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• W2896749619 abstract "This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance.The second major theme is the diffusion of echocardiography throughout perioperative practice. There are now guidelines and training pathways to guide its generalization into everyday practice. The third major theme is the paradigm shift in perioperative fluid management. Recent large randomized trials suggest that fluids are drugs that require a precise prescription with respect to type, dose, and duration. The final theme is patient safety in the cardiac perioperative environment. A recent expert scientific statement has focused attention on this issue because most perioperative errors are preventable. It is likely that clinical research in this area will blossom because this is a major opportunity for improvement in our specialty. The patient care processes identified in these research highlights will further improve perioperative outcomes for our patients. This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance. The second major theme is the diffusion of echocardiography throughout perioperative practice. There are now guidelines and training pathways to guide its generalization into everyday practice. The third major theme is the paradigm shift in perioperative fluid management. Recent large randomized trials suggest that fluids are drugs that require a precise prescription with respect to type, dose, and duration. The final theme is patient safety in the cardiac perioperative environment. A recent expert scientific statement has focused attention on this issue because most perioperative errors are preventable. It is likely that clinical research in this area will blossom because this is a major opportunity for improvement in our specialty. The patient care processes identified in these research highlights will further improve perioperative outcomes for our patients. THIS ARTICLE IS THE SIXTH in the annual series for the Journal of Cardiothoracic and Vascular Anesthesia.1Ramakrishna H, Reidy C, Riha H, et al: The year in cardiothoracic and vascular anesthesia: selected highlights from 2012. J Cardiothorac Vasc Anesth 27:86-91, 2013Google Scholar We thank our editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series, namely the research highlights of the year that pertain to the specialty of cardiothoracic and vascular anesthesia. The major themes selected for this past year are outlined in this introduction, and then each highlight is reviewed in detail in the main body of the article.The literature highlights in our specialty for 2013 begin with the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr. Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr. Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance.The second major theme in our specialty for 2013 is the diffusion of echocardiography throughout perioperative practice, including noncardiac surgery and the intensive care unit. There are now guidelines and training pathways to support and guide the implementation of this advanced technology into everyday perioperative practice. The third major theme for 2013 is the paradigm shift that is taking place in perioperative fluid management. Recent large randomized trials have refined the idea that fluids should be viewed as drugs that should be precisely prescribed with respect to type, dose, and duration. The final theme for 2013 is patient safety in the cardiac perioperative environment. A recent expert scientific statement has focused considerable attention on this issue because most errors are preventable. It is likely that clinical research in this area will blossom because this is a major opportunity for improvement in our specialty. The themes selected for this sixth highlights article have only sampled the advances in our specialty for 2013. The patient care processes identified in these highlights will further improve perioperative outcomes for our patients.The 60th anniversary of cardiopulmonary bypassIn October 1931 at the Massachusetts General Hospital, John H. Gibbon Jr witnessed the death of a 53-year-old woman from acute pulmonary embolism, despite heroic surgery.2Castillo J.G. Silvay G. John H. Gibbon Jr, and the 60th anniversary of the first successful heart-lung machine.J Cardiothorac Vasc Anesth. 