New frontiers in aortic therapy: focus on current trials and devices in transcatheter aortic valve replacement.

The first decade of clinical experience with transcatheter aortic valve replacement since 2002 saw the development of 2 main valve systems, namely the Edwards Sapien balloon-expandable valve series and the Medtronic self-expanding CoreValve. These 2 valve platforms now have achieved commercial approval and application worldwide in patients with severe aortic stenosis whose perioperative risk for surgical intervention is high or extreme. In the second decade of transcatheter aortic valve replacement, clinical experience and refinements in valve design have resulted in clinical drift towards lower patient risk cohorts.

Postoperative amnesia in a patient undergoing general anesthesia for electro-physiologic (EP) catheter ablation of an irritable atrial focus.

This case report describes the anesthetic management of a 67-year-old who underwent a catheter based pulmonary vein isolation (PVI) of long-standing, persistent atrial fibrillation. When the patient awoke from the 6.5 hour procedure, he was found to have a transient retrograde and anterograde amnesia that persisted for 18-24 hours postoperatively.

Perioperative conduction disturbances after transcatheter aortic valve replacement.

Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population.

Major themes for 2012 in cardiovascular anesthesia and intensive care.

There was major progress through 2012 in cardiovascular anesthesia and intensive care. Although recent meta-analysis has supported prophylactic steroid therapy in adult cardiac surgery, a large Dutch multicenter trial found no outcome advantage with dexamethasone. A second large randomized trial is currently testing the outcome effects of methyprednisolone in this setting.

The year in cardiothoracic and vascular anesthesia: selected highlights from 2012.

Cardiothoracic and vascular critical care has emerged as a subspecialty due to procedural breakthroughs, an aging population, and a multidisciplinary collaboration. This subspecialty now has a dedicated professional society, recently published guidelines, and plans for standardized certification. This paradigm shift represents a major collaboration opportunity for our specialty.

Challenges after the first decade of transcatheter aortic valve replacement: focus on vascular complications, stroke, and paravalvular leak.

Transcatheter aortic valve replacement (TAVR) is entering its second decade. Three major clinical challenges have emerged from the first decade of experience: vascular complications, stroke, and paravalvular leak (PVL). Major vascular complications remain common and independently predict major bleeding, transfusion, renal failure, and mortality.

Manual vacuum aspiration for first-trimester abortion.

Objective: To assess the safety and effectiveness of manual vacuum aspiration for abortion in a primary care office setting.

Design: Retrospective chart audit.

Setting: Private family practice office.

Elevated plasma atrial natriuretic factor and vasopressin in high-altitude pulmonary edema.

A diagnosis of acute high-altitude pulmonary edema was made in five male skiers (age, 35.0 +/- 1.8 years) by history and physical examination and was confirmed by a characteristic chest radiogram showing alveolar infiltrates associated with a normal cardiac silhouette.

Birth control failure.

Birth control failure usually results from the incorrect or inconsistent use of contraceptives. By providing anticipatory counseling, based on an understanding of the reasons for birth control failure, family physicians can help curtail the current epidemic of unwanted pregnancies.

High-altitude pulmonary edema in Vail, Colorado, 1975-1982.

Between 1975 and 1982 a total of 47 cases of high-altitude pulmonary edema occurred in Vail, Colorado, elevation 2,500 m (8,200 ft). All occurred in visitors from lower altitudes. The mean age of the patients was 35.

Birth control failure among patients with unwanted pregnancies: 1982-1984.

Three hundred twenty-three patients who underwent abortion counseling between 1982 and 1984 were interviewed to determine the cause of birth control failure. Twenty-three percent employed no birth control and 27 percent used diaphragms, the majority either inconsistently or incorrectly. Twenty-two percent of the pregnancies were due to oral contraceptive-related failures; and the remainder were due to spermicide, condom, rhythm method, multiple method, and intrauterine device failures.

Analysis of a rural family-practice-based evening clinic staffed by a PA.

A family practice in rural Breckenridge, Colorado began an evening clinic during the winter months of 1981-82 to serve the extra 1,000 to 2,000 residents that that community accommodated each year during the ski season. The clinic was staffed by a PA, who was aided by an office assistant, on weekdays from 5 P.M.

High-altitude pulmonary edema among visitors to Summit County, Colorado.

Twenty-nine cases of high-altitude pulmonary edema (HAPE) affecting visitors to Summit County, Colorado, were analyzed. The mean age of the group was 37.8 years, and all the patients were male.

Medical Problems in Alpine Sliding.

In brief: Very few injuries resulted from use of the Breckenridge Alpine Slide from 1979 through 1982. Virtually all injuries resulted from sleds sliding out of their troughs or from one sled colliding with another. One patient sustained a fracture of two lumbar transverse processes and a renal contusion when she was hit from behind by a sled, and another patient developed a severe allergic reaction 30 minutes after sustaining an abrasion from rubbing against the slide trough.

Unique aspects of downhill ski injuries part 2: diagnosis and acute management of specific injuries.

As in many sports, a wide spectrum of injuries is seen in skiing (Table 1). This includes injuries to the upper and lower extremities as well as miscellaneous injuries and medical problems (frostbite, hypothermia, and high altitude effects). Six relatively unique injuries in skiing will be presented in detail.

Unique aspects of downhill ski injuries part 1: epidemiology and equipment.

Skiing is an exciting sport with a significant potential /or serious injury. This potential for injury can be minimized but never entirely eliminated by modern safety equipment.Upper extremity injuries have become relatively more common as the incidence of lower extremity injuries has decreased.