Influence of Practitioner Dashboard Feedback on Anesthetic Greenhouse Gas Emissions: A Prospective Performance Improvement Investigation.

Anesthetic gases contribute to global warming. We described a two-year performance improvement project to examine the association of individualized provider dashboard feedback of anesthetic gas carbon dioxide equivalent (CDE) production and median perioperative fresh gas flows (FGF) during general anesthetics during perioperative management. Using a custom structured query language (SQL) query, hourly CDE for each anesthetic gas and median FGF were determined.

Reversal of Total Artificial Heart Mechanical Valve Thrombosis Using Catheter-Directed Thrombolysis.

Total artificial heart is associated with increased incidence of thromboembolism, which can prove to be fatal. The presence of four metallic tilting discs increases the chances of thrombus formation and sudden obstruction of the valve in a closed position resulting in severe hemodynamic collapse. Such a condition is conventionally treated by a surgical approach for device change; however, this procedure is extremely high risk and associated with complications and poor outcomes.

Finding a proper "Mate": Comparison of left ventricular assist devices using cerebral oximetry.

Introduction: Axial-flow and centrifugal-flow left ventricular assist devices (LVAD) have been utilized in the management of heart failure, but it remains unknown whether these devices differ in end-organ perfusion. Our goal was to evaluate the association between device type and regional cerebral oxygen saturation (rSO), and determine if this confers any benefit in short-term postoperative outcomes.

Methods: Adult patients who underwent primary LVAD implantation at our institution from 2014 to 2019 were retrospectively analyzed.

Optimizing cerebral oxygenation in cardiac surgery: A randomized controlled trial examining neurocognitive and perioperative outcomes.

Objective: The study objective was to determine whether targeted therapy to optimize cerebral oxygenation is associated with improved neurocognitive and perioperative outcomes.

Methods: In a prospective trial, intraoperative cerebral oximetry monitoring using bilateral forehead probes was performed in cardiac surgical patients who were randomly assigned to an intervention group in which episodes of cerebral oxygen desaturation (<60% for >60 consecutive seconds at either probe) triggered an intervention protocol or a control group in which the cerebral oximetry data were hidden from the clinical team, and no intervention protocol was applied. Cognitive testing was performed preoperatively and at postoperative months 3 and 6; domains studied were response speed, processing speed, attention, and memory.

ASA physical status assignment by non-anesthesia providers: Do surgeons consistently downgrade the ASA score preoperatively?

Objective: The American Society of Anesthesiologists physical status (ASA-PS) is associated with increased morbidity and mortality in the perioperative period. When surgeries are scheduled by surgeons and their staff at our large institution a presumed ASA-PS is chosen. This is because our institution (and, anecdotally, others in our hospital system and elsewhere), recognizing the relationship between higher ASA-PS and poorer postoperative outcomes, requires all patients with higher ASA-PS levels (≥3) to undergo enhanced preoperative workup.

Heparin-Induced Thrombocytopenia: A Comprehensive Clinical Review.

Heparin-induced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. In this comprehensive review, the authors highlight heparin-induced thrombocytopenia's risk factors, clinical presentation, pathophysiology, diagnostic principles, and treatment. The authors place special emphasis on the management of patients requiring procedures using cardiopulmonary bypass or interventions in the catheterization laboratory.

Challenges in the perioperative management of the patient receiving extended-release naltrexone.

Patients receiving extended-release (XR) naltrexone who are having surgery present unique challenges to anesthesia providers, the most obvious of which is an altered response to the effects of opioid agonists. Based on the timing of the last XR naltrexone dose, patients may be refractory to the effects of opioid agonists or potentially more sensitive to dangerous side effects due to receptor upregulation and hypersensitivity. Complicating matters, redosing XR naltrexone soon after opioid use may precipitate opioid withdrawal.

Use of real-time three-dimensional transesophageal echocardiography in type A aortic dissections: advantages of 3D TEE illustrated in three cases.

Stanford type A aortic dissections often present to the hospital requiring emergent surgical intervention. Initial diagnosis is usually made by computed tomography; however transesophageal echocardiography (TEE) can further characterize aortic dissections with specific advantages: It may be performed on an unstable patient, it can be used intra-operatively, and it has the ability to provide continuous real-time information. Three-dimensional (3D) TEE has become more accessible over recent years allowing it to serve as an additional tool in the operating room.

Avoiding ECMO in a patient with "pump" lung post-cardiopulmonary bypass.

As newer anesthesia ventilators are developed their capabilities are becoming more similar to intensive care unit (ICU) ventilators. However, in situations where there is severe decrease in lung compliance, an ICU ventilator may be superior in its ability to regulate inspiratory flow improving both ventilation and oxygenation. We present a case where an ICU ventilator was brought to the operating room and used in the treatment of ARDS post-cardiopulmonary bypass and ultimately allowed us to avoid extracorporeal membrane oxygenation (ECMO) therapy.

Exposure to childhood infections and risk of Epstein-Barr virus--defined Hodgkin's lymphoma in women.

The role of Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) etiology remains unresolved as EBV is detected in only some HL tumors and few studies have tried to reconcile its presence with factors suggesting viral etiology (e.g., childhood social class, infection history).