Obesity and anesthesia.

Purpose Of Review: Surgical procedures on obese patients are dramatically increasing worldwide over the past few years. In this review, we discuss the physiopathology of predominantly respiratory system in obese patients, the importance of preoperative evaluation, preoxygenation and intraoperative positive end expiratory pressure (PEEP) titration to prevent pulmonary complications and the optimization of airway management and oxygenation to reduce or prevent postoperative respiratory complications.

Recent Findings: Many patients are coming to preoperative clinic with medication history of glucagon-like-peptide 1 agonists ( GLP-1) agonists and it has raised many questions regarding Nil Per Os (NPO)/perioperative fasting guidelines due to delayed gastric emptying caused by these medications.

Ability of a Polyphenol-Rich Nutraceutical to Reduce Central Nervous System Lipid Peroxidation by Analysis of Oxylipins in Urine: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Isoprostanes (IsoPs) are lipid peroxidation biomarkers that reveal the oxidative status of the organism without specifying which organs or tissues it occurs in. Similar compounds have recently been identified that can assess central nervous system (CNS) lipid peroxidation status, usually oxidated by reactive oxygen species. These compounds are the neuroprostanes (NeuroPs) derived from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the F-dihomo-isoprotanes derived from adrenic acid (AdA).

Efficacy of proning in acute respiratory distress syndrome on extracorporeal membrane oxygenation.

Objectives: Proning patients with acute respiratory distress syndrome (ARDS) has been associated with increased survival, although few data exist evaluating the safety and feasibility of proning patients with ARDS on extracorporeal membrane oxygenation (ECMO).

Methods: A single-institution retrospective review of all patients with ARDS placed on ECMO between March 1 and May 31, 2020, was performed. All proning events were evaluated for complications, as well as change in compliance, sweep, oxygenation, and flow.

Pre-transplant immune cell function assay as a predictor of early cardiac allograft rejection.

Introduction: ImmuKnow, an immune cell function assay that quantifies overall immune system activity can assist in post-transplant immunosuppression adjustment. However, the utility of pre-transplant ImmuKnow results representing a patient's baseline immune system activity is unknown. This study sought to assess if pre-transplant ImmuKnow results are predictive of rejection at the time of first biopsy in our cardiac transplant population.

Assessing donor organ quality according to recipient characteristics in lung transplantation.

Objective: There is a shortage of donor lungs relative to need, but overall donor organ utilization remains low. The most common reason for refusal is organ quality, but the standards applied to selection vary. In this study we sought to characterize differences in lung utilization according to quality across several clinically distinct recipient pools.

One-Year Outcomes With Venovenous Extracorporeal Membrane Oxygenation Support for Severe COVID-19.

Background: Severe coronavirus disease 2019 (COVID-19) can cause acute respiratory failure requiring mechanical ventilation. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) has been used in patients in whom conventional mechanical ventilatory support has failed. To date, published data have focused on survival from ECMO and survival to discharge.

Early experience with donation after circulatory death heart transplantation using normothermic regional perfusion in the United States.

Objective: This pilot study sought to evaluate the feasibility of our donation after circulatory death (DCD) heart transplantation protocol using cardiopulmonary bypass (CPB) for normothermic regional reperfusion (NRP).

Methods: Suitable local DCD candidates were transferred to our institution. Life support was withdrawn in the operating room (OR).

Hemoadsorption for management of patients on veno-venous ECMO support for severe COVID-19 acute respiratory distress syndrome.

Background And Aim: Patients with severe coronavirus disease 2019 (COVID-19) develop a profound cytokine-mediated pro-inflammatory response. This study reports outcomes in 10 patients with COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO) who were selected for the emergency use of a hemoadsorption column integrated in the ECMO circuit.

Materials And Methods: Pre and posttreatment, clinical data, and inflammatory markers were assessed to determine the safety and feasibility of using this system and to evaluate the clinical effect.

Comparison of device-specific adverse event profiles between Impella platforms.

Background: The Impella (Abiomed) ventricular support system is a family of temporary mechanical circulatory support (MCS) devices used to treat patients with cardiogenic shock, acute cardiogenic decompensation, and for high-risk percutaneous or surgical revascularization. These devices include the percutaneously implanted 2.5/cardiac power (CP) and the surgically implanted 5.

A Simple Prioritization Change to Lung Transplant Allocation May Result in Improved Outcomes.

Background: The lung allocation score (LAS) significantly improved outcomes and wait list mortality in lung transplantation. However, mortality remains high for the sickest wait list candidates despite additional changes to allocation distance. Regulatory considerations of overhauling the current lung allocation system have met significant resistance, and changes would require years to implement.

Extracorporeal Membrane Oxygenation Support in Severe COVID-19.

