and morbidity are bleeding and thrombosis. The nonbiologic surface of an extracorporeal circuit provokes a massive inflammatory response leading to consumption and activation of procoagulant and anticoagulant components. The vast differences in neonatal and adult anticoagulation and transfusion requirements demands tremendous clinical knowledge to provide the best care. Increased use of thrombelastogram will complement other methods current...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Oliver, W. C. Tags: Articles Source Type: journals

Optimal Time for Initiating Extracorporeal Membrane OxygenationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The technical evolution of extracorporeal membrane oxygenation (ECMO) coincides with the vast improvement in intensive care medicine of the past 4 decades. Extracorporeal circulatory technology substitutes for acutely failed cardiac or pulmonary function until these organs regain sustainable function through goal-oriented intensive care practice. The technology has been validated to improve survival in select patients who would otherwise have 100% mortality. This is by far the most complex life-sustaining technology employed and thus can contribute significant risks such that the decision to institute ECMO requires prompt ...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Haile, D. T., Schears, G. J. Tags: Articles Source Type: journals

Update on Safety Equipment for Extracorporeal Life Support (ECLS) CircuitsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Though much has been surveyed and written about the equipment aspects of extracorporeal life support (ECLS) in the past 10 years, there is value in reviewing the use and nonuse of multiple safety devices and techniques. Minimally equipped ECLS circuits for adult and pediatric bridge to decision during cardiac and respiratory failure are rapidly gaining popularity to maintain simplicity and portability. ECLS circuits employed for long-term therapy are outfitted differently and should include more safety devices. The purpose of this review is to compare and contrast the spectrum of minimally equipped ECLS circuits to circuit...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Riley, J. B., Scott, P. D., Schears, G. J. Tags: Articles Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 17, 2009 Category: Anesthesiology Authors: Nuttall, G. A., Schears, G. J. Tags: Articles Source Type: journals

Lessons Learned in Antifibrinolytic Therapy: The BART TrialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article will briefly review these developments with the hope of understanding how this abrupt turnabout took place and will attempt to understand how such events can be avoided in the future. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Murkin, J. M. Tags: Article Source Type: journals

Suction, Salvage, Sutures, and Potions: Blood Management Post-AprotininEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hemostasis management of the cardiac surgical patient has changed following the withdrawal of aprotinin for use in cardiac surgical patients. The challenge to minimize blood loss and reduce exposure of cardiac surgical patients to blood products continues to grow with patients presenting being older and sicker and more complex procedures being performed. The cardiac surgery team has many options available for it to consider; although current recommendations strongly support the use of cell salvage as one process to assist in this challenge, other options need to be equally critically evaluated. (Source: Seminars in Cardiot...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Baker, R. A. Tags: Article Source Type: journals

State-of-the-Art Blood Management in Cardiac SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Blood has been described as the most precious and personal substance in the world. Current directions in cardiac surgery are moving away from transfusing donor "Allogeneic" blood products, and towards improving methods of saving and preserving the patient's own "autologous" blood. Nothing else comes close to the natural healing abilities and homeostasis that one's own whole blood offers. No substitute, whether it is human or artificial, will ever work as well with fluid shifts, hemostasis and homeostasis. News reports today commonly feature severe blood shortages and research documenting recognized transfusion risks such a...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Samolyk, K. A. Tags: Article Source Type: journals

Optimal Versus Suboptimal Perfusion During Cardiopulmonary Bypass and the Inflammatory ResponseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Despite major improvements in perfusion techniques over the past 50 years, it is still not possible to formulate a clear definition of what is meant by optimal perfusion. In part this is due to the lack of sufficient evidence-based data and in part because of the complex pathophysiology that takes place during cardiac surgery with cardiopulmonary bypass. To find an answer we need to understand the exact mechanism of the inflammatory reaction triggered by the cardiopulmonary bypass. However, it is clear that further improvement of the cardiopulmonary bypass components alone will be sufficient. Only a combined strategy can f...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: De Somer, F. Tags: Article Source Type: journals

