Cardiac Anesthesia and Transesophageal Echocardiography

Alina Nicoara, MD is Assistant Professor, Department of Anesthesiology, Duke University. John Wasnick, MD Chairman, Department of Anesthesiology, Texas Tech University Medical Center.

Preface
Contributors to the First Edition
Introduction to Perioperative Echocardiography
What Can Be Learned From Perioperative Transesophageal Echocardiography (TEE)?
What Echocardiographic Modalities Are Employed and How Can They Be Used?
What Are the Indications and Contraindications for Perioperative TEE?
Briefly, How Does Echocardiography Work?
What Constitutes the Standard Perioperative TEE Examination?
How Is TEE Routinely Used Perioperatively?
What Is the Role of Three-Dimensional Echocardiography in Perioperative Management?
How Can Echocardiography Be Used to Determine Cardiac Output, Pressure Gradients, and Other Hemodynamic Measures Formerly Done With a Pulmonary Artery (PA) Catheter?
Image and Video Atlas
Chapter 1 Preoperative Evaluation of the Heart Surgery Patient
Consent for Cardiac Anesthesia
Cardiac Surgery and Teamwork
Coronary Stents or Coronary Artery Bypass?
Cardiology Evaluation
Preoperative Assessment
Preoperative Patient Care and Comfort
Chapter 2 Hemodynamics and Cardiac Anesthesia
Hemodynamic Calculations and Invasive Monitors: Why Are They Important and How Does One Determine Them?
The Pumping Heart: How Does the Pump Contract and Relax?
Pharmacology and Hemodynamics: An Introduction
TEE and Hemodynamic Instability: How TEE Advances the Diagnosis of Hypotension?
Avoiding Hemodynamic Collapse: A Case Illustration
Chapter 3 Perioperative Rhythm Abnormalities
The Electrocardiogram
ECG Abnormalities
Bradyarrhythmias
Temporary Pacemaker
Supraventricular Tachycardias
Ventricular Tachycardia and Fibrillation
TEE and the ECG
Case Scenario
Chapter 4 Routine Cardiac Surgery and Anesthesia
Immediate Preoperative Assessment and Antibiotic Prophylaxis
Monitoring and Vascular Access
Anesthetic Induction and Maintenance
Institution of Cardiopulmonary Bypass
Separation From CPB
Sternal Closure and Patient Transport
Commonly Used Vasoactive Drugs in the Cardiac Surgery Patient
Case Illustration
Summary
Chapter 5 The Complicated Patient for Cardiac Anesthesia and Surgery
The Patient With Impaired Systolic and Diastolic Ventricular Function
The Reoperative Patient
The Diabetic Patient and Perioperative Glucose Control
The Vascular Disease Patient in Need of Cardiac Surgery
The Kidney Failure Patient and Cardiac Surgery
Chapter 6 Aortic Valve Disease
Overview
The Clinical Signs and Symptoms of AV Disease
Physiologic Compensatory Mechanisms of AV Disease
Echocardiography and AV Disease
Surgical and Catheter-Mediated AV Replacement
Anesthetic Implications of AV Diseases
Clinical Scenario: The Patient With Mixed AS/AR and the Emergency Institution of CPB
Chapter 7 Mitral Valve Disease
The Clinical Signs and Symptoms of MV Diseases
Physiologic Compensatory Mechanisms of MV Diseases
Echocardiography and MV Diseases
Surgical and Catheter-Mediated Approaches to the Repair and Replacement of the MV
Surgical Approaches to the Management of Atrial Fibrillation
Anesthetic Implications of MV Diseases
Case Scenario
Chapter 8 Right Heart Valves and Function
The Clinical Signs and Symptoms of Tricuspid Valve Diseases
RV Function
The Pulmonic Valve
Echocardiography of Right Heart Structures and Right Ventricular Function
