Congenital Heart Disease in Adults
Key Points 1. Because of successes in treating congenital cardiac lesions, there are currently as many or more adults than children with congenital heart disease (CHD). 2. These patients may…
Anesthesia for Heart, Lung, and Heart-Lung Transplantation
Key Points 1. Cardiac denervation is an unavoidable consequence of heart transplantation, and reinnervation is at best partial and incomplete. 2. Drugs acting directly on the heart are the drugs…
Valvular Heart Disease: Replacement and Repair
Key Points 1. Although various valvular lesions generate different physiologic changes, all valvular heart disease is characterized by abnormalities of ventricular loading. 2. The left ventricle normally compensates for increases…
Uncommon Cardiac Diseases
Key Points 1. Cardiac tumors are rare. In general, a cardiac mass is more likely a vegetation or a thrombus than a tumor. Secondary (metastatic) tumors are far more common…
Anesthesia for Myocardial Revascularization
Key Points 1. Guideline updates emphasize the efficacy of surgical approaches to myocardial revascularization in patients with multivessel coronary artery disease. 2. Perioperative risk reduction includes careful consideration of all…
Coagulation Monitoring
Key Points 1. Monitoring the effect of heparin is done using the activated coagulation time (ACT), a functional test of heparin anticoagulation. The ACT is susceptible to prolongation because of…
Central Nervous System Monitoring
Key Points 1. Electroencephalography can detect both cerebral ischemia or hypoxia and seizures and can measure hypnotic effect. 2. Middle-latency auditory-evoked potentials objectively document inadequate hypnosis. 3. Somatosensory-evoked potentials may…
Basic Intraoperative Transesophageal Echocardiography
Key Points 1. An ultrasound beam is a continuous or intermittent train of sound waves emitted by a transducer or wave generator that is composed of density or pressure. Ultrasound…
Electrocardiographic Monitoring
Key Points 1. The electrocardiogram reflects differences in transmembrane voltages in myocardial cells that occur during depolarization and repolarization within each cycle. 2. Processing of the electrocardiogram occurs in a…
Monitoring of the Heart and Vascular System
Key Points 1. Patients with severe cardiovascular disease and those undergoing surgery associated with rapid hemodynamic changes should be adequately monitored at all times. 2. Standard monitoring for cardiac surgery…