Endovascular Treatment of Blunt Traumatic Thoracic Aortic InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Blunt traumatic thoracic aortic injury (BTTAI) is a lethal injury associated with a prehospital mortality of 80% to 90%. Patients arriving in the emergency room and considered appropriate to undergo emergency open surgical repair still have a mortality rate of 15% to 30% because of severe associated injuries. Conventional open surgical repair requires a left thoracotomy, single lung ventilation, aortic-cross clamping and unclamping, with or without the adjunct use of partial or full cardiopulmonary bypass and systemic heparinization. All this leads to significant physiological stress and surgical trauma resulting in periop...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Nicolaou, G. Tags: Article Source Type: journals

Autonomic Nervous System and Cardiovascular DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this report, the principals of the analysis of heart rate and blood pressure variability will be explained and the usefulness of these methods to anesthesiologists will be discussed. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Deschamps, A., Denault, A. Tags: Article Source Type: journals

Immediate Postoperative Care of the Heart Transplant Recipient: Perils and TriumphsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The early postoperative care of a heart transplant recipient remains challenging, even in experienced centers with a long tradition of excellence. Approximately 10% to 20% of heart transplant recipients experience potentially life-threatening right ventricular dysfunction intraoperatively and early postoperatively due to an elevated pulmonary vascular resistance. In addition, heart transplant recipients experience a high risk of perioperative hemorrhage, as well as opportunistic infection and rejection. The authors describe a case of severe right ventricular dysfunction in a 46-year-old male several hours after heart trans...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Novick, R. J. Tags: Article Source Type: journals

Redefining the Systemic Inflammatory ResponseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
From the first description of the "systemic inflammatory response" in the early 1990s, it has been recognized that this is a multifaceted response of the body to the combined insult of cardiothoracic surgery with bypass, involving causation by "activation of complement, coagulation, fibrinolytic, and kallikrein cascades, activation of neutrophils with degranulation and protease enzyme release, oxygen radical production, and the synthesis of various cytokines from mononuclear cells." Yet the intervening 15 years have seen a narrowing of research into individual systems and interventions naively targeted at single pathways w...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Landis, R. C. Tags: Article Source Type: journals

Mathematical Modeling in Cardiac Surgery: Helping Clinical Trials Answer the QuestionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Mathematical modeling, based on fundamental principles from engineering may help clinical trial design, aiding in answering problems that remain in cardiac surgery, such as management of carotid artery stenosis in patients undergoing cardiopulmonary bypass (CPB), hematocrit during CPB, adequacy of oxygen delivery during CPB, adequacy of blood pressure management during CPB, filtration during bypass for renal failure, bypass circuit pacification, carbon dioxide wound insufflation and neurological events, and pulsatile to nonpulsatile flow during CPB. In addition, mathematical modeling may help explain deficiencies of previo...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Poullis, M., Poole, R. Tags: Article Source Type: journals

What Was Hot and What Was Not in 2007?: A Literature ReviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
While the number of publications each year in cardiac anesthesia is enormous there are a select group of interesting articles highlighting controversies in current practice or new techniques, medications, procedures which may change practice down the road. The purpose of this article is to review some of these articles. While by no means a systematic review, this article highlights some of the more interesting papers from the cardiac anesthesia and surgical literature from 2007. The articles focus on areas such as: methods to reduce both cerebral dysfunction and renal dysfunction, myocardial protection inhaled volatile ane...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Bainbridge, D. Tags: Article Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 19, 2009 Category: Anesthesiology Authors: Murkin, J. M. Tags: Article Source Type: journals

Pulmonary Manifestations of Liver DiseasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the epidemiology, pathophysiology, clinical features, evaluation and current therapy of these two disorders. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 20, 2009 Category: Anesthesiology Authors: Yeshua, H., Blendis, L. M., Oren, R. Tags: Article Source Type: journals

Cerebral Air Embolism Recognized by Cerebral OximetryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study reports a case in which cerebral desaturation occurred after commencing cardiopulmonary bypass. Consequently, the source of air entrainment was discovered and therapeutic measures implemented. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 20, 2009 Category: Anesthesiology Authors: Fischer, G. W., Stone, M. E. Tags: Article Source Type: journals

