Assessment of Resident Performance During the Cardiac Anesthesia Rotation: Application of the House Officer Clinical Assessment in Cardiac Anesthesiology.

Objective: The assessment of clinical skills was created that evaluates House Officer performance within 13 clinical domains during the Cardiac Anesthesiology rotation to provide an assessment and evaluation process for residents while performing a cardiac anesthetic.

Design: A retrospective evaluation of performance assessments over a 33-month period.

Setting: University hospital-based Accreditation Council for Graduate Medical Education accredited Residency Training program.

Pulmonary Artery Stenosis in a Patient with Prior Histoplasmosis and the Discovery of Complications.

Pulmonary hypertension (PH) results from varied etiologies, leading to progressive symptoms and limiting physical activity and quality of life, with associated morbidity and mortality. External compression of the pulmonary artery (PA) is a rare cause of PH and may give the clinician cause to investigate compression of nearby structures. In this E-Challenge, the authors present a case of PA stenosis in a patient with prior histoplasmosis scheduled for left PA stenting.

Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: a retrospective analysis.

Background: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.

Financial Considerations of an Anesthesia Consult Service.

Surgical patients with complex cardiac disease often require noncardiac surgery. There have been recent articles written concerning the role of the cardiothoracic anesthesiologist as a consultant in the operating room as well as outside the operating theatre. With the evolution of the cardiothoracic anesthesia consult service (CACS), there are many issues regarding medical billing, financial reimbursement, and Medicare rules that anesthesiologists may not be familiar with.

The Implementation of a Preoperative Transthoracic Echocardiography Consult Service by Anesthesiologists.

We describe a preoperative transthoracic echocardiography consult service led by anesthesiologists. The implementation process and the patient cohort are described. Preoperative transthoracic echocardiographic examinations were mostly performed in patients undergoing intermediate- or high-risk noncardiac surgery and in patients with a higher calculated mortality risk.

Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting.

Background: Perioperative evaluation of right ventricular (RV) systolic function is important to follow intraoperative changes, but it is often not possible to assess with transthoracic echocardiographic (TTE) imaging, because of surgical field constraints. Echocardiographic RV quantification is most commonly performed using tricuspid annular plane systolic excursion (TAPSE), but it is not clear whether this method works with transesophageal echocardiographic (TEE) imaging. This study was performed to evaluate the relationship between TTE and TEE TAPSE distances measured with M-mode imaging and in comparison with speckle-tracking TTE and TEE measurements.

Liver Transplantation: Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events.

Objective: The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies.

Design: Data were collected retrospectively from the electronic medical record and institutional echocardiography database.

Echocardiography-based hemodynamic management of left ventricular diastolic dysfunction: a feasibility and safety study.

Background: Patients with left ventricular diastolic dysfunction (LVDD) are at increased risk of postoperative adverse events. The primary aim of this study was to evaluate the safety and feasibility of using echocardiography-guided hemodynamic management (EGHEM) during surgery in subjects with LVDD compared to conventional management. The feasibility of using echocardiography to direct a treatment algorithm and clinical outcomes were compared for safety between groups.

Use of rapid "rescue" perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients.

Objective: To investigate if modified "rescue" echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery.

Design: A retrospective analysis of the medical data.

Setting: Perioperative setting at a single academic medical center.