Cardiac Anesthesia and Transesophageal Echocardiography

by Wasnick, John; Hillel, Zak; Kramer, David; Littwin, Sanford; Nicoara, Alina

• ISBN13: 9780071717984
• ISBN10: 0071717986
• Edition: 1st
• Format: Package
• Copyright: 2011-04-04
• Publisher: McGraw-Hill Education / Medical

Summary

A concise introduction for anesthesiologists new to the cardiac operating roomIncludes companion DVD with more than 100 video clips Cardiac Anesthesia and Transesophageal Echocardiographyprovides readers with clear, straightforward coverage of the essentials of preparing for a cardiac anesthesia case. The book incorporates numerous clinical scenarious to illustrate patient pathologies likely to happen during a cardiac case. Reflecting the fact that transesophageal echocardiography is a vital tool in cardiac anesthesiology, a companion DVD with echo images relating directly to each chapter in the book is included.Features Two-in-one coverage: cardiac anesthesia AND transesophageal echocardiology More than 100 video clips that refer back to the text Cases are presented in a quick-access, templated presentation

Table of Contents

Preface	p. ix
List of Contributors	p. xi
Introduction to Perioperative Echocardiography	p. 1
Preoperative Evaluation of the Heart Surgery Patient	p. 31
Heart Surgery Patients and Consent	p. 31
Cardiac Surgery and Gender	p. 32
Coronary Stents or Coronary Artery Bypass?	p. 33
Cardiology Evaluation	p. 34
Preoperative Assessment	p. 37
Preoperative Red Flags and What (if Anything) to do About Them	p. 39
Hemodynamics and Cardiac Anesthesia	p. 41
Hemodynamic Calculations and Invasive Monitors: Why Are They Important and How to Determine Them?	p. 41
The Pumping Heart: How Does the Pump Contract and Relax?	p. 53
Pharmacology and Hemodynamics: An Introduction	p. 59
TEE and Hemodynamic Instability: How TEE Advances the Diagnosis of Hypotension?	p. 62
Avoiding Hemodynamic Collapse: A Case Illustration	p. 66
Perioperative Rhythm Abnormalities	p. 70
The Electrocardiogram	p. 70
ECG Abnormalities	p. 71
Bradyarrhythmias	p. 72
Temporary Pacemaker	p. 75
Supraventricular Tachycardias	p. 77
Ventricular Tachycardia and Fibrillation	p. 79
TEE and the ECG	p. 80
Case Scenario	p. 80
Routine Cardiac Surgery and Anesthesia	p. 82
Immediate Preoperative Assessment and Antibiotic Prophylaxis	p. 83
Monitoring and Vascular Access	p. 84
Anesthetic Induction and Maintenance	p. 85
Institution of Cardiopulmonary Bypass	p. 88
Separation From CPB	p. 89
Sternal Closure and Patient Transport	p. 93
Commonly Used Vasoactive Drugs in the Cardiac Surgery Patient	p. 93
Case Illustration	p. 94
Summary	p. 95
The Complicated Patient for Cardiac Anesthesia and Surgery	p. 97
The Patient With Impaired Systolic and Diastolic Ventricular Function	p. 97
The Reoperative Patient	p. 112
The Diabetic Patient and Perioperative Glucose Control	p. 113
The Vascular Disease Patient in Need of Cardiac Surgery	p. 114
The Renal Failure Patient and Cardiac Surgery	p. 115
Aortic Valve Disease	p. 119
The Clinical Signs and Symptoms of AV Disease	p. 120
Physiologic Compensatory Mechanisms of AV Disease	p. 123
Echocardiography and AV Disease	p. 124
Surgical and Catheter-Mediated AV Replacement	p. 130
Anesthetic Implications of AV Disease	p. 132
Clinical Scenario: The Patient With Mixed AS/AR and the Emergency Institution of CPB	p. 134
Mitral Valve Disease	p. 136
The Clinical Signs and Symptoms of MV Diseases	p. 137
Physiologic Compensatory Mechanisms of MV Diseases	p. 139
Echocardiography and MV Diseases	p. 141
Surgical and Catheter-Mediated Approaches to the Repair/Replacement of the MV	p. 149
Surgical Approaches to the Management of Atrial Fibrillation	p. 150
Anesthetic Implications of MV Diseases	p. 151
Case Scenario	p. 153
Right Heart Valves and Function	p. 155
The Clinical Signs and Symptoms of TV Diseases	p. 155
RV Function	p. 156
The Pulmonic Valve	p. 157