Noninvasive Cardiac Output Determination: Broadening the Applicability of Hemodynamic MonitoringEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although cardiac output (CO) monitoring is usually only used in intensive care units (ICUs) and operating rooms, there is increasing evidence that CO should be determined and optimized as early as possible, even before admission to the ICU, in the care of hemodynamically compromised patients. A variety of different minimally or noninvasive CO determination techniques have been developed, but not all of them are suitable for early hemodynamic monitoring outside the ICU. In this review, the different available methods for CO monitoring are presented and their potential for early hemodynamic assessment is discussed. (Source: ...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 20, 2009 Category: Anesthesiology Authors: Compton, F., Schafer, J.-H. Tags: Article Source Type: journals

Current Perioperative Management of the Patient With a Cardiac Rhythm Management DeviceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the current status of cardiac rhythm management devices and discusses recommended perioperative management. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 20, 2009 Category: Anesthesiology Authors: Stone, M. E., Apinis, A. Tags: Article Source Type: journals

Improving the Outcome of In-Hospital Cardiac Arrest: The Importance of Being EARNESTEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the prevalence, etiology, and outcome of in-hospital cardiac arrest, with a focus on the determinants of outcome that are amenable to improvement. These include principally components of basic life support that may be supported by either prompting or mechanical assistance (eg, chest compression, ventilation, and defibrillation). Also reviewed are preevent and postevent effectors such as medical staff skills and recognition of impending arrest, induction of mild hypothermia, and stabilization after return of spontaneous circulation. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 20, 2009 Category: Anesthesiology Authors: Dichtwald, S., Matot, I., Einav, S. Tags: Article Source Type: journals

Physiology and Pharmacology of Myocardial Preconditioning and PostconditioningEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the physiology and pharmacology of ischemic and drug-induced preconditioning and postconditioning of the myocardium with special emphasis on the mechanisms by which volatile anesthetics provide myocardial protection. Insights gained from animal and clinical studies are reviewed and recommendations given for the use of perioperative anesthetics and medications. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 20, 2009 Category: Anesthesiology Authors: Huffmyer, J., Raphael, J. Tags: Article Source Type: journals

Emerging Concepts in Acute Kidney Injury Following Cardiac SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Acute kidney injury (AKI) remains a significant cause of morbidity and mortality following cardiac surgery. Through a more thorough understanding of perioperative genomics and the evolving role of early biomarkers ofAKI, the authors seek to improve meaningful outcomes among cardiac surgery patients. In this review, the focus will be on advances in risk stratification, evolving definitions and improving early diagnosis of AKI, identification of effective individualized therapies, and future directions. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Hudson, C., Hudson, J., Swaminathan, M., Shaw, A., Stafford-Smith, M., Patel, U. D. Tags: Article Source Type: journals

Endovascular Approaches to Complex Thoracic Aortic DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Diseases of the thoracic aorta remain among the most lethal and difficult to treat conditions. In 2005, the US Food and Drug Administration approved the first endoprosthesis for the treatment of aneurysms of the descending thoracic aorta; at present, there are 3 thoracic devices approved by the US Food and Drug Administration. Although approved only for the treatment of descending aneurysms, thoracic endografting has other potential off-label applications, including acute and chronic aortic dissection and traumatic aortic transection. Endovascular repair of thoracic aortic pathology is emerging as the preferred treatment s...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Hughes, G. C., Sulzer, C. F., McCann, R. L., Swaminathan, M. Tags: Article Source Type: journals

An Argument for Routine Ultrasound Screening of the Thoracic Aorta in the Cardiac Surgery PopulationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Stroke and neurological injury are among the most devastating and disabling complications associated with cardiac surgery. Transesophageal echocardiography and epiaortic ultrasound allow for sensitive, point-of-care diagnosis of thoracic aortic disease, which is especially common in patients with heart disease. Unlike other operative procedures, the manipulation of the ascending aorta is routine in cardiac surgery and often unavoidable. Dislodgement and embolization from the ascending and aortic arch atheromas have been clearly associated with manipulation during cardiac surgery. Epiaortic ultrasound and transesophageal ec...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Whitley, W. S., Glas, K. E. Tags: Article Source Type: journals

