Cerebral Hypoxia Caused by Flow Confliction During Minimally Invasive Cardiac Surgery With Retrograde Perfusion: A Word of Caution

Kanda, Hirotsugu; Kunisawa, Takayuki; Kuwabara, Hiroto; Iida, Takafumi; Toyama, Yoshiyuki; Kanao-Kanda, Megumi; Mori, Chie; Kamiya, Hiroyuki

doi:10.1053/j.jvca.2017.10.007

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Life-threatening cerebral hypoxemia can ensue if this mixing of blood occurs distal to the aortic arch. An abrupt fall in cerebral oximetry can help recognize this condition immediately (11).…”

Section: Monitoringmentioning

confidence: 99%

Anesthesia for minimally invasive cardiac surgery

White¹,

Patvardhan²,

Falter³

2021

J Thorac Dis

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Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable.MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations.Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.

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Section: Monitoringmentioning

confidence: 99%

Anesthesia for minimally invasive cardiac surgery

White¹,

Patvardhan²,

Falter³

2021

J Thorac Dis

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“…This may occur if the endoballoon migrates but can also be seen if the heart is allowed to eject blood while there is no ventilation and the CPB return flow is distal to the innominate artery. The perfusion of the upper body with deoxygenated blood while the lower body enjoys oxygenated perfusion is known as Harlequin syndrome and may lead to life-threatening cerebral hypoxia [20].…”

Section: Monitoringmentioning

confidence: 99%

Anaesthesia for Minimally Invasive Cardiac Surgery

Aston,

Zeloof,

Falter

2023

JCDD

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Minimally invasive cardiac surgery (MICS) has been used since the 1990s and encompasses a wide range of techniques that lack full sternotomy, including valve and coronary artery graft surgery as well as transcatheter procedures. Due to the potential benefits offered to patients by MICS, these procedures are becoming more common. Unique anaesthetic knowledge and skills are required to overcome the specific challenges presented by MICS, including mastery of transoesophageal echocardiography (TOE) and the provision of thoracic regional analgesia. This review evaluates the relevance of MICS to the anaesthetist and discusses pre-operative assessment, the relevant adjustments to intra-operative conduct that are necessary for these techniques, as well as post-operative care and what is known about outcomes.

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