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Hung KC, Chang YJ, Chang YP, Ho CN, Lan KM, Chen JY, Wang LK, Huang PW, Sun CK. The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis. Sci Rep 2022; 12:18192. [PMID: 36307502 PMCID: PMC9616852 DOI: 10.1038/s41598-022-21980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.
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Affiliation(s)
- Kuo-Chuan Hung
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ying-Jen Chang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Yang-Pei Chang
- grid.412019.f0000 0000 9476 5696Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan ,grid.412027.20000 0004 0620 9374Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Ning Ho
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Mao Lan
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Li-Kai Wang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ping-Wen Huang
- grid.452796.b0000 0004 0634 3637Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Cheuk-Kwan Sun
- grid.414686.90000 0004 1797 2180Department of Emergency Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445 Taiwan ,grid.411447.30000 0004 0637 1806College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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Padmanabhan C. Intraoperative imaging-should it not be the standard of care? Indian J Thorac Cardiovasc Surg 2021; 37:379-380. [PMID: 34220020 PMCID: PMC8218149 DOI: 10.1007/s12055-021-01190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 09/29/2022] Open
Affiliation(s)
- Chandrasekar Padmanabhan
- Department of Cardiothoracic Surgery, GKNM Hospital, Coimbatore, India
- Heart Failure and Transplantation, GKNM Hospital, Coimbatore, India
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Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol 2021; 78:112-122. [PMID: 33957241 DOI: 10.1016/j.jacc.2021.04.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The impact of utilization of intraoperative transesophageal echocardiography (TEE) at the time of isolated coronary artery bypass grafting (CABG) on clinical decision making and associated outcomes is not well understood. OBJECTIVES The purpose of this study was to determine the association of TEE with post-CABG mortality and changes to the operative plan. METHODS A retrospective cohort study of planned isolated CABG patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database between January 1, 2011, and June 30, 2019, was performed. The exposure variable of interest was use of intraoperative TEE during CABG compared with no TEE. The primary outcome was operative mortality. The association of TEE with unplanned valve surgery was also assessed. RESULTS Of 1,255,860 planned isolated CABG procedures across 1218 centers, 676,803 (53.9%) had intraoperative TEE. The percentage of patients receiving intraoperative TEE increased over time from 39.9% in 2011 to 62.1% in 2019 (p trend <0.0001). CABG patients undergoing intraoperative TEE had lower odds of mortality (adjusted odds ratio: 0.95; 95% confidence interval: 0.91 to 0.99; p = 0.025), with heterogeneity across STS risk groups (p interaction = 0.015). TEE was associated with increased odds of unplanned valve procedure in lieu of planned isolated CABG (adjusted odds ratio: 4.98; 95% confidence interval: 3.98 to 6.22; p < 0.0001). CONCLUSIONS Intraoperative TEE usage during planned isolated CABG is associated with lower operative mortality, particularly in higher-risk patients, as well as greater odds of unplanned valve procedure. These findings support usage of TEE to improve outcomes for isolated CABG for high-risk patients.
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Hu X, Li X, Boggett S, Yang Y, Chun-Ting W, Anstey J, Royse A, Royse C. Routine Intraoperative Inhaled Milrinone and Iloprost Reduces Inotrope Use in Patients Undergoing Cardiac Surgery: A Retrospective Cohort Pilot Study. Anesth Analg 2020; 131:527-536. [PMID: 32371741 DOI: 10.1213/ane.0000000000004793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Catecholamine inotropes are frequently used after cardiopulmonary bypass (CPB) but may have undesirable effects. The aim was to identify whether the routine use of inhaled pulmonary vasodilators might reduce the requirement for inotrope drugs after cardiac surgery. METHODS Retrospective cohort study of sequential patients undergoing cardiac surgery at the Royal Melbourne Hospital performed by a single surgeon and anesthesia care team, within 14 months before and after routine implementation of inhaled pulmonary vasodilators, August 2017. Milrinone 4 mg and iloprost 20 µg were inhaled using a vibrating mesh nebulizer (Aerogen) before initiation of CPB and at chest closure. Other aspects of clinical management were unaltered over the time period. Two investigators blinded to each other extracted data from electronic and written medical records. The primary outcome was any use of inotropes in the perioperative period; a Fisher exact test was used to analyze any differences between the 2 groups. Demographic data, hemodynamic data, and use of inotropes and vasopressors were collected from induction of anesthesia to 36 hours postoperative in the intensive care unit (ICU). Hospital and ICU length of stay, cost, and complications were collected. RESULTS Any use of inotropes was significantly lower with inhaled pulmonary dilators (62.5% vs 86.8%, odds ratio [95% confidence interval {CI}], 0.253 (0.083-0.764); P = .011), including intraoperative inotrope use (37.5% vs 86.8%, odds ratio [95% CI], 0.091 (0.03-0.275); P < .001). ICU length of stay was significantly lower with inhaled pulmonary dilators (45 hours, interquartile range [IQR], 27-65 vs 50 hours, IQR, 45-74; P = .026). There were no significant differences among major postoperative complications or costs between groups. CONCLUSIONS Routine use of inhaled milrinone 4 mg and iloprost 20 µg before and after CPB is associated with reduced postoperative inotrope use.