Transesophageal Echocardiography and Noncardiac SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article details recommendations to familiarize anesthesiologists with TEE technology to exploit it to its fullest potential to achieve better patient monitoring standards and eventually improve outcome. Training of greater numbers of anesthesiologists in TEE is needed to increase awareness of the indications and contraindications. Until relatively inexpensive TEE equipment is available, the initial cost of equipment acquisition remains a significant prohibitive factor limiting its widespread use. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Mahmood, F., Christie, A., Matyal, R. Tags: Article Source Type: journals

Real-Time 3-Dimensional Echocardiography in the Operating RoomEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Real-time 3-dimensional transesophageal echocardiography (RT-3D-TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging modality. The development of RT-3D-TEE allows for live 3D imaging as it circumvents most of the disadvantages of reconstructive 3D methods. RT-3D-TEE will likely revolutionize perioperative assessment of complex 3D structures, such as the mitral valve (MV), as it provides important mechanistic insights into functional and ischemic mitral regurgitation. The MV is particularly suited to live RT-3D-TEE assessment because of the complex interrelationships among the va...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Jungwirth, B., Mackensen, G. B. Tags: Article Source Type: journals

New Echocardiographic Techniques for Evaluating Left Ventricular Myocardial FunctionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ultrasound imaging of the heart continues to play an important role in diagnosis and management of patients with cardiovascular diseases. Recent advances in ultrasound technology and introduction of newer imaging modalities have enabled improved assessment of left ventricular myocardial function. Tissue Doppler imaging and 2-dimensional speckle tracking allow more objective quantification of myocardial function in the form of tissue velocities, displacement, strain, and strain rate. Similarly, contrast-enhanced echocardiography and 3-dimensional echocardiography have provided a unique insight into left ventricular form and...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Marcucci, C., Lauer, R., Mahajan, A. Tags: Article Source Type: journals

Thinking From Inside the BoxEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - December 23, 2008 Category: Anesthesiology Authors: Swaminathan, M. Tags: Article Source Type: journals

Health-Related Quality of Life After Cardiac SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Gorman Koch, C., Khandwala, F., Blackstone, E. H. Tags: Article Source Type: journals

Public Health Reporting: The United States PerspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The release of 2 landmark reports by the Institute of Medicine titled, "To Err Is Human: Building a Safer Health System" and "Crossing the Quality Chasm" were instrumental in the identification of safety and quality issues. Since their release, federal and state programs of public reporting of performance measures have attempted to close the quality gap of care that is inappropriate, not timely, or lacking an evidence base. Cardiac surgery has long been the focus of public scrutiny, and now, as we move from an era of managed care to public reporting, reimbursement for cardiac surgery procedures will be tied to performance....
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Halpin, L. S., Barnett, S. D., Henry, L. L., Choi, E., Ad, N. Tags: Article Source Type: journals

Perception and Reporting of Cardiac Surgical PerformanceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The high level of interest in surgical outcomes has led to the publication of mortality rates in the public domain. In cardiac surgery, the availability of quite sophisticated risk assessment has allowed these outcomes to be adjusted for risk. The European System for Cardiac Operative Risk Evaluation is a widely recognized and used risk scoring system and has been used and validated throughout Europe and beyond. The logistic version is now the most commonly applied, but recalibration may be required. The methodology and statistics for measuring risk-adjusted performance are available, and regular audit and performance moni...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Klein, A. A., Nashef, S. A. M. Tags: Article Source Type: journals

Predicting Outcomes for Cardiac Surgery Patients After Intensive Care Unit AdmissionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Most performance assessments of cardiac surgery programs use models based on preoperative risk factors. Models that were primarily developed to assess performance in general intensive care unit (ICU) populations have also been used to evaluate the quality of surgical, anesthetic, and ICU management after cardiac surgery. Although there are currently 5 models for evaluating general ICU populations, only the Acute Physiology and Chronic Health Evaluation (APACHE) system has been independently validated for cardiac surgery patients. This review describes the evolution, rationale, and accuracy of APACHE models that are specifi...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Kramer, A. A., Zimmerman, J. E. Tags: Article Source Type: journals

