The anesthesia community has openly debated if the care of transplant patients was generalist or specialist care ever since the publication of an opinion paper in 1999 recommended subspecialty training in the field of liver transplantation anesthesia. In the past decade, liver transplant anesthesia has become more complex with a sicker patient population and evolving evidence-based practices. Transplant training is currently not required for accreditation or certification in anesthesiology,...

Anesthesia providers are frequently exposed to radiation during routine patient care in the operating room and remote anesthetizing locations. Eighty-two percent of anesthesiology residents (n = 57 responders) at our institution had a “high” or “very high” concern about the level of ionizing radiation exposure, and 94% indicated interest in educational materials about radiation safety. This article highlights key learning points related to basic physical principles, effects of ionizing...

More than 3000 peer-reviewed publications on the topic of liver transplantation were published in 2016. The goal of this article is to provide a concise review of pertinent literature for anesthesiologists who participate in liver transplantation. The authors selected and presented 33 articles published in 2016 on the topics of MELD policy; cardiovascular, pulmonary, and renal issues; coagulation and transfusion; anesthetic agents; hemodynamic monitors; acute liver failure; and donor issues. ...

Nathaen Weitzel, one of the Editors-in-Chief of SCVA, talks to Ernesto Pretto of The Society for the Advancement of Transplant Anesthesia (SATA). They discuss transplant anesthesia and highlight how Seminars in Cardiothoracic and Vascular Anesthesia will now serve as the official home journal for SATA.   To view the SATA Editorial in the March 2017 issue of SCVA, click here.

Due to familiarity, short half-life, ease of monitoring, and the availability of a reversal agent, heparin remains the anticoagulant of choice for cardiac operations requiring cardiopulmonary bypass (CPB). However, occasionally patients require CPB but should not receive heparin, most often because of acute or subacute heparin-induced thrombocytopenia (HIT). In these cases, if it is not feasible to wait for the disappearance of HIT antibodies, an alternative anticoagulant must be selected. A...

The postoperative course of a patient undergoing cardiac surgery (CS) is dictated by a largely predictable set of interactions between disease-specific and therapeutic factors. ICU personnel need to quickly develop a detailed understanding of the patient’s current status and how critical care resources can be used to promote further recovery and eventual independence from external support. The goal of this article is to describe a typical operative and postoperative course, with emphasis on...

Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary thromboembolic hypertension remains underdiagnosed. It is imperative that all patients with pulmonary hypertension (PH) be screened for the presence of CTEPH since this form of PH is potentially curable with pulmonary...

The September 2013 Podcast discusses the key management points relating to delirium in the perioperative period.  Dr. Michael Wall is an leading expert in anesthesiology and intensive care, who authored the article "Delirium: past present and future."  This podcast interview discusses the etiology of perioperative delirium, as well as management tips, screening tools, and considerations for the anesthesiologist and intensivist.  This podcast is an excellent complement to the...

The December 2013 Podcast discusses perioperative considerations for right heart failure in the setting of LVAD implantation. Dr. Ambardekar is a cardiologist specializing in management of heart failure, and provides a unique perspective on this subject. The podcast discusses the pathophysiology of right heart failure, predictive test modalities for right hear failure at LVAD implantation, as well as postoperative considerations in this population. The discussion is an excellent complement to...

Perioperative fluid management is of significant importance during pulmonary resection surgery and esophagectomy. Excessive fluid administration has been consistently shown as a risk factor for lung injury after thoracic procedures. Probable causes of this serious complication include fluid overload, lung lymphatics and pulmonary endothelial damage. Along with new insights regarding the Starling equation and the absence of a third space, current evidence supports a restrictive fluid regimen...

Pain after thoracic surgery can be severe and, in the acute phase, contribute to perioperative morbidity and mortality. Unfortunately, patients also incur a significant risk of chronic pain. Although there are guidelines for postoperative pain management in these patients, there is no widespread surgical or anesthetic best practice. Here, we review the recent literature on techniques specific to perioperative pain control for thoracic patients, including medical management, neuraxial...

The techniques and equipment of cardiopulmonary bypass (CPB) have evolved over the past 60 years, and numerous numbers of cardiac surgical procedures are conducted around the world using CPB. Despite more widespread applications of percutaneous coronary and valvular interventions, the need for cardiac surgery using CPB remains the standard approach for certain cardiac pathologies because some patients are ineligible for percutaneous procedures, or such procedures are unsuccessful in some. The...

The June SCVA podcast highlights the key points for Infants with Hypoplastic Left Heart Syndrome, in a discussion with the two expert authors Drs. Twite and Ing. This fascinating interview covers management details, pathophysiology, and general considerations for surgical repair of these extremely complicated patients.   To view the article, click here.