Cesarean Section in a Group 1 Pulmonary Hypertension Parturient Patient: A Case Report.

Severe pulmonary hypertension (PH) during pregnancy poses considerable challenges due to the physiological changes and increased cardiovascular demands. Close multidisciplinary management is essential throughout the peripartum period. The critical steps taken to provide anesthesia safely and successfully for a planned cesarian section are outlined, with special care for communication between the cardiothoracic surgery and obstetric team.

Central Versus Peripheral Invasive Arterial Blood Pressure Monitoring in Liver Transplant Surgery.

Introduction Invasive blood pressure monitoring is essential in liver transplant surgery due to expected major hemodynamic shifts. The use of central versus peripheral arterial access, however, is institution-dependent, which can affect clinical decisions regarding vasopressor therapy. Although there are studies that demonstrate inconsistencies based on arterial cannulation sites, few studies have compared femoral and radial artery blood pressures in patients undergoing liver transplant surgery.

Prominent Eustachian Valve Mimicking Inferior Rim of Atrial Septum Causing Iatrogenic Inferior Vena Cava Type Sinus Venosus Atrial Septal Defect.

The Eustachian valve is an embryologic remnant at the junction of the inferior vena cava (IVC) and right atrium (RA). While it typically does not have any pathologic significance, veno-arterial shunting can rarely occur in patients with prominent eustachian valves and atrial septal defects (ASD), causing cyanosis and hypoxemia despite normal pulmonary pressures. We present a case of a patient with iatrogenic residual sinus venosus IVC-type ASD secondary to a prominent Eustachian valve that was misinterpreted as the inferior rim of the atrial septum during initial ASD repair.

Real-time echocardiographic guidance for confirming septal placement of right ventricular leads: A pilot study.

Introduction: Accuracy of fluoroscopy in predicting septal placement of the right ventricular (RV) leads is poor. This pilot study evaluated the feasibility and impact of real-time transthoracic echocardiogram (TTE) during RV lead placement.

Method: Consecutive patients undergoing transvenous RV lead placement and had a point of care ultrasound team available for TTE guidance were included in the study.

Anesthetic Management for Inclusion Body Myositis in Coronary Artery Bypass Graft Surgery.

Anesthetic management for patients with certain neuromuscular disorders may be challenging due to contraindications to triggering agents secondary to increased susceptibility for malignant hyperthermia (MH). Inclusion body myositis (IBM) is an inflammatory muscle disease that causes concern for the anesthesiologist due to potential respiratory muscle weakness and hyperkalemia with succinylcholine. Elevated serum creatinine kinase levels found in IBM also raise the possibility of increased susceptibility to MH.

Drug Infusion Systems: Technologies, Performance, and Pitfalls.

This review aims to broadly describe drug infusion technologies and raise subtle but important issues arising from infusion therapy that can potentially lead to patient instability and morbidity. Advantages and disadvantages of gravity-dependent drug infusion are described and compared with electromechanical approaches for precise control of medication infusion, including large-volume peristaltic and syringe pumps. This review discusses how drugs and inert carriers interact within infusion systems and outlines several complexities and potential sources of drug error.