Selected 2022 Highlights in Congenital Cardiac Anesthesia Stein, Mary L.; Bilal, Musa B.; Faraoni, David ...
Journal of cardiothoracic and vascular anesthesia,
July 2023, 2023-Jul, 2023-07-00, 20230701, Letnik:
37, Številka:
7
Journal Article
Recenzirano
Odprti dostop
This article is a review of the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist, and was published in 2022. After a search of the United States National ...Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2022. The authors of this manuscript considered the following topics noteworthy to be included in this review—intensive care unit admission after congenital cardiac catheterization interventions, antifibrinolytics in pediatric cardiac surgery, the current status of the pediatric cardiac anesthesia workforce in the United States, and kidney injury and renal protection during congenital heart surgery.
Introduction
The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is most commonly implanted under general anesthesia (GA), due to the intraoperative discomfort associated with tunneling ...and dissection. Postoperative pain can be substantial and is often managed with opioids. There is a growing interest in transitioning away from the routine use of GA during S‐ICD implantation, while also controlling perioperative discomfort without the use of narcotics. As such, we assessed the feasibility of a multimodal analgesia regimen that included regional anesthesia techniques in patients undergoing S‐ICD implantation.
Methods and Results
Twenty patients received truncal plane block (TBL) immediately before S‐ICD implantation. The first 10 patients were implanted under general anesthesia (GA + TBL), and the next 10 patients were implanted under deep sedation (DS + TBL). Additionally, the DS + TBL patients were also prescribed a structured regimen of nonopioid analgesics in the perioperative period. Opioid consumption was calculated as milligram morphine equivalents (MME). In‐hospital opioid consumption was significantly lower in the patients implanted with DS + TBL (MME = 0) as compared with patients receiving GA + TBL (MME = 60; P = 0.004).
Conclusions
Subcutaneous ICD implantation with anesthesia‐delivered DS and a multimodal anesthetic regimen that includes TBL is feasible and associated with significantly less perioperative opioid consumption.
The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is most commonly implanted under general anesthesia (GA) due to the intraoperative discomfort associated with tunneling and dissection. Postoperative pain can be substantial, and is often managed with opioids.
Selected 2019 Highlights in Congenital Cardiac Anesthesia Ross, Faith J.; Vu, Eric L.; Fang, Zhe A. ...
Journal of cardiothoracic and vascular anesthesia,
August 2020, 2020-Aug, 2020-08-00, 20200801, Letnik:
34, Številka:
8
Journal Article
Recenzirano
This article is a review of the highlights of pertinent literature published in 2019, which is of interest to the pediatric cardiac anesthesiologist. After a search of the United States National ...Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2019. The authors of this manuscript considered the following topics noteworthy and were included in this review: advances in pediatric heart transplantation, blood management in pediatric cardiac surgery, the impact of nutrition on outcomes in congenital heart surgery, and the use of vasopressin in patients after Fontan palliation.
Glycine transporter 1 (GlyT1) plays a crucial role in regulating extracellular glycine concentrations and might thereby constitute a new drug target for the modulation of glycinergic inhibition in ...pain signaling. Consistent with this view, inhibition of GlyT1 has been found to induce antinociceptive effects in various animal pain models. We have shown previously that the lidocaine metabolite N-ethylglycine (EG) reduces GlyT1-dependent glycine uptake by functioning as an artificial substrate for this transporter. Here, we show that EG is specific for GlyT1 and that in rodent models of inflammatory and neuropathic pain, systemic treatment with EG results in an efficient amelioration of hyperalgesia and allodynia without affecting acute pain. There was no effect on motor coordination or the development of inflammatory edema. No adverse neurological effects were observed after repeated high-dose application of EG. EG concentrations both in blood and spinal fluid correlated with an increase of glycine concentration in spinal fluid. The time courses of the EG and glycine concentrations corresponded well with the antinociceptive effect. Additionally, we found that EG reduced the increase in neuronal firing of wide-dynamic-range neurons caused by inflammatory pain induction. These findings suggest that systemically applied lidocaine exerts antihyperalgesic effects through its metabolite EG in vivo, by enhancing spinal inhibition of pain processing through GlyT1 modulation and subsequent increase of glycine concentrations at glycinergic inhibitory synapses. EG and other substrates of GlyT1, therefore, may be a useful therapeutic agent in chronic pain states involving spinal disinhibition.
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Three-dimensional rods form an integral part of the microstructure in materials with high applicability like eutectoid composites. Morphological evolution of the these rods, governed ...by its inherent difference in the curvature, is analysed by employing a thermodynamically consistent phase-field model in this work. Similar to the study of 2D plate-like structures, an analytical approach is extended to comprehend the kinetics of this volume-diffusion governed transformation. Despite the agreement of the theoretical treatment with the 2D simulations, the onset of contra-diffusion, a behaviour which has been shown to be absent in two-dimension, introduces a progressive deviation from the expected kinetics. However, a simplified relation between the time-taken for the spheroidization ττ′ and the aspect-ratio of the ‘capped’ rod wtp is attained from the outcomes of the phase-field simulation, which is expressed as ττ′≈5.8wtp2. The phase-field study is further extended to analytically ill-posed but physically observed ‘uncapped’ and ‘faceted’ rods, to understand the mechanism of its transformation and subsequently, analytical expressions are obtained to predict the transformation kinetics of these rods. Moreover, it is uncovered that irrespective of the initial configuration of the rod (faceted or otherwise), capped rods form an intrinsic part of the morphological evolution.
In complete agreement with the experimental observations, present study determines the critical aspect-ratio wtp=8, above which the spheroidization involves the breaking-up of the rods (‘ovulation’). The formation of ‘satellite’ particle(s) which introduces coarsening into the morphological evolution of the rods is also analysed. Furthermore, it is identified that the distance between the spheroids (ds), after ovulation and coarsening, follows a definite relation proportional to the height of the rod (w), given by ds≈0.0143w1.71.
The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, ...the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes.
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