2013; 134: 203-207Abstract Full Text Full Text PDF Scopus (8) Google Scholar, 3Singh J. Dhaliwal R.S. Luthra S. et al.Seventy-five years after the birth of an idea: a tribute to John H. Gibbon Jr.J Am Coll Surg. 2006; 202: 384-385Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar This experience sparked the idea of cardiopulmonary bypass (CPB), which led this remarkable surgical pioneer to develop a CPB model and then to conduct the first successful cardiac operation with CPB on May 6, 1953 at Thomas Jefferson University in Philadelphia.2Castillo J.G. Silvay G. John H. Gibbon Jr, and the 60th anniversary of the first successful heart-lung machine.J Cardiothorac Vasc Anesth. 2013; 134: 203-207Abstract Full Text Full Text PDF Scopus (8) Google Scholar, 3Singh J. Dhaliwal R.S. Luthra S. et al.Seventy-five years after the birth of an idea: a tribute to John H. Gibbon Jr.J Am Coll Surg. 2006; 202: 384-385Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 4Bloom J.P. Yeo C.J. Cohn H.E. et al.John H. Gibbon, Jr MD: surgical innovator, pioneer, and inspiration.Am Surg. 2011; 77: 1112-1114PubMed Google Scholar The patient was an 18-year-old college student with severe right ventricular heart failure secondary to a large atrial septal defect.2Castillo J.G. Silvay G. John H. Gibbon Jr, and the 60th anniversary of the first successful heart-lung machine.J Cardiothorac Vasc Anesth. 2013; 134: 203-207Abstract Full Text Full Text PDF Scopus (8) Google Scholar The closure of the atrial septal defect was repaired on CPB by Gibbon with a total CPB time of 45 minutes. The patient recovered uneventfully. Although there were earlier cardiac surgical procedures with CPB, Gibbon and his team were responsible for the first successful case, fulfilling the dream held by a surgical research fellow in Boston more than 20 years previously.2Castillo J.G. Silvay G. John H. Gibbon Jr, and the 60th anniversary of the first successful heart-lung machine.J Cardiothorac Vasc Anesth. 2013; 134: 203-207Abstract Full Text Full Text PDF Scopus (8) Google Scholar, 3Singh J. Dhaliwal R.S. Luthra S. et al.Seventy-five years after the birth of an idea: a tribute to John H. Gibbon Jr.J Am Coll Surg. 2006; 202: 384-385Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 4Bloom J.P. Yeo C.J. Cohn H.E. et al.John H. Gibbon, Jr MD: surgical innovator, pioneer, and inspiration.Am Surg. 2011; 77: 1112-1114PubMed Google Scholar This case was reported by Gibbon at a surgical symposium held shortly thereafter.5Gibbon Jr, J.H. Application of a mechanical heart and lung apparatus to cardiac surgery.Minn Med. 1954; 37: 171-185PubMed Google Scholar John H. Gibbon is therefore a founding father of CPB, which has become a cornerstone in the conduct of cardiac surgery in the contemporary era for the full spectrum of procedures.The first consequence of this major milestone in our specialty has been gradual evolution of mechanical applications within the scope of CPB and beyond to include ventricular assist devices, extracorporeal membrane oxygenation, and robotics, all of which have been comprehensively reviewed recently in the Journal.6Hall R. Identification of inflammatory mediators and their modulation by strategies for the management of the systemic inflammatory during cardiac surgery.J Cardiothorac Vasc Anesth. 2013; 27: 983-1032Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar, 7Sidebotham D. Allen S.J. McGeorge A. et al.Venovenous extracorporeal membrane oxygenation in adults: practical aspects of circuits, cannulae, and procedures.J Cardiothorac Vasc Anesth. 2012; 26: 893-899Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 8Odonkor P.M. Stansbury L. Garcia J.P. et al.Perioperative management of adult surgical patients on extracorporeal membrane oxygenation support.J Cardiothorac Vasc Anesth. 2013; 27: 329-344Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 9Deshpande S.P. Lehr E. Odonkor P. et al.Anesthetic management of robotically assisted totally endoscopic coronary artery bypass surgery (TECAB).J Cardiothorac Vasc Anesth. 2013; 27: 586-599Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 10Slininger K.A. Haddadin A.S. Mangi A.A. Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery.J Cardiothorac Vasc Anesth. 2013; 27: 752-759Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 11Gaitan B.D. Thunberg C.A. Stansbury L.G. et al.Development, Current status and anesthetic management of the implanted artificial heart.J Cardiothorac Vasc Anesth. 2011; 25: 1179-1192Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 12Thunberg C.A. Gaitan B.D. Arabia F.A. et al.Ventricular assist devices today and tomorrow.J Cardiothorac Vasc Anesth. 