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Affiliation(s)
- Xiaobo Hu
- From the Department of Intensive Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Department of Intensive Care Medicine, Western Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Xiaoqiang Li
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Stuart Boggett
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Yang
- Department of Intensive Care Medicine, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Wang Chun-Ting
- From the Department of Intensive Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - James Anstey
- Department of Intensive Care Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Departments of Surgery
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio
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Moreno O, Ochagavía A, Artigas A, Barbadillo S, Tomás R, Bosque MD, Fortia C, Baigorri F. Impact of goal directed basic echocardiography on diagnostic and therapeutic management in an ICU of cardiac surgery. Med Intensiva 2019; 44:534-541. [PMID: 31474457 DOI: 10.1016/j.medin.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Few studies have evaluated the impact in diagnosis and therapeutic management of basic transthoracic echocardiography in postoperated cardiac surgery. The aim of our study was to evaluate the impact of basic transthoracic echocardiography in the management of this kind of patients. DESIGN Over an 18-month period, we prospectively studied all patients admitted to a university hospital Intensive Care Unit following heart surgery. We evaluated clinically all of them to establish a diagnosis and an initial treatment. We performed basic transthoracic echocardiography for a diagnosis evaluation that was compared with clinical diagnosis. If they differed, we assessed to change treatment and evaluate the therapeutic response. We performed a descriptive analysis. RESULTS We included 136 patients and performed 203 echocardiographies. Transthoracic echocardiography differed of initial diagnosis in 101 (49.8%) echocardiographies. In 56 of these echocardiographies (55.44%), we could give an alternative diagnosis with a change in the treatment in 30patients (53,6%). We found clinical improvement in 26 patients (86.76%) in the following 30-60minutes. CONCLUSIONS Basic transthoracic echocardiography is useful in diagnostic and therapeutic management of postoperative cardiac surgery patients. We could not confirm the clinical diagnosis in half of the performed echocardiographies. In most patients in whom we observe a change in the diagnosis due to echocardiography, we observed a clinical improvement after changing the treatment.
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Affiliation(s)
- O Moreno
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Ochagavía
- Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Madrid, España
| | - A Artigas
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Madrid, España; Servicio de Medicina Intensiva, Hospital Universitari Sagrat Cor, Barcelona, España
| | - S Barbadillo
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - R Tomás
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - M D Bosque
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - C Fortia
- Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España
| | - F Baigorri
- Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España
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Badran HM, Ahmed MK, Beshay MM, Zein FEA. A comparative study between transthoracic and transesophageal echo modalities in evaluation of left ventricular deformation. Egypt Heart J 2019; 71:4. [PMID: 31659538 PMCID: PMC6821410 DOI: 10.1186/s43044-019-0004-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 2D strain imaging has been proved as an accurate technique for the assessment of left ventricular (LV) function using transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) has become a standard and essential technique in clinical practice especially when TTE is inconclusive. Adding 2D strain imaging to TEE might be valuable in the evaluation of cardiac performance. The aim of the present study was to compare 2D strain imaging using TTE and TEE in the assessment of left ventricular deformation in patients with cardiovascular diseases. RESULTS This study was conducted on sixty patients, who were referred for TEE for various clinical indications. All patients were examined with both TTE and TEE 2D strain imaging. Global and regional strain parameters including longitudinal (LS), circumferential (CS), and radial (RS) were examined. Analysis of 2D strain using TTE was time sparing than TEE (16 ± 1 vs 19 ± 2 min, P < 0.001). From 1020 segments explored using TTE, 97% (LS) and 93% (CS and RS) of the segments were fully analyzed versus 90% and 88% using TEE respectively (P < 0.01). TEE longitudinal strain has an excellent agreement with TTE-derived measurements and a modest agreement in circumferential strain but a notable disparity in radial strain values. Both regional and global LS and RS measured by TTE showed higher values (P < 0.01, < 0.03) compared with its corresponding values measured by TEE. Whereas segmental and global values of CS were higher using TTE modes, the difference with the analogous TEE values did not reach statistical significance. LS and CS measured by TTE and TEE showed excellent but similar correlation with LV EF and wall motion score index. CONCLUSION 2D strain using TTE is user friendly compared to TEE. However, because of the good agreement, TEE 2D strain might represent an appropriate alternative in the evaluation of global LV deformation.
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Hauser ND, Swanevelder J. Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE. Echo Res Pract 2018; 5:R101-R113. [PMID: 30303686 PMCID: PMC6144934 DOI: 10.1530/erp-18-0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transoesophageal echocardiography (TOE) has, in certain clinical situations, become an almost universal monitor and diagnostic tool. In the perioperative environment, TOE is frequently used to guide anaesthetic management and assist with surgical decision making for, but not limited to, cardiothoracic, major vascular and transplant operations. The use of TOE is not limited to the theatre environment being frequently used in outpatient clinics, emergency departments and intensive care settings. Two case reports, one of oesophageal perforation and another of TOE utilization in a patient having previously undergone an oesophagectomy, introduce the need for care while using TOE and highlight the need for vigilance. The safe use of TOE, the potential complications and the suggested contra-indications are then considered together with suggestions for improving the safety of TOE in adult and paediatric patients.
