Publications by authors named "Skubas N"
Introduction: The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub-analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs.
View Article and Find Full Text PDFEfficacy of Drug-Coated Balloon Angioplasty in Pulmonary Vein Stenosis or Total Occlusion.
JACC Clin Electrophysiol
August 2024
Article Synopsis
- Current treatments for pulmonary vein stenosis (PVS) and total occlusion (PVTO) face challenges with high rates of restenosis, prompting a study on a new method.
- This study compares drug-coated balloon (DCB) angioplasty and stenting to traditional angioplasty and stenting, analyzing data from two patient groups over different time periods.
- Results show that the DCB method significantly lowers the chances of restenosis and need for additional procedures compared to standard care, highlighting its effectiveness and safety.
Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear.
Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy.
Article Synopsis
- Albumin is commonly used in various clinical settings for improving blood flow, fluid removal, and managing cirrhosis complications, leading to guidelines created by the International Collaboration for Transfusion Medicine.
- A dedicated panel, including researchers and a patient representative, developed these guidelines based on a systematic review of existing studies, resulting in 14 recommendations for adult and pediatric critical care, cardiovascular surgery, kidney therapy, and cirrhosis management.
- Most recommendations (12 out of 14) advised against widespread albumin usage in many scenarios, highlighting a lack of strong evidence, with only two recommendations suggesting conditional use in specific cirrhosis cases.
Middle aortic syndrome (MAS) is a rare disorder characterized by narrowing of the aorta. Depending on the location and extent of aortic narrowing, surgical management may be necessary to prevent long-term sequelae, such as stroke and congestive heart failure. We report a case of MAS and discuss the unique intraoperative anesthetic considerations including hemodynamic monitoring proximal and distal to the aortic narrowing, minimizing the risk of spinal cord ischemia, and utilization of intraoperative dobutamine stress testing to guide surgical management.
View Article and Find Full Text PDFBackground: Intravenous albumin is commonly utilised in cardiovascular surgery for priming of the cardiopulmonary bypass circuit, volume replacement, or both, although the evidence to support this practice is uncertain. The aim was to compare i.v.
View Article and Find Full Text PDFStudy Objective: Obesity, defined by the World Health Organization as body mass index (BMI) ≥ 30.0 kg/m, is associated with adverse outcomes and challenges during surgery. Difficulties during endotracheal intubation, occur in 3-8% of procedures and are among the principal causes of anesthetic-related morbidity and mortality.
View Article and Find Full Text PDFBackground: We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery.
Methods: We retrospectively examined adult patients undergoing elective or urgent cardiac surgery at the Cleveland Clinic between 2008 and 2019. The incidence of preincision cardiac arrest, defined as arrest between induction of general anesthesia and surgical incision, was reported.
Article Synopsis
- Monitored anesthesia care (MAC) is increasingly favored over general anesthesia (GA) for transcatheter aortic valve replacement (TAVR), reducing complications and improving efficiency.
- In a study involving 998 patients, those receiving MAC exhibited significantly shorter procedural and fluoroscopy times, lower contrast volume, and reduced radiation exposure, alongside quicker recovery times and higher discharge rates to home.
- While MAC showed lower 30-day mortality compared to GA, there were no significant differences in long-term mortality or major adverse cardiac events, indicating MAC’s safety and effectiveness with newer valve technologies.
Background: Transesophageal echocardiography can be a useful monitor during noncardiac surgery, in patients with comorbidities and/or undergoing procedures associated with substantial hemodynamic changes. The goal of this study was to investigate if transesophageal-echocardiography-related knowledge could be acquired during anesthesia residency.
Methods: After institutional review board approval, a prospective observational study was performed in two anesthesiology residency programs.
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount.
View Article and Find Full Text PDFMore anesthesiologists are routinely using transesophageal echocardiography (TEE) during liver transplant surgery, but the effects on patient outcome are unknown. Transplant anesthesiologists are therefore uncertain if they should undergo additional training and adopt TEE. In response to these clinical questions, the Society for the Advancement of Transplant Anesthesia appointed experts in liver transplantation and who are certified in TEE to evaluate all available published evidence on the topic.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to compare patient outcomes between those treated with inhaled epoprostenol (iEpo) and low tidal volume ventilation during cardiopulmonary bypass and those who did not receive the medication at all or only received it as a rescue therapy.
- A retrospective chart review involved 71 patients, predominantly male (78.9%), undergoing various cardiac procedures, revealing significant differences in postoperative complications between groups.
- Results showed that patients treated with iEpo had higher rates of open chest after surgery and longer mechanical ventilation duration compared to the control group, suggesting the use of iEpo as a preventive measure could lead to better outcomes than using it as a last resort.