Core Topics in Cardiac Anaesthesia

organ dysfunctions or simply hospital survival; but a healthy, productive long-term survivor (Murphy et al,2009). Anesthetic protocols in cardiac surgery are investigated and analized in terms of their effect on postoperative mortality and incidence of myocardial infarction following cardiac surgery, postoperative cardiac troponin release, need for inotropic support, time on mechanical ventilation, ICU and hospital stay (Landoni et al,2009). How to reference In order to correctly reference this scholarly work, feel free to copy and paste the following:

Seminars in Cardiothoracic and Vascular Anesthesia, 2002

European Journal of Anaesthesiology, 2010

HSR proceedings in intensive care & cardiovascular anesthesia, 2011

Significant variability in transfusion practice persists despite guidelines. Although the lysine analogues are effective antifibrinolytics, safety concerns exist with high doses tranexamic acid. Despite recombinant activated factor VII promising results in massive bleeding after cardiac surgery, it significantly increases arterial thromboembolic risk. Aortic valve repair may evolve to standard of care. Transcatheter aortic valve implantation is an established therapy for aortic stenosis. The cardiovascular anesthesiologist features prominently in the new guidelines for thoracic aortic disease. Although intense angiotensin blockade improves outcomes in heart failure, it might aggravate the maintenance of perioperative systemic vascular tone. Ultrafiltration is an alternative to diuresis for volume overload in heart failure. Management of heart failure titrated to brain natriuretic peptide activity reduces mortality. A major surgical advance has been the significant outcome improvemen...

Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique challenges to the cardiac anesthesiologist who is responsible not only for maintaining hemodynamics but at the same time anesthesia and analgesia for these patients. Unique pathophysiologic changes during CPB result in pharmacokinetic alterations that impact the serum and tissue concentrations of IV and volatile anesthetics. CPB has evolved into routine, safe and reliable system that requires intensive specialized training to operate. It is the function of the perfusionist to maintain and operate this equipment during CPB; however anesthesiologist and surgeon caring for the patient undergoing CPB bear the responsibility of understanding this equipment and its function in order to manage the patient undergoing surgical procedure safely. Anesthetic management of patient coming for cardiac surgery and different component of cardiopulmonary bypass will be discuss in this review article.

IP Innovative Publication Pvt. Ltd., 2019

Can J Anaesth, 2002

Purpose: This study was designed to examine the efficacy of low-dose intrathecal morphine (ITM) on extubation times and pain control after cardiac surgery. Methods: 43 patients undergoing elective cardiac surgery were enrolled in this prospective, randomized, double-blind placebo controlled trial. Patients were given a pre-induction dose of ITM (6 µg•kg-1 per ideal body weight in 5 mL normal saline, group ITM) or 5 mL of intrathecal normal saline (group ITS). Anesthesia was induced with thiopental (3 mg•kg-1), sufentanil, midazolam and rocuronium. The total allowable doses of sufentanil and midazolam for the entire case were limited to 0.5 µg•kg-1 and 0.045 mg•kg-1 respectively. Anesthesia was maintained with isoflurane before and during cardiopulmonary bypass (CPB), and with propofol after CPB. In the postanesthesia care unit, patients received nurse-administered morphine followed by patient-controlled analgesia morphine. Serial visual analogue scale pain scores, morphine use, mini-mental state examinations and pulmonary function tests were measured for 48 hr. Patient satisfaction questionnaires were completed at the time of discharge. Results: Mean times to extubation from the application of dressings were short and did not differ between groups (ITM = 41.4 ± 33.0 min, ITS = 39.2 ± 37.1 min). During the first 24 hr postoperatively, the ITM group had improved pain control and a lower iv morphine requirement than the control group, both at rest and during deep breathing. Both forced expiratory volume in one second and forced vital capacity were improved in the ITM group. There were no differences in spinal-related side effects or in the overall complication rates. Patient satisfaction was high in both groups. Conclusion: Low-dose ITM for cardiac surgery did not delay early extubation, but it improved postoperative analgesia and pulmonary function. Objectif : Vérifier l'efficacité d'une faible dose de morphine intrathécale (MIT) sur le temps d'extubation précoce et le contrôle de la douleur après une opération en cardiochirurgie. Méthode : L'étude prospective, randomisée et à double insu contre placebo a été menée auprès de 43 patients de cardiochirurgie élective. Les patients ont reçu une dose de MIT avant l'induction (6 µg•kg-1 par poids corporel idéal dans 5 mL de solution salée, groupe MIT) ou 5 mL de solution salée intrathécale (groupe SIT). L'anesthésie a été induite avec du thiopental (3 mg•kg-1), du sufentanil, du midazolam et du rocuronium. Les doses totales permises de sufentanil et de midazolam pour toute l'opération ont été respectivement limitées à 0,5 µg•kg-1 et à 0,045 mg•kg-1. L'anesthésie a été maintenue avec de l'isoflurane avant et pendant la circulation extracorporelle (CEC), et avec du propofol après la CEC. À la salle de réveil, les patients ont reçu de la morphine administrée par une infirmière, puis par injection auto-contrôlée. Les séries de scores de douleur de l'échelle visuelle analogique, la consommation de morphine, les mini-examens de l'état mental et l'exploration respiratoire fonctionnelle ont été mesurés pendant 48 h. Des questionnaires sur la satisfaction des patients ont été remplis au moment du départ.

Journal of cardiothoracic and vascular anesthesia, 2014

This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance. The second major theme is the diffusion of echocardiography throughout perioperative practice. There are now guidelines and training pathways to guide its generalization into everyday practice. The third major theme is the paradigm shift in perioperative fluid management. Recent large randomized trials suggest that fluids are drugs ...

Current Opinion in Anaesthesiology, 2020

Purpose of review The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there. Recent findings Recent literature indicates that many complicated cardiac procedures can be performed in CCL under monitored anesthesia care. At the same time several of them (e.g. transcatheter aortic valve replacement) are quickly becoming a viable alternative for surgical valve replacement. The most recent expansion of CCL procedures is related to rapidly growing population of grown-ups with congenital heart disease. All aforementioned developments present new challenges to an anesthesiologist. Summary New and fast development of percutaneous cardiac interventions has created a new working place for the anesthesiologist-the CCL. Our expertise in complex cardiac pathophysiology allows conduct of complicated procedures outside of the operating theater. For the same reasons, there is ongoing discussion whether anesthesia support in CCL should be provided by a general or cardiac anesthesiologist. Keywords anesthesia, cardiac catheterization laboratory, grown up congenital heart disease, transcatheter valve procedures LOCATION AND DESIGN OF CARDIAC CATHETERIZATION LABORATORY The physical environment of the CCL is planned to accommodate the needs of the interventional cardiologist and the size and topography are usually not designed for the provision of anesthesia. There may be a lack of dedicated monitors, anesthesia