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Affiliation(s)
- Neil David Hauser
- Department of Anaesthesia & Perioperative Medicine Groote Schuur & Red Cross Children’s Hospitals, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia & Perioperative Medicine Groote Schuur & Red Cross Children’s Hospitals, University of Cape Town, Cape Town, South Africa
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8
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Lin CY, Lee KT, Ni MY, Tseng CN, Lee HA, Su IL, Ho HP, Tsai FC. Impact of reduced left ventricular function on repairing acute type A aortic dissection: Outcome and risk factors analysis from a single institutional experience. Medicine (Baltimore) 2018; 97:e12165. [PMID: 30170461 PMCID: PMC6392594 DOI: 10.1097/md.0000000000012165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Preoperative left ventricular dysfunction is a risk factor for postoperative mortality and morbidity in cardiovascular surgeries with cardiopulmonary bypass, including thoracic aortic surgery. Using a retrospective study design, this study aimed to clarify the short- and mid-term outcomes of patients who underwent acute type A aortic dissection (ATAAD) repair with reduced left ventricular function.Between July 2007 and February 2018, a total of 510 adult patients underwent surgical repair of ATAAD in a single institution. The patients were classified as having left ventricular ejection fraction (LVEF) <50% (low EF group, n = 86, 16.9%) and LVEF ≥50% (normal group, n = 424, 83.1%) according to transesophageal echocardiographic assessment at the operating room. Preoperative demographics, surgical information, and postoperative complication were compared between the two groups. Three-year survival was analyzed using the Kaplan-Meier actuarial method. Serial echocardiographic evaluations were performed at 1, 2, and 3 years postoperation.Demographics, comorbidities, and surgical procedures were generally homogenous between the 2 groups, except for a lower rate of aortic arch replacement in the low EF group. The averaged LVEFs were 44.3 ± 2.5% and 65.8 ± 6.6% among the low EF and normal groups, respectively. The patients with low EF had higher in-hospital mortality (23.3% versus 13.9%, P = .025) compared with the normal group. Multivariate analysis revealed that intraoperative myocardial failure requiring extracorporeal membrane oxygenation support was an in-hospital mortality predictor (odds ratio, 16.99; 95% confidence interval, 1.23-234.32; P = .034), as was preoperative serum creatinine >1.5 mg/dL. For patients who survived to discharge, the 3-year cumulative survival rates were 77.8% and 82.1% in the low EF and normal groups, respectively (P = .522). The serial echocardiograms revealed no postoperative deterioration of LVEF during the 3-year follow-up.Even with a more conservative aortic repair procedure, the patients with preoperative left ventricular dysfunction are at higher surgical risk for in-hospital mortality. However, once such patients are able to survive to discharge, the midterm outcome can still be promising.
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Affiliation(s)
- Chun-Yu Lin
- Department of Cardiothoracic and Vascular Surgery
| | | | - Ming-Yang Ni
- Department of Anesthesiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Hsiu-An Lee
- Department of Cardiothoracic and Vascular Surgery
| | - I-Li Su
- Department of Cardiothoracic and Vascular Surgery
| | - Heng-Psan Ho
- Department of Cardiothoracic and Vascular Surgery
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Affiliation(s)
- K Muralidhar
- Senior Consultant and Professor, Department of Anaesthesia and Intensive Care, Narayana Hrudayalaya Hospitals, Bengaluru, Karnataka, India; Professor, Department of International Health, University of Minnesota, USA
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Iglesias I, Bainbridge D, Murkin J. Intraoperative Echocardiography: Support for Decision Making in Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2016; 8:25-35. [PMID: 15372125 DOI: 10.1177/108925320400800107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraoperative echocardiography (including transesophageal echocardiography, epiaortic ultrasound and epicardial echocardiography) is commonly performed in North American hospitals during cardiac anesthesia. Several authors have reported on the positive impact of intraoperative echocardiography on patients’ outcomes. Transesophageal echocardiography is useful in identifying anatomic and functional abnormalities either before or after cardiopulmonary bypass and helps to make decisions in the care of high-risk and unstable patients. In minimally invasive and robotically assisted surgery, transesophageal echocardiography is essential in order to guide cannulation of venous and arterial vessels for cardiopulmonary bypass and in providing immediate assessment of the quality of the performed repair. Intraoperative echocardiography can also detect complications associated with the performed procedure and can be an excellent hemodynamic monitor in unstable patients. In this paper different scenarios where intraoperative echocardiography is useful are reviewed, some clinical cases are shown to illustrate, and a review of related literature is reported.
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Affiliation(s)
- Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada.
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Fox J, Glas K, Swaminathan M, Shernan S. The Impact of Intraoperative Echocardiography on Clinical Outcomes Following Adult Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2016; 9:25-40. [PMID: 15735842 DOI: 10.1177/108925320500900104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past 30 years, intraoperative echocardiography has become an invaluable diagnostic tool and monitor of cardiac performance for the management of cardiac surgical patients. The essential information provided by intraoperative echocardiography regarding hemodynamic management, cardiac valve function, congenital heart lesions, and great vessel pathology has contributed to its widespread popularity. Numerous investigations have been conducted in an attempt to specifically demonstrate a beneficial impact of intraoperative echocardiography in cardiac surgery. However, there is a relative paucity of data derived from prospective trials in which the use of intraoperative echocardiography has been randomized among various cardiac surgical patient populations to formally ascertain, rather than simply infer, its putative impact on perioperative decision-making and clinical outcomes. Ironically, the popularity of intraoperative echocardiography has imposed ethical limitations on performing randomized trials in patient populations for whom significant benefit has been previously inferred. Nonetheless, significant evidence has been published to support its almost universal acceptance as an important perioperative diagnostic tool and monitor for cardiac surgical patients. This review focuses on the impact of intraoperative echocardiography on clinical outcomes in the more common adult cardiac surgical scenarios, including coronary artery bypass graft surgery, mitral and aortic valve surgery, and in evaluating the intrathoracic aorta.