Risk Stratification Models for Cardiac SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article will focus on the European System for Cardiac Operative Risk Evaluation, the Society of Thoracic Surgeons score, the Parsonnet score, Cleveland Clinic Model, the Bayes model, and the Northern New England Score. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Granton, J., Cheng, D. Tags: Article Source Type: journals

An Introduction to Statistical Methods Used in Binary Outcome ModelingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Logistic regression is a cornerstone of epidemiology and the method of choice for risk adjustment models in cardiac surgery and critical care. Although linear regression methods may be satisfactory to evaluate relationships between independent (predictor) variables and a outcome that is continuous, a more complex mathematical approach is required when the outcome is binary (yes/no; alive/dead). Although the odds are 4 to 1 that finding an antilogarithm may sound intimidating, once you get past the initial equations and terminology, we go on to discuss how to select variables for a model, how to deal with collinearity and i...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Nathanson, B. H., Higgins, T. L. Tags: Article Source Type: journals

Improving Quality of Care in Cardiac Surgery: Evaluating Risk Factors, Processes of Care, Structures of Care, and OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The 1985 release of hospital report cards by the Health Care Financing Administration awakened the public's awareness of variations in outcomes following patient treatment. In 1972, the Department of Veterans Affairs initiated an oversight process for all VA-based cardiac surgery programs. In response to Public Law 99-166, the Continuous Improvement in Cardiac Surgery Program (CICSP) national database was developed in 1987. This CICSP effort reported variations in outcomes across VA cardiac programs. In 1997, the CICSP expanded (CICSP-X) to identify the interrelationships of risk factors with processes and structures of ca...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Shroyer, A. L. W., McDonald, G. O., Wagner, B. D., Johnson, R., Schade, L. M., Bell, M. R., Grover, F. L. Tags: Article Source Type: journals

Metrics That Matter: Can Transparency Fix the Health Care System?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - September 19, 2008 Category: Anesthesiology Authors: Higgins, T. L. Tags: Article Source Type: journals

Mediastinoscopy and Video-Assisted Thoracoscopic Surgery: Anesthetic Pitfalls and ComplicationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Endoscopic evaluation of the thoracic cavity was first described in 1910 when Jacobaeus used a cystoscope for pleural examination. Significant advances in thoracoscopic surgery, including the use of high-definition videoscopy and refinements in surgical technique, have created a vast array of increasingly complex procedures that can be performed. The minimally invasive nature of video-assisted thoracoscopic surgery (VATS) makes it ideal for diagnostic and therapeutic procedures in ambulatory and critically ill patients. Mediastinoscopy is often performed immediately preceding VATS to permit sampling of mediastinal lymph no...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 16, 2008 Category: Anesthesiology Authors: Thomsen, R. W. Tags: Article Source Type: journals

Anesthetic Considerations for Lung TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Lung transplantation is the definitive treatment for end-stage lung disease. The number of lung transplantations performed is limited by the number of donors available and is far outnumbered by the potential recipients on the waiting list. Advances in surgical methods, organ preservation, and immunosuppression have decreased the morbidity and mortality associated with this procedure during the last few decades. Specific anesthetic concerns are associated with lung transplantation, including careful preoperative assessment of pulmonary and cardiac function, adequate venous access and monitors, and ventilation techniques, su...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 16, 2008 Category: Anesthesiology Authors: Baez, B., Castillo, M. Tags: Article Source Type: journals

Preoperative Evaluation for Thoracic SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung v...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 16, 2008 Category: Anesthesiology Authors: Bernstein, W. K., Deshpande, S. Tags: Article Source Type: journals

Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and PostoperativeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Mechanical ventilation of patients undergoing thoracic surgery is often challenging. These patients frequently have significant underlying comorbidities, including cardiopulmonary disease, and often must undergo 1-lung ventilation. Perioperative respiratory complications are common and are multifactorial in etiology. Increasing evidence suggests that mechanical ventilation is associated with, and may even cause, lung damage in both sick and healthy patients. Gas exchange to provide acceptable end-organ oxygenation remains a primary goal but so too is minimization of risks for acute lung injury. Every ventilator strategy is...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 16, 2008 Category: Anesthesiology Authors: Lytle, F. T., Brown, D. R. Tags: Article Source Type: journals