Background: Coronavirus disease 2019 (COVID-19) remains a worldwide pandemic with a high mortality rate among patients requiring mechanical ventilation. The limited data that exist regarding the utility of extracorporeal membrane oxygenation (ECMO) in these critically ill patients show poor overall outcomes. This report describes our institutional practice regarding the application and management of ECMO support for patients with COVID-19 and reports promising early outcomes.

Ethical and logistical concerns for establishing NRP-cDCD heart transplantation in the United States.

Controlled heart donation after circulatory determination of death (cDCD) is well established internationally with good outcomes and could be adopted in the United States to increase heart supply if ethical and logistical challenges are comprehensively addressed. The most effective and resource-efficient method for mitigating warm ischemia after circulatory arrest is normothermic regional perfusion (NRP) in situ. This strategy requires restarting circulation after declaration of death according to circulatory criteria, which appears to challenge the legal circulatory death definition requiring irreversible cessation.

Is Exhaustion More Sensitive Than Disengagement to Burnout in Academic Anesthesia? A Study Using the Oldenburg Burnout Inventory.

Reportedly, clinicians of all kinds are experiencing alarming rates of burnout, and its prevalence among anesthesia providers is high. We examined burnout in a large academic anesthesia department with a commonly used questionnaire, the Oldenburg Burnout Inventory, which provides scores on two scales, "exhaustion" and "disengagement." We examined differences in scores between exhaustion and disengagement and their prevalences.

There Is Great Ignorance About the Brain Death Concept Among the Population in Santiago de Cuba (Cuba).

Introduction: The knowledge of the brain death (BD) concept is important when determining the attitude toward organ donation.

Objective: To analyze the level of knowledge of the BD concept among the population in Santiago de Cuba and determine the factors that condition it.

Methods: From the Collaborative International Donor Project, we obtained a sample of Cubans living in the area of Santiago de Cuba (n = 455).

Attitude Toward Organ Donation in the Population of Cienfuegos, Cuba.

Introduction: The sensitization of the population toward organ donation is fundamental; for that reason, it is important to determine the factors that condition the opinion toward donation on the population scope in order to carry out cost-effective campaigns.

Objective: To analyze the attitude toward the donation of the proper organs for transplantation among the population residing in Cienfuegos, Cuba.

Method: Population under study: Population who reside in Cienfuegos, Cuba.

Impact of concomitant mitral valve repair for severe mitral regurgitation at the time of continuous-flow left ventricular assist device insertion.

Objectives: Mitral regurgitation (MR) is common in patients with end-stage heart failure. We assessed the effect of performing concomitant mitral valve repair during continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with severe preoperative MR.

Methods: We performed a single-centre, retrospective review of all patients who underwent CF-LVAD implantation between December 1999 and December 2013 (n = 469).

The Stent Is Not to Blame: Lessons Learned With a Simplified US Version of the Frozen Elephant Trunk.

Background: We analyzed trends, assessed outcomes and lessons learned, and investigated whether using a simplified US version of the frozen elephant trunk (FET) technique to treat complex arch pathology poses additional risk.

Methods: From 2010 to 2015, we performed 129 consecutive ET procedures (traditional ET [t-ET], n = 92 [71.3%]; FET, n = 37 [28.

Homozygous Factor X gene mutations Gly380Arg and Tyr163delAT are associated with perinatal intracranial hemorrhage.

Intracranial hemorrhage (ICH) is a severe complication of Factor X (FX) deficiency. We report 6 homozygous patients with central nervous system (ICH) bleeds. Five patients are homozygous for the mutation Gly380Arg and one for the novel deletion Tyr163delAT.

Plasma homocysteine levels in renal transplanted patients on cyclosporine or tacrolimus therapy: effect of treatment with folic acid.

Hyperhomocysteinemia, an independent risk cardiovascular factor, has been reported in renal transplanted patients (RTP). The aim of the present study was to evaluate homocysteine levels in RTP treated with cyclosporine or tacrolimus, and the changes observed in the two groups of patients after treatment with folic acid. Forty-two RTP with stable function (21 treated with cyclosporine and 21 with tacrolimus, matched by gender and age) were studied.

Reconstruction after multilevel corpectomy in the cervical spine. A sagittal plane biomechanical study.

Study Design: An in vitro biomechanical study of reconstruction techniques used after multilevel cervical corpectomy.

Objectives: To determine the biomechanical behavior of the cervical spine after a multilevel corpectomy and reconstruction with a strut graft and supplementation of the graft with anterior and posterior plates.

Summary Of Background Data: Reconstruction of the spine after multilevel corpectomy represents a significant challenge, with nonunion or graft dislodgment being relatively common.