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Affiliation(s)
- John Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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12
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Increased tracheal cuff pressure during insertion of a transoesophageal echocardiography probe: A prospective, observational study. Eur J Anaesthesiol 2016; 32:549-54. [PMID: 25564781 DOI: 10.1097/eja.0000000000000204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Excessive tracheal cuff pressure reduces tracheal mucosal blood flow and increases tracheal morbidity. Inserting a transoesophageal echocardiography (TOE) probe has been shown to increase tracheal cuff pressure. OBJECTIVE To evaluate the effect of inserting a TOE probe on tracheal cuff pressure and compare the effect in patients who received a single-lumen endotracheal tube (SLT) with those who received a double-lumen endotracheal tube (DLT). DESIGN A prospective, observational study. SETTING Single-centre trial, study period from October 2013 to January 2014. PATIENTS Forty-four adult patients scheduled for elective cardiothoracic surgery requiring intraoperative TOE monitoring. INTERVENTIONS After tracheal intubation with a SLT (n = 22) or DLT (n = 22), the tracheal cuff was inflated to 18 mmHg (25 cmH2O) with air. Tracheal cuff pressure was monitored continuously for 5 min after inserting the TOE probe. MAIN OUTCOME MEASURES The primary endpoint was steady-state tracheal cuff pressure after insertion of the TOE probe. RESULTS Median (interquartile range, IQR) tracheal cuff pressure stabilised at 3 (2 to 3) min in the SLT group and at 2 (1 to 3) min in the DLT group. Steady-state cuff pressure was significantly higher in the DLT group than that in the SLT group [36.7 (31.3 to 44.1) vs. 31.3 (29.6 to 35.7) cmH2O; (P = 0.03)]. Steady-state cuff pressure more than 40 cmH2O was observed in two patients (18.2%) in the SLT group and nine patients (40.9%) in the DLT group (P = 0.02). CONCLUSION Insertion of a TOE probe increased tracheal cuff pressure in both the SLT and DLT groups. The increase in cuff pressure was greater in patients who received a DLT. Frequent measurement and adjustment of cuff pressure should be emphasised particularly when TOE is used in patients receiving a DLT. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02034643.
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Fletcher N, Geisen M, Meeran H, Spray D, Cecconi M. Initial clinical experience with a miniaturized transesophageal echocardiography probe in a cardiac intensive care unit. J Cardiothorac Vasc Anesth 2015; 29:582-7. [PMID: 25575411 DOI: 10.1053/j.jvca.2014.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the safety of a novel, miniaturized, monoplane transesophageal echocardiography probe (mTEE) and its potential as a hemodynamic monitoring tool. DESIGN This was a retrospective analysis of the clinical evaluation of a disposable mTEE in ventilated patients with severe cardiogenic shock requiring hemodynamic support. mTEE assessment was performed by operators with mixed levels of TEE training. Information on hemodynamic interventions based on mTEE findings was recorded. SETTING A tertiary university cardiac critical care unit. PARTICIPANTS Male and female critical care patients admitted to the unit with severe hemodynamic instability. INTERVENTIONS Insertion of miniaturized disposable TEE probe and hemodynamic and other critical care interventions based on this and conventional monitoring. MEASUREMENTS AND MAIN RESULTS In 41 patients (51.2% female, 73.2% after cardiac surgery), hemodynamic support probe insertion was accomplished without major complications. A total of 195 mTEE studies were performed, resulting in changes in therapy in 37 (90.2%) patients based on mTEE findings, leading to an improvement in hemodynamic parameters in 33 (80.5%) patients. Right ventricular (RV) failure was diagnosed in 25 patients (67.6%) and mTEE had a direct therapeutic impact on management of RV failure in 17 patients (68 %). CONCLUSIONS Insertion and operation of a novel, miniaturized transoesophageal echocardiography probe can be performed for up to 72 hours without major complications. Repeated assessment using this device provides complementary information to invasive monitoring in the majority of patients and has an impact on hemodynamic management.
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Affiliation(s)
- Nick Fletcher
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom.