2010; 24: 656-680Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar This set of indications for mechanical devices have been responsible for gradual paradigm shifts within our specialty and throughout anesthesiology and critical care.The second consequence of this major milestone has been the singular importance of seminal case reports, which, despite the drift to randomized trials within perioperative cardiothoracic practice, retain a vital niche, as outlined in a superb recent editorial in the Journal.13Hessel E.A. Why we should continue to publish case reports.J Cardiothorac Vasc Anesth. 2013; 27: 825-827Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The transformative power of case reports in our specialty since Gibbon have included Barnard’s description of the first successful heart transplant in 1967, Kaplan’s description of electrocardiographic lead V5 monitoring in 1976, Kaplan’s description of intravenous nitroglycerin in adult cardiac surgical patients, the advent of percutaneous coronary intervention in 1978, vasopressin for hemodynamic rescue in challenging pheochromocytoma resections in 2004, and the recent recognition of hormonal treatment as a therapeutic option for severe gastrointestinal bleeding associated with ventricular assist devices.14Barnard C.N. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town.S Afr Med J. 1967; 41: 1271-1274PubMed Google Scholar, 15Kaplan J.A. King 3rd, S.B. The precordial electrocardiographic lead (V5) in patients who have coronary artery disease.Anesthesiology. 1976; 45: 570-574Crossref PubMed Scopus (25) Google Scholar, 16Kaplan J.A. Dunbar R.W. Jones E.I. Nitroglycerin infusion during coronary artery surgery.Anesthesiology. 1976; 45: 14-21Crossref PubMed Scopus (97) Google Scholar, 17Gruntzig A. Transluminal dilatation of coronary artery stenosis.Lancet. 1978; 1: 263Abstract PubMed Scopus (1072) Google Scholar, 18Augoustides J.G. Abrams M. Berkowitz D. et al.Vasopressin for hemodynamic rescue in catecholamine-resistant vasoplegic shock after resection of massive pheochromocytoma.Anesthesiology. 2004; 101: 1022-1024Crossref PubMed Scopus (43) Google Scholar, 19Gutsche J.T. Atluri P. Augoustides J.G. Treatment of ventricle assist device associated gastrointestinal bleeding with hormonal therapy.J Cardiothorac Vasc Anesth. 2013; 27: 940-944Google Scholar Case reports retain a niche because they may be hypothesis generating and may lead to significant progress in the practice and safety of our specialty.13Hessel E.A. Why we should continue to publish case reports.J Cardiothorac Vasc Anesth. 2013; 27: 825-827Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Although case reports are rarely cited and deflate the impact factor of a major Journal, there remains a strong consensus to publish outstanding case reports in our Journal, given their aforementioned merits.13Hessel E.A. Why we should continue to publish case reports.J Cardiothorac Vasc Anesth. 2013; 27: 825-827Abstract Full Text Full Text PDF PubMed Scopus (6) Google ScholarThe consequences of the landmark clinical achievements of John H. Gibbon forever transformed cardiovascular perioperative practice. The pervasive influence of CPB and related mechanical circulatory approaches are clearly evident in the educational content of leading contemporary professional societies in cardiovascular and thoracic anesthesiology such as the Society of Cardiovascular Anesthesiologists (full meeting details available at www.scahq.org, last accessed October 5, 2013), the European Association of Cardiothoracic Anaesthesiologists (full details available at www.eacta.org, last accessed on October 6, 2013), the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (full meeting details available at www.iacta2014.com, last accessed on October 8, 2013), and the Chinese Society of Cardiovascular and Thoracic Anesthesiologists (full meeting details available at www.csaol.cn, last accessed on October 7, 2013). Despite the amazing progress in CPB and mechanical circulatory support in the last 60 years, the frontiers are still advancing with multiple current controversies, including CPB monitoring and ventricular assist devices, which have invigorated the pro/con section of the Journal.20Vernick W.J. Gutsche J.T. Pro: Crebral oximetry should be a routine monitor during cardiac surgery.J Cardiothorac Vasc Anesth. 2013; 27: 385-389Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 21Gregory A. Kohl B.A. Con: Near-infrared spectroscopy has not proven its utility as a standard monitor in cardiac surgery.J Cardiothorac Vasc Anesth. 