Protecting the spinal cord during thoracic endovascular aortic repair-who should place the spinal drain?

A well-placed and functioning lumbar spinal drain, for spinal cord protection, is an important aspect of the perioperative care of patients undergoing thoracic endovascular aortic repair (TEVAR) procedures. Spinal cord injury (SCI) is a devastating complication of TEVAR procedures and is most often associated with Crawford type 2 repairs. Current evidence-based guidelines for the surgical management of patients with thoracic aortic disease include the role of lumbar spine catheter placement and drainage of cerebrospinal fluid (CSF) intraoperatively as part of a strategy to prevent spinal cord ischemia.

Cardiogenic and septic shock associated with aortic and mitral valve infective endocarditis caused by from a urinary tract infection.

, also known as nutritionally variant streptococcus, is part of the normal flora of the oral cavity and urogenital and intestinal tracts and is a rare cause of infective endocarditis. It is fastidious or difficult to culture and associated with high rates of septic embolization, treatment failure and mortality. We describe an unusual presentation of infective endocarditis with severe mitral valve regurgitation due to in an immunocompetent patient.

Prolonged circulatory support with an Impella assist device in the management of cardiogenic shock associated with takotsubo syndrome, severe sepsis and acute respiratory distress syndrome.

Severe sepsis has been known to trigger for takotsubo syndrome which is associated with profound physical or emotional stress. Severe sepsis is also associated with sepsis-induced cardiomyopathy, a reversible myocardial depression. We report a case in which a patient with takotsubo syndrome, cardiogenic shock, severe sepsis, and adult respiratory distress syndrome was managed with an Impella Cardiac Power circulatory support device for 108 h (4.

Developing Modules to Train Anesthesiology Residents & Medical Students in a Lung Isolation Technique.

Background: One-lung ventilation (OLV) can be accomplished by using ether a double-lumen endotracheal tube (DLT) or a bronchial blocker. Patient factors, surgical requirements and the anesthesiologist's expertise influence technique choice. Bronchial blockers are in general less traumatic, safer to place, and suitable in a wider variety of scenarios than DLTs, but require greater technical skill.