| | - Martin Geisen
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Hanif Meeran
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Dominic Spray
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Maurizio Cecconi
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
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Denault A, Lamarche Y, Rochon A, Cogan J, Liszkowski M, Lebon JS, Ayoub C, Taillefer J, Blain R, Viens C, Couture P, Deschamps A. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol 2014; 30:S459-77. [PMID: 25432139 DOI: 10.1016/j.cjca.2014.09.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 02/07/2023] Open
Abstract
Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest. Herein, we discuss the reasons that each of these components are particularly important in improving perioperative care, describe how they can be addressed, and their impact in the care of patients who undergo cardiac surgery.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Critical Care Program, Montreal Heart Institute, and Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
| | - Yoan Lamarche
- Department of Cardiac Surgery and Critical Care Program, Montreal Heart Institute, and Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mark Liszkowski
- Department of Medicine, Cardiology and Critical Care Program, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Taillefer
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Blain
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Claudia Viens
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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15
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Thorsgard ME, Morrissette GJ, Sun B, Eales F, Kshettry V, Flavin T, Tyberg R, Garberich RF, Harris KM. Impact of Intraoperative Transesophageal Echocardiography on Acute Type-A Aortic Dissection. J Cardiothorac Vasc Anesth 2014; 28:1203-7. [DOI: 10.1053/j.jvca.2014.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Indexed: 11/11/2022]
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16
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Harvey NJ. Intraoperative echocardiography assessment of left and right ventricular function. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2011.10872729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- NJ Harvey
- Department of Anaesthesia, Glenfield Hospital, University Hospitals of Leicester, UK
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17
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Elgebaly AS, Eldabaa AA. Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery? Anesth Essays Res 2014; 8:216-22. [PMID: 25886229 PMCID: PMC4173615 DOI: 10.4103/0259-1162.134510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery. HYPOTHESIS Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking. DESIGN A prospective randomized observational clinical trial study. AIMS The authors compared the utility of I-gel airway with a conventional ETT during the induction and maintenance of anesthesia with sevoflurane and fentanyl in adults undergoing cardiac surgery. PATIENTS AND METHODS A total of 49 adult patients underwent cardiac surgery were randomized into two groups according to the airway management: I-gel group (n = 23) and ETT group (n = 26). Doses of fentanyl and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge pressure [PCWP]) were recorded preoperative, 5 min following tracheal intubation or I-gel airway insertion, after skin incision, after stenotomy, and after weaning off bypass. RESULTS None of the patients in the I-gel group required additional doses of fentanyl during the I-gel insertion, compared with 74% of the patients during laryngoscopy and endotracheal insertion in the ETT group, for an average total dose of 22.6 ± 0.6 μg/kg. The MAP and HR did not significantly differ from the baseline values at any point of measurement in either group. Furthermore, CVP, PAP, and PCWP measured during the procedure were significantly lower in I-gel group than ETT group. Extubation required more amount of time in ETT than I- gel group. CONCLUSION The I-gel airway is well-tolerated by adult patients undergoing cardiac surgery, and requires lower total doses of anesthetics than endotracheal intubation with hemodynamic control and helps in fast-tracking.
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Affiliation(s)
- Ahmed Said Elgebaly
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Ali Eldabaa
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Tanta, Egypt
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18
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Barber RL, Fletcher SN. A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility. Anaesthesia 2014; 69:764-76. [DOI: 10.1111/anae.12663] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 12/11/2022]
Affiliation(s)
| | - S. N. Fletcher
- St George's Hospital and Honorary Senior Lecturer; St George's University of London; London UK
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19
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Ingrande J, Lemmens HJ. Medical devices for the anesthetist: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:45-53. [PMID: 24707188 PMCID: PMC3971909 DOI: 10.2147/mder.s43428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools, ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use.
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Affiliation(s)
- Jerry Ingrande
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hendrikus Jm Lemmens
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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20
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Abstract
OBJECTIVE Portable ultrasound is now used routinely in many ICUs for various clinical applications. Echocardiography performed by noncardiologists, both transesophageal and transthoracic, has evolved to broad applications in diagnosis, monitoring, and management of critically ill patients. This review provides a current update on focused critical care echocardiography for the management of critically ill patients. METHOD Source data were obtained from a PubMed search of the medical literature, including the PubMed "related articles" search methodology. SUMMARY AND CONCLUSIONS Although studies demonstrating improved clinical outcomes for critically ill patients managed by focused critical care echocardiography are generally lacking, there is evidence to suggest that some intermediate outcomes are improved. Furthermore, noncardiologists can learn focused critical care echocardiography and adequately interpret the information obtained. Noncardiologists can also successfully incorporate focused critical care echocardiography into advanced cardiopulmonary life support. Formal training and proctoring are important for safe application of focused critical care echocardiography in clinical practice. Further outcomes-based research is urgently needed to evaluate the efficacy of focused critical care echocardiography.
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21
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Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, Hahn RT, Shanewise JS, Adams MS, Shernan SK. Special article: basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg 2013; 117:543-558. [PMID: 23966648 DOI: 10.1213/ane.0b013e3182a00616] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Scott T Reeves
- From the Medical University of South Carolina (S.T.R., A.C.F.); Weill-Cornell Medical College, New York, New York (N.J.S.); Duke University, Durham, North Carolina (M.S.); Brigham's and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.K.S.); Emory University, Atlanta, Georgia (W.S.W., K.E.G.); Columbia University College of Physicians and Surgeons, New York, New York (R.T.H., J.S.S.); and Massachusetts General Hospital, Boston, Massachusetts (M.S.A.)
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22
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Yamamoto T, Schindler E. A case of anastomosis malposition of the Blalock-Taussig shunt diagnosed using perioperative transesophageal echocardiography monitoring. J Clin Monit Comput 2013; 28:165-7. [PMID: 24046098 DOI: 10.1007/s10877-013-9509-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/31/2013] [Indexed: 11/28/2022]
Abstract
The perioperative transesophageal echocardiography (TEE) is a very useful and minimal invasive monitoring not only for the cardiac anesthesia management, but also for the anesthesia management of the non-cardiac operations of the heart high risk patients. In this case report, we report a case of the urgent Blalock-Taussig shunt (BT shunt) operation for a small patient of Fallot's tetralogy with anoxic spell, which showed an atypical change of hemodynamics and SpO2 with the shunt opening. After the BT shunt anastomosis, the diastolic blood pressure decreased with the shunt opening, however, the expected rise of SpO2 was not provided. By the perioperative TEE monitoring with the single plane TEE transducer for neonate; UST-52110S (Hitachi Aloka Medical, Tokyo, Japan) with 4.5 mm in diameter, the cause of this atypical change of hemodynamics and SpO2 was diagnosed to be an accidental anastomosis malposition of the BT shunt to the right pulmonary vein and reported to the operator during the operation, and the operation was performed correctly.