Anesthetic Management of Patients With Pulmonary HypertensionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Advances in the treatment of patients with chronic pulmonary hypertension have greatly improved their functional status and longevity, and increasing numbers of these complex patients are presenting for elective noncardiac surgery. In this communication we will briefly review the classification and pathophysiology of pulmonary hypertension, summarize outpatient pharmacotherapy approaches, and discuss the perioperative preparation and management of these complex patients. With an understanding of the underlying pathophysiology of the disease and pharmacology of these new therapies, combined with careful perioperative planni...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 16, 2008 Category: Anesthesiology Authors: MacKnight, B., Martinez, E. A., Simon, B. A. Tags: Article Source Type: journals

Update on Thoracic Anesthesia: Where Are We Today?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - July 16, 2008 Category: Anesthesiology Authors: Brady, M. B. Tags: Article Source Type: journals

Early Detection of an Acute Cerebral Event During Cardiopulmonary Bypass Using a Bispectral Index MonitorEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A case in which the bispectral index monitor underwent an acute change that was most likely the earliest indicator of an intraoperative stroke during replacement of an aortic valve is discussed in this study. The timely response to this intraoperative event may have facilitated a better outcome by virtue of more rapid interventions to limit the severity of the injury. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 21, 2008 Category: Anesthesiology Authors: Leggat, C. S., Fischer, G. W. Tags: Article Source Type: journals

Near Infrared Spectroscopy (NIRS) in ChildrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Near infrared spectroscopy (NIRS) is a noninvasive method for the in vivo monitoring of tissue oxygenation. Originally used predominantly to assess cerebral oxygenation, NIRS has gained widespread popularity in many clinical settings in all age groups. Changes in regional tissue oxygenation as detected by NIRS may reflect the delicate balance between oxygen delivery and consumption in more than one organ system. However, more studies are required to establish the ability of NIRS monitoring to improve patient outcome. This review provides a comprehensive description of NIRS in children. (Source: Seminars in Cardiothoracic a...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 21, 2008 Category: Anesthesiology Authors: Chakravarti, S., Srivastava, S., Mittnacht, A. J. C. Tags: Article Source Type: journals

Recent Advances in Application of Cerebral Oximetry in Adult Cardiovascular SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Cerebral oximetry is a noninvasive technology that continuously monitors cerebral tissue oxygen saturation, which is a sensitive index of global cerebral hypoperfusion. On the basis of near-infrared spectroscopy technology, information is provided on the availability of oxygen in brain tissue at risk during numerous pathological conditions. Complementary to the arterial oxygen saturation measured by pulse oximetry, cerebral tissue oxygen saturation reflects regional cerebral metabolism and the balance of local cerebral oxygen supply/demand. Recently, patient management with the guidance of cerebral oximetry has resulted in...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 21, 2008 Category: Anesthesiology Authors: Fischer, G. W. Tags: Article Source Type: journals

Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Valvular heart disease can be an important finding in patients presenting for noncardiac surgery. Valvular heart disease and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events. Appropriate preoperative assessment, adequate perioperative monitoring, and early intervention, should hemodynamic disturbances occur, may help prevent adverse events and improve patient outcome. This review article aims to guide the practitioner in the various aspects of anesthetic management in the perioperative care of patients with valvular heart disease. The phar...
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 21, 2008 Category: Anesthesiology Authors: Mittnacht, A. J., Fanshawe, M., Konstadt, S. Tags: Article Source Type: journals

Regional Anesthesia in Elderly Patients Undergoing Carotid Surgery: Report of a Case SeriesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Carotid endarterectomy with regional anesthesia can be performed safely in the elderly population with low mortality and morbidity. Regional anesthesia may have advantages over general anesthesia and could potentially aid in avoiding complications related to shunt use. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)
Source: Seminars in Cardiothoracic and Vascular Anesthesia - April 21, 2008 Category: Anesthesiology Authors: Aslim, E., Akay, T. H., Candan, S., Ozkan, S., Akpek, E., Gultekin, B. Tags: Article Source Type: journals