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Cardiovascular Considerations in Anesthetic Management for a Patient With Antiphospholipid Syndrome and Decreased Cardiac Function: A Case Study
Anesth Prog. 2021 Mar 1;68(1):33-37. doi: 10.2344/anpr-67-03-07.ABSTRACTThis case report describes the prolonged general anesthetic management of a 41-year-old woman with antiphospholipid syndrome (APS), systemic lupus erythematosus, and previously undiagnosed decreased cardiac function who underwent planned partial resection of the left tongue, tracheostomy, neck dissection, and pedicled flap reconstruction. This was immediately followed by emergent surgery to salvage the flap, and 1 month later, revision of the soft tissue flap was performed. A preoperative echocardiogram was performed because of her various risk factors...
Source: Anesthesia Progress - April 7, 2021 Category: Anesthesiology Authors: Makiko Shibuya Yukifumi Kimura Shigeru Takuma Nobuhito Kamekura Toshiaki Fujisawa Source Type: research

How to Manage the Perioperative Patient on Combined Anticoagulant and Antiplatelet Therapy: Comments on the 2020 ACC Consensus Decision Pathway
Antithrombotic drugs are frequently used to prevent or treat various common cardiovascular disorders like acute coronary syndrome (ACS), stroke, atrial fibrillation (AF), and venous thromboembolism (VTE). Mainly, two classes of oral antithrombotic drugs are on market: anticoagulants, which slow down clot formation by reduced thrombin generation and fibrin formation; and antiplatelet drugs, which prevent platelet activation and formation of stable clots. Combined anticoagulant and antiplatelet therapy might be indicated in some patients, but it is associated with increased risk of critical bleeding.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 28, 2021 Category: Anesthesiology Authors: Daniel Bolliger, Jens Fassl, Gabor Erdoes Tags: Editorial Commentary Source Type: research

NobleStitch ™ EL PFO Closure Guided by Transesophageal Echocardiography
Paradoxical embolism secondary to a persistent patent foramen ovale (PFO) is a significant source of embolic stroke and has been increasingly targeted by percutaneous interventional techniques. Both implanted devices and more recently, “deviceless” closure methods (i.e. suturing) have been developed. While device closure methods have historically been the predominant approach, issues related to the implanted devices such as migration, embolization, need for anticoagulation, device related thrombosis (DRT), erosion into adjacen t cardiovascular structures, and endocarditis are well documented.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 5, 2020 Category: Anesthesiology Authors: Sridhar R. Musuku, Adithya Srikanthan, Divya Cherukupalli, Jaqueline Donovan, Alexander D. Shapeton, Brion Winston Tags: Case Report Source Type: research

NobleStitch EL PFO Closure Guided by Transesophageal Echocardiography
Paradoxical embolism secondary to a persistent patent foramen ovale (PFO) is a significant source of embolic stroke and increasingly has been targeted by percutaneous interventional techniques. Both implanted devices and, more recently, deviceless closure methods (ie, suturing) have been developed. Although device closure methods historically have been the predominant approach, issues related to the implanted devices, such as migration, embolization, need for anticoagulation, device-related thrombosis, erosion into adjacent cardiovascular structures, and endocarditis are well-documented.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 5, 2020 Category: Anesthesiology Authors: Sridhar R. Musuku, Adithya Srikanthan, Divya Cherukupalli, Jaqueline Donovan, Alexander D. Shapeton, Brion Winston Tags: Case Report Source Type: research

Management of Acute Ischemic Stroke-Specific Focus on Anesthetic Management for Mechanical Thrombectomy.
Abstract Acute ischemic stroke is a neurological emergency with a high likelihood of morbidity, mortality, and long-term disability. Modern stroke care involves multidisciplinary management by neurologists, radiologists, neurosurgeons, and anesthesiologists. Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend thrombolytic therapy with intravenous (IV) alteplase within the first 3-4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16-24 hours depending on specific inclusion criteria. The anesthesia and critical care provider may b...
Source: Anesthesia and Analgesia - September 16, 2020 Category: Anesthesiology Authors: Businger J, Fort AC, Vlisides PE, Cobas M, Akca O Tags: Anesth Analg Source Type: research

Viable Hemostasis Obtained With Prothrombin Complex Concentrate in Patients Who Refuse Standard Allogeneic Blood Transfusion and Undergo Complex Cardiac Surgery: A Case Series
Human 4-factor prothrombin complex concentrate (4F-PCC) may reduce blood loss during surgery. This case series described perioperative outcomes among 9 patients who refused standard allogeneic blood transfusion, underwent complex cardiac surgery with aortic involvement, and received intraoperative 4F-PCC. Additional intraoperative cointerventions included protamine (n = 9), aminocaproic acid (n = 8), fibrinogen concentrate (n = 6), desmopressin (n = 6), factor VIIa (n = 2), and tranexamic acid (n = 1). Outcomes included postoperative death (n = 1), major postoperative bleeding (n = 1), deep vein thrombosis (n = 2), and isc...
Source: A&A Case Reports - July 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

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