Echocardiographic Evaluation of the Tricuspid Valve and Tricuspid Regurgitation
Surgical Approaches to TV Diseases
Anesthetic Implications of TV Diseases, Pulmonary Hypertension, and RV Failure
Case Scenario: The Patient With Endocarditis
Chapter 9 Anesthesia for Repair of Diseases of Thoracic Aorta
Diseases of the Ascending Thoracic Aorta
Diseases of the Descending Thoracic Aorta
Anesthetic Management of the Patient With Disease of the Thoracic Aorta
Distal Aortic Perfusion and Spinal Cord Protection During Descending Thoracic Aneurysm Resection and Endovascular Stenting
Deep Hypothermic Circulatory Arrest
Echocardiography in the Management of Thoracic Aortic Diseases
Case Scenario
Chapter 10 Hypertrophic Obstructive Cardiomyopathy and Cardiac Masses
Signs, Symptoms, and Diagnosis of HCM
Pathology of HCM
Medical Therapy for HCM
Dynamic Obstruction of the LVOT
Anesthetic Management of the HCM Patient for Noncardiac Surgery
Anesthetic Management for Surgical Repair of HCM
The Surgical Approach to HCM Repair
Cardiac Masses
Case Scenario: 22-Year-Old Man With Sudden Cardiac Death
Chapter 11 Ventricular Assist Devices and Heart Transplantation
Intra-Aortic Balloon Counterpulsation and the Heart Surgery Patient
Ventricular Assist Devices: Designs and Indications
Short-Term VAD Placement
Long-Term VAD Placement
Anesthetic Management of VADs
TEE and VADs
Heart Transplantation
Case Scenario
Chapter 12 Anesthesia for Patients With Congenital Heart Disease
Atrial Septal Defects
Ventricular Septal Defects
Tetralogy of Fallot
Transposition of the Great Arteries
Single Ventricle Patients
Anesthesia for Noncardiac Surgery in Adults With Congenital Heart Disease
Cardiac Surgery and Pregnancy
TEE and CHD
Chapter 13 Off-Pump, Robotic, and Minimally Invasive Heart Surgery
Minimally Invasive Surgical Approaches
Anesthetic Challenges for Off-Pump and Minimally Invasive Surgery
Is Off-Pump Surgery Better Than On-Pump Surgery?
Case Scenario
Chapter 14 The Postoperative Care of the Cardiac Surgery Patient
Routine Transport and Report
Inflammation and the Cardiac Surgery Patient
Genetic Associations and Cardiac Surgery Outcomes
Perioperative Neurological Injury
Respiratory Failure
Acute Kidney Injury
ICU Hemodynamics
Analgesia, Electrolytes, Glucose
Echocardiography in the ICU
Summary
Chapter 15 Anesthesia for Electrophysiology, Hybrid, and Catheterization Procedures
Electrophysiology and Other Catheter-Based Procedures Overview
EP Procedures
Anesthetic Management of EP Procedures
Risks and Complications of Out-Of-The-OR Cardiac Procedures
Chapter 16 Coagulopathy, Bleeding, and Cardiac Anesthesia Emergencies
Hemostasis and Cardiac Surgery
Prevention of Blood Loss During Cardiac Surgery
When to Transfuse
Outcomes Following Transfusion
Massive Transfusion and Cardiac Trauma
Options for Patients Who Refuse Blood Product Administration
The Emergency Patient From the Cardiac Catheterization Laboratory
Perioperative Tamponade
Chapter 17 Cardiopulmonary Bypass
The Plumbing of CPB
Bypassing the Heart
Bypassing the Lungs
Preserving the Heart
Protecting the Brain
Electrolytes and CPB
Anticoagulation and CPB
Systemic Inflammation and CPB
Echocardiography and CPB
Extracorporeal Membrane Oxygenation (ECMO)
Chapter 18 Postoperative Analgesia for Cardiac Surgery
What Are the Systemic Implications of Pain in the Cardiac Surgery Patient?
What Modalities Are Available to Treat Postoperative Pain?
Enhanced Recovery Following Cardiac Surgery
Summary
Index