2013; 27: 390-394Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 22Morris R.J. Shore E.D. Pro: LVAD: Patient’s desire for termination of VAD therapy should be challenged.J Cardiothorac Vasc Anesth. 2013; 27: 1048-1050Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 23Kini V. Kirkpatrick J.N. Con: Patient’s desire for termination of destination LVAD therapy should be respected.J Cardiothorac Vasc Anesth. 2013; 27: 1051-1052Abstract Full Text Full Text PDF PubMed Scopus (2) Google ScholarThe Journal also published this year a special article as a tribute to Dr. W. J. Kolff, an intellectual giant in the development of mechanical organ support.24Stanley T.H. A tribute to Dr Willem J. Kolff: Innovative inventor, physician, scientist, bioengineer, mentor, and significant contributor to modern cardiovascular surgical and anesthetic practice.J Cardiothorac Vasc Anesth. 2013; 27: 600-613Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Before his immigration to America, Dr. Kolff made major strides in his early experiments with dialysis and CPB. After his immigration to America, Dr. Kolff had a prestigious career, based initially at the Cleveland Clinic (1950-1967) and then at the University of Utah (1967-1997). This remarkable physician-scientist was a founding member of the American Society for Artificial Internal Organs and in his sustained career made important contributions to the development of clinical dialysis, CPB, and the total artificial heart.24Stanley T.H. A tribute to Dr Willem J. Kolff: Innovative inventor, physician, scientist, bioengineer, mentor, and significant contributor to modern cardiovascular surgical and anesthetic practice.J Cardiothorac Vasc Anesth. 2013; 27: 600-613Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Because of these multiple innovations, it is beyond doubt that he has contributed significantly to contemporary perioperative cardiovascular practice.24Stanley T.H. A tribute to Dr Willem J. Kolff: Innovative inventor, physician, scientist, bioengineer, mentor, and significant contributor to modern cardiovascular surgical and anesthetic practice.J Cardiothorac Vasc Anesth. 2013; 27: 600-613Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Our specialty has been significantly influenced by the seminal contributions of cardiovascular pioneers such as Dr. Gibbon and Dr. Kolff. The paradigm shifts in cardiothoracic and vascular anesthesia that have resulted from the contributions of these perioperative pioneers have opened new worlds that continue to be explored for the achievement of excellence in the care of our patients.2Castillo J.G. Silvay G. John H. Gibbon Jr, and the 60th anniversary of the first successful heart-lung machine.J Cardiothorac Vasc Anesth. 2013; 134: 203-207Abstract Full Text Full Text PDF Scopus (8) Google Scholar, 24Stanley T.H. A tribute to Dr Willem J. Kolff: Innovative inventor, physician, scientist, bioengineer, mentor, and significant contributor to modern cardiovascular surgical and anesthetic practice.J Cardiothorac Vasc Anesth. 2013; 27: 600-613Abstract Full Text Full Text PDF PubMed Scopus (1) Google ScholarThe diffusion of echocardiography throughout perioperative practicePerioperative echocardiography as a skill set has become a standard feature in the contemporary practice of cardiac anesthesia with guidelines published beginning in 1999 for transesophageal, epicardial, and epiaortic imaging. A controversy has recently developed regarding whether general anesthesiologists should be trained and certified in basic echocardiography, as vigorously debated in a 2010 pro/con in the Journal.25Green M. Heyer A.S. Con: General anesthesiologists should not be trained and certified in basic transesophageal echocardiography.J Cardiothoracic Vasc Anesth. 2010; 24: 189-190Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 26Goldstein S. Pro: The general anesthesiologist should be trained and certified in transesophageal echocardiography.J Cardiothorac Vasc Anesth. 2010; 24: 183-188Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Focused, goal-directed transthoracic echocardiography (TTE) has recently emerged as a viable option not only in the emergency room and intensive care unit but also in the anesthesia preoperative unit, operating room, and post-anesthesia care unit.27Cowie B. Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: Feasible and alters patient management.J Cardiothorac Vasc Anesth. 