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Affiliation(s)
- Tomohiro Yamamoto
- Department of Pediatric Anesthesiology and Critical Care Medicine, Children's Hospital Asklepios Klinik Sankt Augustin, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany,
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23
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Maltais S, Costello WT, Billings FT, Bick JS, Byrne JG, Ahmad RM, Wagner CE. Episodic Monoplane Transesophageal Echocardiography Impacts Postoperative Management of the Cardiac Surgery Patient. J Cardiothorac Vasc Anesth 2013; 27:665-9. [DOI: 10.1053/j.jvca.2013.02.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Indexed: 11/11/2022]
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24
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Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, Hahn RT, Shanewise JS, Adams MS, Shernan SK. Basic Perioperative Transesophageal Echocardiography Examination: A Consensus Statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26:443-56. [DOI: 10.1016/j.echo.2013.02.015] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Arntfield RT, Millington SJ. Point of care cardiac ultrasound applications in the emergency department and intensive care unit--a review. Curr Cardiol Rev 2013; 8:98-108. [PMID: 22894759 PMCID: PMC3406278 DOI: 10.2174/157340312801784952] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 04/02/2011] [Accepted: 05/12/2011] [Indexed: 12/20/2022] Open
Abstract
The use of point of care echocardiography by non-cardiologist in acute care settings such as the emergency department (ED) or the intensive care unit (ICU) is very common. Unlike diagnostic echocardiography, the scope of such point of care exams is often restricted to address the clinical questions raised by the patient's differential diagnosis or chief complaint in order to inform immediate management decisions. In this article, an overview of the most common applications of this focused echocardiography in the ED and ICU is provided. This includes but is not limited to the evaluation of patients experiencing hypotension, cardiac arrest, cardiac trauma, chest pain and patients after cardiac surgery.
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Affiliation(s)
- Robert T Arntfield
- Division of Critical Care and Division of Emergency Medicine, Western University, 800 Commissioners Rd East, London, Ontario, Canada, N6A 5W9.
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26
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Gouveia V, Marcelino P, Reuter DA. The role of transesophageal echocardiography in the intraoperative period. Curr Cardiol Rev 2013; 7:184-96. [PMID: 22758616 PMCID: PMC3263482 DOI: 10.2174/157340311798220511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 02/18/2011] [Accepted: 02/21/2011] [Indexed: 12/17/2022] Open
Abstract
The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience.
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Affiliation(s)
- Veronica Gouveia
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Itzehoe, Germany.
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27
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Buck T, Kortmann K, Plicht B, Kamler M, Tsagakis K, Thielmann M, Jakob HG, Erbel R. Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery. Clin Res Cardiol 2013; 102:351-9. [PMID: 23392530 DOI: 10.1007/s00392-013-0544-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/23/2013] [Indexed: 11/25/2022]
Abstract
AIMS To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated. METHODS AND RESULTS In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (p < 0.05) of patients with both presurgical and postsurgical IOTEE. CONCLUSION We found an alarming high number of unsuspected pathologies by IOTEE causing substantial alterations of surgery. Beyond this, whether patients received presurgical IOTEE or not made a significant difference on the number of pathologies left unoperated.
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Affiliation(s)
- Thomas Buck
- Department of Cardiology, West German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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28
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Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg 2012; 115:1007-28. [PMID: 23011559 DOI: 10.1213/ane.0b013e31826a79c1] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. This evolution should start at the medical student level and be reinforced throughout specialist training. The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Affiliation(s)
- Colin F Royse
- Department of Surgery, The University of Melbourne, 245 Cardigan St., Carlton, Victoria, Australia, 3053.
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29
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Pérez Vela J, Martín Benítez J, Carrasco González M, De la Cal López M, Hinojosa Pérez R, Sagredo Meneses V, del Nogal Saez F. Guías de práctica clínica para el manejo del síndrome de bajo gasto cardíaco en el postoperatorio de cirugía cardíaca. Med Intensiva 2012; 36:e1-44. [DOI: 10.1016/j.medin.2012.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/07/2012] [Indexed: 01/04/2023]
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30
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Kurt M, Tanboga IH, Isik T, Kaya A, Ekinci M, Bilen E, Can MM, Karakas MF, Bayram E, Aksakal E, Sevimli S. Comparison of Transthoracic and Transesophageal 2-Dimensional Speckle Tracking Echocardiography. J Cardiothorac Vasc Anesth 2012; 26:26-31. [DOI: 10.1053/j.jvca.2011.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 11/11/2022]
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31
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Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatr Crit Care Med 2011; 12:S2-S11. [PMID: 22129545 DOI: 10.1097/pcc.0b013e318220e7ea] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review. METHODOLOGY A search of MEDLINE, EMBASE, PubMed, and the Cochrane Database was conducted to find controlled trials of heart rate, electrocardiography, noninvasive and invasive blood pressure, atrial pressure, end-tidal carbon dioxide, and pulse oximetry monitoring. Adult and pediatric data were considered. Guidelines published by the Society for Critical Care Medicine, the American Heart Association, the American Academy of Pediatrics, and the International Liaison Committee on Resuscitation were reviewed, including further review of references cited. RESULTS AND CONCLUSIONS Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.
