In prebypass imaging the midesophageal 5 chamber view with color Doppler demonstrated a bullet in the aortic root and absence of aortic valve regurgitation. With simultaneous orthogonal imaging the bullet was localized to the non-coronary sinus of Valsalva within the aortic valve. An eccentric mitral regurgitation jet was found in the anterior leaflet of the mitral valve in the midesophageal long axis view. RCC= Right coronary cusp of the aortic valve. LCC= Left coronary cusp of the aortic valve....
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Post-bypass images of the ME 4C view showed no gross abnormality. The midesophageal long axis view demonstrated trace central mitral regurgitation after repair, no residual aortic regurgitation, and an intact aortic root. A2= Middle scallop of the anterior leaflet of the mitral valve. P2= Middle scallop of the posterior leaflet of the mitral valve. AV= Aortic Valve.
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Tranexamic acid reduces blood loss and transfusion requirements with no significant thrombotic adverse effects. Postoperative seizures have been seen in cardiac surgical patients in association with patient (advanced age, underlying neurologic disease, chronic kidney disease); surgical (open cardiac procedures, long bypass times); and drug (high tranexamic acid dose) risk factors. Tranexamic acid dosing regimens should be decreased in patients with chronic kidney dysfunction secondary to reduced...
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The aim of this study was to investigate the influence of xenon-based anesthesia on somatosensory-evoked potentials.
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Acute Kidney Injury (AKI) is an important complication after cardiac surgery and increases the morbidity and mortality of patients while increasing health care costs.1 AKI occurs in up to 30% of patients undergoing cardiac surgery, and dialysis is necessary in 1% to 2%.2 Preoperative risk factors for AKI in these patients include age, diabetes, anemia, renal insufficiency, contrast exposure, atrial fibrillation, and lower ejection fraction. Intraoperative factors include cardiopulmonary bypass (CPB)...
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Three-dimensional printing is increasingly used in the health care industry. Making patient-specific anatomic task trainers has been one of the more commonly described uses of this technique specifically, allowing surgeons to perform complex procedures on patient-specific models in a nonoperative setting. With regard to transesophageal echocardiography (TEE) training, commercially available simulators have been increasingly used. Even though these simulators are haptic in nature and anatomically...
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PATIENTS UNDERGOING cardiac surgery are at risk for cardiovascular collapse from a variety of pathologies including, but not limited to, hemorrhage, tamponade, myocardial infarction, arrhythmias, or cardiogenic shock. Tension pneumothorax is a rare complication after cardiac surgery and requires prompt recognition and treatment. The subsequent case report describes an occurrence of tension pneumothorax and hemodynamic instability after the use of an airway exchange catheter (AEC) to extubate and...
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THE RECENT publication of The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy by Borger et al.1 is the most comprehensive to date after several other publications.2-5 We aim to provide a short synopsis of these guidelines with a particular focus on the potential implications for cardiothoracic anesthesiologists and the perioperative echocardiographers.
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THE MICRO RNAs (miR) are small, endogenous, noncoding RNAs functioning as “molecular switches,” regulating the gene expression. They have surfaced as the central mediators of cellular proliferation, differentiation, and apoptosis. The ubiquitous involvement of miR in biological processes, tissue-specific expression, and biostability has evoked interest in their diagnostic and therapeutic potential across a wide range of pathophysiological states encountered in perioperative and critical care medicine.
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As treatments for hematologic malignancies continue to advance, many patients with active disease and many more in remission will present for cardiac surgical procedures. Radiation and chemotherapeutic therapies for hematologic malignancies often result in cardiopulmonary injury. Evidence demonstrates that patients with hematologic malignancies undergoing cardiac surgery are at risk for perioperative adverse events, including bleeding, clotting, infection, and immunomodulation. However, short- and...