2009; 23: 450-456Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 28Cowie B. Focused transthoracic echocardiography predicts perioperative cardiovascular morbidity.J Cardiothorac Vasc Anesth. 2012; 26: 989-993Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar It is the beginning of a paradigm shift.A pilot prospective single-center trial (n = 50) demonstrated that appropriately trained anesthesiologists can reliably perform a focused perioperative TTE in 98% of referred patients undergoing noncardiac surgery.27Cowie B. Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: Feasible and alters patient management.J Cardiothorac Vasc Anesth. 2009; 23: 450-456Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar The most common indications for this referral were suspected valvular disease, hemodynamic instability, and quantification of ventricular function. The most common indication for focused TTE was an undifferentiated systolic murmur in 50% of cases; 38% of these referred cases were subsequently diagnosed with aortic stenosis. The results of this echocardiographic examination influenced perioperative management in 84% of cases. There was excellent agreement between the focused TTE and the subsequent formal comprehensive TTE performed by the cardiology service in 87% of cases. During the study period of 1 year, focused TTE was requested at in 0.5% of cases (50 overall with a case volume of about 10,000 cases).27Cowie B. Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: Feasible and alters patient management.J Cardiothorac Vasc Anesth. 2009; 23: 450-456Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar In a follow-up clinical trial at the same university medical center in Melbourne, Australia (n = 222), 18% of noncardiac surgical patients referred for focused perioperative TTE had subsequent adverse cardiac events: 61.5%, myocardial infarctions; 15.4%, new arrhythmias; 10.3%, severe hypotension; and 12.8% mortality.28Cowie B. Focused transthoracic echocardiography predicts perioperative cardiovascular morbidity.J Cardiothorac Vasc Anesth. 2012; 26: 989-993Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Adverse cardiac events were common in the following scenarios: 64% of patients with pulmonary hypertension, 56% of patients with ventricular dysfunction, and 17% of patients with stenotic valvular disease. A very high-risk clinical profile was also defined as follows: Patients with pulmonary hypertension, ventricular dysfunction, and/or stenotic valvular disease had a 77% risk of a perioperative adverse cardiac event.28Cowie B. Focused transthoracic echocardiography predicts perioperative cardiovascular morbidity.J Cardiothorac Vasc Anesth. 2012; 26: 989-993Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar A very low risk profile was also defined as follows: Patients with a normal focused TTE, a flow murmur, or isolated regurgitant valvular disease enjoyed 100% freedom from adverse perioperative cardiac events.28Cowie B. Focused transthoracic echocardiography predicts perioperative cardiovascular morbidity.J Cardiothorac Vasc Anesth. 2012; 26: 989-993Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Based on this analysis, focused TTE performed by anesthesiologists in the perioperative period can stratify cardiac risk in noncardiac surgical patients.A recent single-center trail evaluated the management effects of rescue echocardiography (n = 31: 9 TTE, 22 transesophageal echocardiography; 2006-2010) in adult noncardiac surgical patients with unexplained perioperative hemodynamic instability.29Shillcutt S.K. Markin N.W. Montzingo C.R. et al.Use of rapid rescue perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients.J Cardiothorac Vasc Anesth. 2012; 26: 362-370Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar Rescue echocardiography provided a diagnosis in all cases as follows: 51.6%, left ventricular dysfunction; 29%, right ventricular dysfunction; 16.1%, hypovolemia; 16.1%, pulmonary embolus; 12.9%, myocardial ischemia, with more than one diagnosis occurring in multiple patients. Based on hemodynamic information provided during rescue echocardiography, 67.8% of patients received altered pharmacologic therapy and 13% of patients underwent an emergent secondary procedure (pulmonary thrombectomy, aortic repair, pericardial drainage, and percutaneous coronary intervention).28Cowie B. Focused transthoracic echocardiography predicts perioperative cardiovascular morbidity.J Cardiothorac Vasc Anesth. 