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Intraoperative Monitoring with Transesophageal Echocardiography in Cardiac Surgery. Braz J Anesthesiol 2011; 61:495-512. [DOI: 10.1016/s0034-7094(11)70058-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022] Open
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Smyth K, Hebballi R, Peterson MK. Use of transoesophageal echocardiography during the peri-operative period for trauma patients. J ROY ARMY MED CORPS 2011; 156:373-9. [PMID: 21302659 DOI: 10.1136/jramc-156-04s-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The medical facility at Camp Bastion continues to evolve as a consequence of the increased throughput of battlefield trauma patients. There is a requirement for rapid and accurate diagnosis of haemodynamic instability and continued haemodynamic monitoring throughout the peri-operative period. Transoesophageal echocardiography (TOE) has been used for this purpose in the arena of cardiac anaesthesia since the mid 1980s. It is being introduced to other peri-operative settings where severe haemodynamic instability is expected. The old proverb: 'There are none so blind as those who cannot see' (Jeremiah 5:21) is applicable to this topic, in that TOE is proven to be a rapid, portable, safe and effective tool in the assessment of the haemodynamically unstable patient. This paper explores the application of TOE for the assessment of the major causes of haemodynamic instability in the trauma population.
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Affiliation(s)
- K Smyth
- Royal Air Force, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester
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34
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Jerath A, Vegas A, Meineri M, Silversides C, Feindel C, Beattie S, Corrin M, Tait G. An interactive online 3D model of the heart assists in learning standard transesophageal echocardiography views. Can J Anaesth 2010; 58:14-21. [DOI: 10.1007/s12630-010-9410-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022] Open
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Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, Goepfert M, Gogarten W, Grosse J, Heller A, Heringlake M, Kastrup M, Kroener A, Loer S, Marggraf G, Markewitz A, Reuter D, Schmitt D, Schirmer U, Wiesenack C, Zwissler B, Spies C. S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2010. [DOI: 10.1007/s00398-010-0790-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Utility of Transesophageal Echocardiography During Severe Hypotension in Non-cardiac Surgery. Braz J Anesthesiol 2010; 60:513-21. [DOI: 10.1016/s0034-7094(10)70062-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 05/16/2010] [Indexed: 11/21/2022] Open
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37
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Denault AY, Deschamps A, Couture P. Intraoperative Hemodynamic Instability During and After Separation From Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth 2010; 14:165-82. [DOI: 10.1177/1089253210376673] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Every year, more than 1 million patients worldwide undergo cardiac surgery. Because of the aging of the population, cardiac surgery will increasingly be offered to patients at a higher risk of complications. The consequence is a reduced physiological reserve and hence an increased risk of mortality. These issues will have a significant impact on future health care costs because the population undergoing cardiac surgery will be older and more likely to develop postoperative complications. One of the most dreaded complications in cardiac surgery is difficult separation from cardiopulmonary bypass (CPB). When separation from CPB is associated with right-ventricular failure, the mortality rate will range from 44% to 86%. Therefore, the diagnosis and the preoperative prediction of difficult separation from CPB will be crucial to improve the selection and care of patients and to prevent complications for this high-risk patient population.
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Affiliation(s)
- André Y. Denault
- Department of Anesthesiology, Montréal Heart Institute and Université de Montréal, Montréal, Quebec, Canada,
| | - Alain Deschamps
- Department of Anesthesiology, Montréal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montréal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
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Michelena HI, Abel MD, Suri RM, Freeman WK, Click RL, Sundt TM, Schaff HV, Enriquez-Sarano M. Intraoperative echocardiography in valvular heart disease: an evidence-based appraisal. Mayo Clin Proc 2010; 85:646-55. [PMID: 20592170 PMCID: PMC2894720 DOI: 10.4065/mcp.2009.0629] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications.
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Affiliation(s)
- Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, Goepfert M, Gogarten W, Grosse J, Heller AR, Heringlake M, Kastrup M, Kroener A, Loer SA, Marggraf G, Markewitz A, Reuter D, Schmitt DV, Schirmer U, Wiesenack C, Zwissler B, Spies C. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2010; 8:Doc12. [PMID: 20577643 PMCID: PMC2890209 DOI: 10.3205/000101] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Indexed: 01/20/2023]
Abstract
Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefässchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).
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Affiliation(s)
- M. Carl
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Alms
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Germany
| | - J. Braun
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Dongas
- Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - J. Erb
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Goetz
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M. Goepfert
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - W. Gogarten
- Department of Anaesthesiology and Intensive Care, University of Muenster, Germany
| | - J. Grosse
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. R. Heller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M. Heringlake
- Department of Anesthesiology, University of Luebeck, Germany
| | - M. Kastrup
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Kroener
- Department of Cardiothoracic Surgery, University of Cologne, Germany
| | - S. A. Loer
- Department of Anesthesiology, VU University Hospital Center, Amsterdam, The Netherlands
| | - G. Marggraf
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, Essen, Germany
| | - A. Markewitz
- Department of Cardiovascular Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - D. Reuter
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - D. V. Schmitt
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany
| | - U. Schirmer
- Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - C. Wiesenack
- Department of Anaesthesia, University Hospital of Regensburg, Germany
| | - B. Zwissler
- Clinic of Anesthesiology, Ludwig Maximilian University, Munich, Germany
| | - C. Spies
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
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Mebazaa A, Pitsis AA, Rudiger A, Toller W, Longrois D, Ricksten SE, Bobek I, De Hert S, Wieselthaler G, Schirmer U, von Segesser LK, Sander M, Poldermans D, Ranucci M, Karpati PCJ, Wouters P, Seeberger M, Schmid ER, Weder W, Follath F. Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery. Crit Care 2010; 14:201. [PMID: 20497611 PMCID: PMC2887098 DOI: 10.1186/cc8153] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery.
