Indications for the gasless transaxillary robotic approach to thyroid surgery: experience of forty-seven procedures at the american hospital of paris.

Background: Thyroid surgery is in a state of evolution from traditional open approaches to novel robotic techniques. The gasless transaxillary approach to thyroid surgery is effective in the management of thyroid cancer, and complications after robotic thyroidectomy are no higher than experienced after open or endoscopic techniques. The transaxillary robotic approach also avoids an anterior neck scar.

Anesthetic implications for robot-assisted transaxillary thyroid and parathyroid surgery: a report of twenty cases.

Gasless transaxillary robot-assisted endoscopic thyroid surgery has recently been proposed and developed in South Korea and the United States. Perianesthetic implications and their evolution for 20 patients scheduled to undergo this innovative surgical technique are presented. The anesthetic considerations focus on the length of surgery due to the learning curve, the risk of the ipsilateral arm posture, and postoperative pain evaluation and management.

Slow pathway elimination for atrioventricular nodal reentrant tachycardia with the 8-mm tip cryoablation catheter: an 18-month follow-up study.

Purpose: The 9-French 8-mm tip cryoablation catheter confers a high rate of acute slow pathway (SP) elimination and an acceptable short-term outcome in patients with atrioventricular nodal reentrant tachycardia (AVNRT). The aim of this study was to investigate the long-term outcome of patients treated with this electrode in this indication.

Methods: Eighty-two patients (female = 52) with a mean age of 54.

Reduction of procedure duration and radiation exposure with a dedicated inner lumen mapping catheter during pulmonary vein cryoablation.

Background: The Achieve catheter (AC; Medtronic-CryoCath, Pointe-Claire, Canada) is a circular mapping catheter introduced through the lumen of the cryoballoon (CB) catheter which is safe and effective to both navigate the CB to the pulmonary veins (PV) and allow PV potential recording during PV cryoablation. The aim of this study was to evaluate the impact of the use of the AC on procedural outcomes.

Methods: Sixteen consecutive patients (14 men) underwent AC-guided PV isolation (PVI) for drug-refractory paroxysmal atrial fibrillation (AF; AC group).

Pulmonary vein isolation using a single size cryoballoon chosen according to transesophageal echocardiography information.

Background: Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter is a new technique for atrial fibrillation (AF) ablation. Previous studies used computer tomography (CT) or magnetic resonance imaging (MRI) scan to determine the pulmonary vein (PV) diameter and anatomy for choosing the CB size. We evaluated pre-ablation transoesophageal-echocardiography (TEE) as an alternative to CT/MRI scan in patients undergoing AF ablation for determining the appropriate size of the CB.

Comparative cardiac effects of terlipressin, vasopressin, and norepinephrine on an isolated perfused rabbit heart.

Background: Terlipressin, a synthetic analog of arginine-vasopressin (AVP), has been proposed as an effective vasopressive therapy in catecholamine-resistant vasodilatory shock. Although beneficial effects of terlipressin on systemic arterial pressure have been clearly demonstrated, its intrinsic effects on coronary circulation and myocardial performances remain unknown.

Methods: The authors compared the coronary and myocardial effects of terlipressin (1-100 nM, n = 10), AVP (10-1000 pM, n = 10), and norepinephrine (1-100 nM, n = 10) on an erythrocyte-perfused isolated rabbit heart.

Routine use of bilateral skeletonized internal thoracic artery grafts in middle-aged diabetic patients.

Background: The purpose of this study was to determine whether middle-aged diabetic patients aged less than 70 years could have routine use of bilateral skeletonized internal thoracic artery grafting without an increased surgical risk.

Methods: Between January 1997 and December 2003, 712 consecutive patients aged less than 70 years underwent bilateral internal thoracic artery grafting. Among these, 164 were diabetic and underwent bilateral internal thoracic artery grafting without other preoperative selection than age.

Predictive performance and variability of the cardiac anesthesia risk evaluation score.

Background: The Cardiac Anesthesia Risk Evaluation (CARE) score, a simple Canadian classification for predicting outcome after cardiac surgery, was evaluated in 556 consecutive patients in Paris, France. The authors compared its performance to those of two multifactorial risk indexes (European System for Cardiac Operative Risk Evaluation [EuroSCORE] and Tu score) and tested its variability between groups of physicians (anesthesiologists, surgeons, and cardiologists).

Methods: Each patient was simultaneously assessed using the three scores by an attending anesthesiologist in the immediate preoperative period.

Remifentanil induces systemic arterial vasodilation in humans with a total artificial heart.

Background: To assess intrinsic vascular effects of remifentanil, increased concentrations were infused in critically ill patients with a total artificial heart.

Methods: In the early postoperative period after implantation of a total artificial heart, nine ventilated patients requiring short general anesthesia were included in this study. After anesthesia was induced with 0.

Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors.

Background: Terlipressin, a precursor that is metabolized to lysine-vasopressin, has been proposed as a drug for treatment of intraoperative arterial hypotension refractory to ephedrine in patients who have received long-term treatment with renin-angiotensin system inhibitors. The authors compared the effectiveness of terlipressin and norepinephrine to correct hypotension in these patients.

Methods: Among 42 patients scheduled for elective carotid endarterectomy, 20 had arterial hypotension following general anesthesia that was refractory to ephedrine.

Brachial plexus nerve block exhibits prolonged duration in the elderly.

Background: Upper limb trauma occurs frequently in elderly patients for whom peripheral nerve blocks are often preferred for anesthesia. The characteristics of such regional blocks have, however, never been described in an elderly population. Therefore, the authors assessed prospectively the onset and duration of upper extremity peripheral nerve block (the mid-humeral block) in elderly and young patients undergoing emergency upper extremity surgery.

Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery.

Objective: To evaluate the incidence and prognosis of a moderate increase in serum creatinine early after cardiac surgery.

Design: Retrospective clinical study.

Setting: Surgical intensive care unit in a university hospital.

Intraoperative diagnosis of an unsuspected left atrial myxoma by transesophageal echocardiography.

The authors report the intraoperative diagnosis using transesophageal echocardiography (TEE) of an unsuspected myxoma in a patient admitted for an acute occlusion of the aorta, resulting in emergency excision of the atrial tumor. This observation illustrates the usefulness of intraoperative TEE examination to identify life-threatening pathology.