2012; 26: 989-993Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Although all patients recovered intraoperatively, only 81% progressed to hospital discharge. Based on this analysis, the investigators concluded that rescue echocardiography has a critical role in the diagnosis and management of perioperative hemodynamic instability in noncardiac surgery.The significant clinical utility of echocardiography has also been increasingly recognized in high-risk noncardiac surgery such as liver transplantation, given the multiple common mechanisms for perioperative hemodynamic instability.30Valentine E. Gregorits M. Gutsche J.T. et al.Clinical update in liver transplantation.J Cardiothorac Vasc Anesth. 2013; 27: 809-815Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 31Robertson AC, Eagle SS: Transesophageal echocardiography during orthotopic liver transplantation: Maximizing information without the distraction. J Cardiothorac Vasc Anesth 28:141-154, 2014Google Scholar Despite concern about the risks of bleeding from esophageal varices, the clinical penetration of transesophageal echocardiography (TEE) in high-volume liver transplant centers has recently been demonstrated.32Wax D.B. Torres A. Scher C. et al.Transesophageal echocardiography utilization in high-volume liver transplantation centers in the United States.J Cardiothorac Vasc Anesth. 2008; 22: 811-813Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar The extensive literature concerning TTE and TEE in liver transplantation has recently been explored in detail in the Journal in relation to the major phases of the procedure (dissection phase, venovenous bypass, anhepatic phase, reperfusion phase) and in relation to specific cardiovascular conditions, whether known preoperatively or not.31Robertson AC, Eagle SS: Transesophageal echocardiography during orthotopic liver transplantation: Maximizing information without the distraction. J Cardiothorac Vasc Anesth 28:141-154, 2014Google ScholarThe diffusion of echocardiography from cardiac surgery throughout noncardiac surgery has also captured the attention of major societies such as the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.33Reeves S.T. Finley A.C. Skubas N.J. et al.Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.Anesth Analg. 2013; 117: 543-558Crossref PubMed Scopus (58) Google Scholar These two professional societies have recently published a consensus statement describing the basic perioperative TEE examination.33Reeves S.T. Finley A.C. Skubas N.J. et al.Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.Anesth Analg. 2013; 117: 543-558Crossref PubMed Scopus (58) Google Scholar This basic TEE guideline is distinguished from the 1999 TEE guideline detailing the performance of a comprehensive intraoperative multiplane TEE examination with 20 standard views.34Shanewise J.S. Cheung A.T. Aronson A. et al.ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.Anesth Analg. 1999; 89: 870-884Crossref PubMed Google Scholar The basic perioperative TEE consensus statement begins with an overview of the history of TEE in the perioperative setting and then outlines the medical knowledge and training required for competency in basic TEE. Thereafter, the expert consensus describes the 11 TEE views that together comprise the full basic TEE perioperative examination: the midesophageal 4-chamber view; the midesophageal 2-chamber view; the midesophageal long-axis view; the midesophageal ascending aortic long-axis view; the midesophageal ascending aortic short-axis view; the midesophageal aortic valve short-axis view; the midesophageal right ventricular inflow-outflow view; the midesophageal bicaval view; the transgastric midpapillary short-axis view; and the descending aortic short-axis and long-axis views.33Reeves S.T. Finley A.C. Skubas N.J. et al.Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.Anesth Analg. 2013; 117: 543-558Crossref PubMed Scopus (58) Google ScholarThis comprehensive guideline then discusses the indications for basic perioperative TEE in the following categories: global and regional left ventricular function, right ventricular function, hypovolemia, basic valvular lesions, pulmonary embolism, neurosurgery, air embolism, pericardial effusion and thoracic trauma, and simple congenital heart disease in adults.33Reeves S.T. Finley A.C. Skubas N.J. et al.Basic perioperative transesophageal echocardiography examinati" @default.
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• W2896749619 title "The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2013" @default.
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