cardAnesthJan08 - Cardiac Anesthesia Update Charles E....

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Cardiac Anesthesia Update Charles E. Smith, MD Professor, CWRU School of Medicine Director, CT Anesthesia MetroHealth Medical Center
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Objectives 1. ASE guidelines- IOTEE 2. ACC/AHA guidelines- Valves 3. Diabetes + hyperglycemia 4. Neurocognitive dysfunction 5. Transfusion
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ASE/SCA Guidelines- TEE Accelerated growth of IOTEE by anesthesia Complexity of US technology Conduct of exam Interpretation of results Mathews JP et al: ASE / SCA Recommendations and Guidelines for CQI in Perioperative Echo. JASE + Anesth Analg 2006.
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Training + Credentialing 2 levels of training: basic + advanced Basic: within usual practice of anesthesia ventricular fct, gross valve lesions Advanced: full diagnostic potential of echo ASE /SCA/NBE: Testamur status: exam Board certified: 1 yr TEE/ CT fellowship [vs alternate training, 2-4 yr, 300 exams] Credentialing: hospital-specific process Mathews JP et al: JASE + Anesth Analg 2006.
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Standard TEE Exam: Guidelines Comprehensive: 20 cross-sectional views UE level: Asc aorta, MPA, L+R atria, AV+PV ME level : L+R atria, L+R ventricles, MV+TV TG: L+R ventricles Thoracic Aorta : Desc + distal arch Mathews JP et al: ASE / SCA Recommendations and Guidelines for CQI in Perioperative Echo. JASE + Anesth Analg 2006.
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Transgastric view: L+R ventricles
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ME views: L+R atria, L+R ventricles, MV+TV
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UE views: Asc aorta, MPA, L+R atria, AV+PV, pulm veins
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Thoracic Aorta: prox asc aorta, distal arch, descending
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ACC/AHA Guidelines Review of literature by experts Grade evidence: Level A →C [RCT→opinion] Recommendations: Class I: beneficial Class IIa: generally in favor Class IIb: less well established Class III: not useful, potentially harmful? AAC/AHA Task Force on Practice Guidelines. Circulation 2006;114(5)e84-231. Endorsed by SCA, STS
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Valvular Heart Disease Decision to repair/replace valve should be made before surgery IOTEE should be used to confirm dx, evaluate repair + evaluate new findings (e.g., moderate AS in setting of CABG, moderate AI if ↓ EF or ↑ LVEDD, aortic root reconstruction if dilated > 5 cm) AAC/AHA Task Force on Practice Guidelines. Circulation 2006;114(5)e84-231. Endorsed by SCA, STS
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IOTEE Indications Class I: valve repair, valve replacement- stentless / autograft (Ross), valve surgery in setting of endocarditis Level of evidence= B Class IIa: all valve surgeries Level of evidence =C AAC/AHA Task Force on Practice Guidelines. Circulation 2006;114(5)e84-231. Endorsed by SCA, STS
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Aortic Stenosis Check annulus size Verify size of aortic root (mismatch? aneurysmal?) After bypass: problems w prosthesis: immobility, leaks AAC/AHA Task Force on Practice Guidelines. Circulation 2006;114(5)e84-231. Endorsed by SCA, STS
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Severe Aortic Stenosis 5.7 m/s 2.0 cm 1.3 m/s 2.0 2 1.3 AVA = 3.14 ( ------) X ------ = 0.72 cm 2 2 5.7
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Severe Aortic Regurgitation T 1/2 = 84 ms T 1/2 = 84 ms Vena Contracta = 11 mm Vena Contracta = 11 mm
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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cardAnesthJan08 - Cardiac Anesthesia Update Charles E....

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