Echocardiography of Right Heart Structures and Right Ventricular Function	p. 157
Surgical Approaches to TV Diseases	p. 160
Anesthetic Implications of TV Diseases, Pulmonary Hypertension, and RV Failure	p. 160
Case Scenario: The Patient With Endocarditis	p. 160
Anesthesia for Repair of Diseases of Thoracic Aorta	p. 162
Diseases of the Ascending Thoracic Aorta	p. 163
Diseases of the Descending Thoracic Aorta	p. 165
Anesthetic Management of the Patient With Disease of the Thoracic Aorta	p. 166
Distal Aortic Perfusion and Spinal Cord Protection During Descending Thoracic Aneurysm Resection	p. 168
Deep Hypothermic Circulatory Arrest	p. 171
Echocardiography in the Management of Thoracic Aortic Diseases	p. 171
Case Scenario	p. 172
Hypertrophic Obstructive Cardiomyopathy and Cardiac Masses	p. 175
Signs, Symptoms, and Diagnosis of HCM	p. 176
Pathology of HCM	p. 178
Medical Therapy for HCM	p. 179
Dynamic Obstruction of the LVOT	p. 180
Anesthetic Management of the HCM Patient for Noncardiac Surgery	p. 180
Anesthetic Management for Surgical Repair of HCM	p. 181
The Surgical Approach to HCM Repair	p. 182
Cardiac Masses	p. 184
Case Scenario: 22-Year-Old Man With Sudden Cardiac Death	p. 185
Ventricular Assist Devices and Heart Transplantation	p. 186
Intra-Aortic Balloon Counterpulsation and the Heart Surgery Patient	p. 187
Ventricular Assist Devices: Designs and Indications	p. 188
Short-Term VAD Placement	p. 189
Long-Term VAD Placement	p. 192
Anesthetic Management of VADs	p. 193
TEE and VADs	p. 194
Heart Transplantation	p. 195
Case Scenario	p. 196
Anesthesia for Patients With Congenital Heart Disease	p. 198
Atrial Septal Defects	p. 199
Ventricular Septal Defects	p. 202
Tetralogy of Fallot	p. 206
Transposition of the Great Arteries	p. 211
Single Ventricle Patients	p. 216
Anesthesia for Noncardiac Surgery in Adults With Congenital Heart Disease	p. 223
Cardiac Surgery and Pregnancy	p. 226
TEE and CHD	p. 227
Off-Pump, Robotic, and Minimally Invasive Heart Surgery	p. 229
Minimally Invasive Surgical Approaches	p. 229
Anesthetic Challenges for Off-Pump and Minimally Invasive Surgery	p. 232
Is Off-Pump Surgery Better Than On-Pump Surgery?	p. 234
Case Scenario	p. 235
The Postoperative Care of the Cardiac Surgery Patient	p. 237
Routine Transport and Report	p. 238
Inflammation and the Cardiac Surgery Patient	p. 239
Genetic Associations and Cardiac Surgery Outcomes	p. 240
Perioperative Neurologic Injury	p. 241
Respiratory Failure	p. 243
Renal Dysfunction	p. 244
ICU Hemodynamics	p. 245
Analgesia, Electrolytes, Glucose	p. 247
Echocardiography in the ICU	p. 247
Anesthesia in the Electrophysiology and Catheterization Laboratories	p. 251
Electrophysiology and Other Catheter-Based Procedures Overview	p. 251
EP Procedures	p. 253
Anesthetic Management of EP Procedures	p. 256
Risks and Complications of out-of-the-OR Cardiac Procedures	p. 259
Coagulopathy, Bleeding, and Cardiac Anesthesia Emergencies	p. 265
Hemostasis and Cardiac Surgery	p. 265
Prevention of Blood Loss During Cardiac Surgery	p. 269
When to Transfuse	p. 269
Outcomes Following Transfusion	p. 270
Massive Transfusion and Cardiac Trauma	p. 271
Options for Patients Who Refuse Blood Product Administration	p. 273
The Emergency Patient From the Cardiac Catheterization Laboratory	p. 273
Perioperative Tamponade	p. 274
Cardiopulmonary Bypass	p. 277
The Plumbing of CPB	p. 278
Bypassing the Heart	p. 278
Bypassing the Lungs	p. 281
Preserving the Heart	p. 283
Protecting the Brain	p. 284
Electrolytes and CPB	p. 285
Anticoagulation and CPB	p. 286
Systemic Inflammation and CPB	p. 288
Echocardiography and CPB	p. 288
Postoperative Analgesia for Cardiac Surgery	p. 291
What are the Systemic Implications of Pain in the Cardiac Surgery Patient?	p. 292
What Modalities are Available to Treat Postoperative Pain?	p. 293
Index	p. 303
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