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Many patients with advanced cancer experience aggressive care during the end-of-life. Several studies have evaluated the benefits of palliative care (PC) on the reduction of aggressive measures; however, limited data are available about their benefit in Brazilian patients. (Source: Journal of Pain and Symptom Management)
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Little attention has been given to social environmental factors associated with advance care planning (ACP) among African Americans or persons living with advanced Human Immunodeficiency Virus (PLHIVs). (Source: Journal of Pain and Symptom Management)
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Dysphagia is usually associated with malignancies of the head, neck, and upper gastrointestinal tract, but also occurs in those with tumours outside anatomic swallow regions. It can lead to aspiration pneumonia, malnutrition, reduced quality of life, and psychosocial distress. No studies have yet reliably described dysphagia prevalence in those with malignancies outside anatomic swallow regions. (Source: Journal of Pain and Symptom Management)
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In order to dramatically advance the evidence base for pediatric palliative care (PPC) interventions, practices, and programs in the United States and similar practice settings, the field needs to better understand the challenges and opportunities for rigorous scholarship. (Source: Journal of Pain and Symptom Management)
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PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pcfacs@aahpm.org. (Source: Journal of Pain and Symptom Management)
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Few randomized controlled trials of advance care planning with a decision aid (DA) show an effect on patient preferences for end-of-life (EOL) care over time, especially in racial/ethnic settings outside the United States. (Source: Journal of Pain and Symptom Management)
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We sought to increase intensive care unit-family meeting (ICU-FM) documentation in the electronic health record in Veterans Affairs (VA) hospitals. (Source: Journal of Pain and Symptom Management)
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Individuals with Cystic Fibrosis (CF) frequently survive into adulthood and many have multi-faceted symptoms that impair quality of life. (Source: Journal of Pain and Symptom Management)
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Understanding the magnitude and risk-factors for symptom burden of cancer patients at the end-of-life is critical to guiding effective patient- and system-level interventions. (Source: Journal of Pain and Symptom Management)
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Clinicians deciding whether to refer a patient or family to specialty palliative care report facing high levels of uncertainty. Most research on medical uncertainty has focused on prognostic uncertainty. As part of a pediatric palliative referral intervention for oncology teams we explored how uncertainty might influence palliative care referrals. (Source: Journal of Pain and Symptom Management)
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Palliative care is rarely accessible in low- and middle-income countries, and lack of adequate training for healthcare providers is a key reason. In Vietnam, the Ministry of Health, major hospitals and medical universities, and foreign physician-educators have partnered to initiate palliative care training for physicians. (Source: Journal of Pain and Symptom Management)
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Many hospitalized patients receive care that is not concordant with their goals. Teaching communication skills that better align goals and treatment can improve the care that patients receive. (Source: Journal of Pain and Symptom Management)
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Breast cancer morbidity and mortality disproportionately affect medically underserved women. Most studies of the experience of living with advanced breast cancer do not focus on this population. A deeper understanding of racial/ethnic minorities ’ and low-income patients’ experiences is needed to reduce breast cancer health and healthcare disparities. (Source: Journal of Pain and Symptom Management)
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We write to express our appreciation for the many tributaries of care and concern around pediatric palliative care research that are reflected in the paper Challenges and Priorities for Pediatric Palliative Care Research (submitted for publication by Drs. Chris Feudtner and Joanne Wolfe – July 2019). We are caregivers whose children and families have been the beneficiaries of pediatric palliative care, and we are dedicated to building awareness of its critical value in our roles as staff and parent...
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Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritised for urgent palliative care? (Source: Journal of Pain and Symptom Management)
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Patients with end-stage renal disease (ESRD) undergoing dialysis experience multiple concurrent symptoms. These symptoms cluster together and have negative impacts on patient outcomes. However, information on changes in symptom clusters over time is limited. (Source: Journal of Pain and Symptom Management)
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Researchers, hospices, and government agencies administer standardized questionnaires to caregivers for assessing end-of-life care quality. Caregiving experiences may influence end-of-life care quality reports, which have implications for caregiver outcomes, and are a clinical and policy priority. (Source: Journal of Pain and Symptom Management)
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Communication, especially delivery of difficult news, remains a key part of clinical practice. Fallowfield defined difficult news as “any information that produces a negative alteration to a person’s expectations about their present and future”.1 However, despite its importance, many medical providers lack the skill and ability to effectively deliver difficult news to their patients. A recent study done in Poland, found tha t less than 47% of patients are content with how difficult news is delivered...
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Palliative care (PC) is associated with increased quality of life for individuals with life-limiting illnesses. Despite growing recognition of the need for public advocacy and involvement, data on public perception of PC is limited. We sought to examine patterns of beliefs, socio-demographic differences, and the impact of information source on perceptions of PC. (Source: Journal of Pain and Symptom Management)
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There is a need for brief measurement instruments that do not cause burden to hospice caregivers. The Caregiver Quality of Life Index (CQLI) has been used in several studies, but assessment of its psychometric properties has been minimal. The CQLI-R (revised) instrument was found to have equivalent properties but also has had minimal testing in small samples. (Source: Journal of Pain and Symptom Management)
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