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Affiliation(s)
- Alexandre Mebazaa
- Department of Anaesthesia and Intensive care, INSERM UMR 942, Lariboisière Hospital, University of Paris 7 - Diderot, 2 rue Ambroise Paré, Paris, France.
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Guru R. Importance of transoesophageal echocardiography in preventing complications due to intraoperative dislodgement of left atrial thrombus. Indian J Anaesth 2010; 54:577-9. [PMID: 21224983 PMCID: PMC3016586 DOI: 10.4103/0019-5049.72655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Klein AA, Snell A, Nashef SAM, Hall RMO, Kneeshaw JD, Arrowsmith JE. The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice. Anaesthesia 2009; 64:947-52. [DOI: 10.1111/j.1365-2044.2009.05991.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Skubas NJ. Two-dimensional, Non-Doppler Strain Imaging during Anesthesia and Cardiac Surgery. Echocardiography 2009; 26:345-53. [DOI: 10.1111/j.1540-8175.2008.00868.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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45
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Gadhinglajkar SV, Sreedhar R, Jacob D, Jayakumar K, Adil S, Nagi GS, Skubas NJ, Chaney MA. Case 1--2009. Retrocardiac sponge-induced hemodynamic instability after cardiac surgery. J Cardiothorac Vasc Anesth 2009; 23:102-9. [PMID: 19159842 DOI: 10.1053/j.jvca.2008.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Indexed: 11/11/2022]
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Mahmood F, Christie A, Matyal R. Transesophageal echocardiography and noncardiac surgery. Semin Cardiothorac Vasc Anesth 2008; 12:265-89. [PMID: 19033272 DOI: 10.1177/1089253208328668] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of transesophageal echocardiography (TEE) for monitoring during cardiac and noncardiac surgery has increased exponentially over the past few decades. TEE has evolved from a diagnostic tool to a monitoring device and a procedural adjunct. The close proximity of the TEE transducer to the heart generates high-quality images of the intracardiac structures and their spatial orientation. The use of TEE in noncardiac and critical care settings is not well studied, and the evidence of the benefits of its use in these settings is lacking. Despite the widespread availability of TEE equipment in US hospitals, less than 30% of anesthesiologists are formally trained in the use of perioperative TEE. In this review, the safety and indications of TEE are reviewed and detailed analysis of the best available evidence in this regard is presented. Landmark trials evaluating the use of TEE and its therapeutic impact in noncardiac surgical setting are critically reviewed. 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.
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Affiliation(s)
- Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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47
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Côté G, Denault A. Transesophageal echocardiography-related complications. Can J Anaesth 2008; 55:622-47. [DOI: 10.1007/bf03021437] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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48
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Morganstern J, Kanchuger M. Pro: all off-pump coronary artery bypass graft surgeries should include intraoperative transesophageal echocardiography assessment. J Cardiothorac Vasc Anesth 2008; 22:625-8. [PMID: 18662644 DOI: 10.1053/j.jvca.2008.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Jill Morganstern
- Department of Anesthesiology, New York University School of Medicine, New York, NY 10016, USA.
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Qizilbash B, Couture P, Denault A. Impact of Perioperative Transesophageal Echocardiography in Aortic Valve Replacement. Semin Cardiothorac Vasc Anesth 2008; 11:288-300. [DOI: 10.1177/1089253207311789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intraoperative transesophageal echocardiography (TEE) is currently being used routinely during aortic valve replacement (AVR). TEE provides information that can lead to modifications of anesthetic and surgical care that leads to improved outcome. Numerous studies have shown that modifications in therapy occur from 10% to more than 40% of cases. The impact of TEE can be divided among modifications of therapy before, during, and after cardiopulmonary bypass. Before cardiopulmonary bypass, TEE can provide prognostic information, optimize hemodynamics, and diagnose conditions that were not appreciated before surgery, including patient—prosthesis mismatch. TEE can guide and modify the placement of various bypass cannulae. After bypass, TEE verifies the surgical result, rules out left and right ventricular outflow tract obstruction, and assures stable hemodynamics. Although current guidelines state that aortic valve surgery is a class IIa indication for TEE use, the authors' experience suggests that TEE should be routinely used in AVR.
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Affiliation(s)
- Baqir Qizilbash
- Department of Anesthesiology, Montreal Heart Institute/ Université de Montréal, Montreal, Quebec, Canada,
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute/ Université de Montréal, Montreal, Quebec, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute/ Université de Montréal, Montreal, Quebec, Canada
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Swanevelder J. Intra-operative echocardiography assessment of ventricular function. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2008. [DOI: 10.1080/22201173.2008.10872518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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