Multimodality neurologic monitoring assured optimal brain cooling and bihemispheric delivery of retrograde cerebral perfusion. Necessary retrograde pressure and flow were often higher than values previously reported. Avoidance of profound cerebral venous oxygen desaturation during retrograde cerebral perfusion and rewarming was associated with rapid recovery of neurologic function.
The recent successful implantation of the AbioCor im plantable replacement heart at the Rudd Heart-Lung Institute, Jewish Hospital, Louisville, KY, has renewed clinical interest in the use of the mechanical replace ment heart as therapy for intractable heart failure. Al though the number of orthotopic heart transplants has plateaued in the past decade, the number of patients requiring transplantation continues to increase. This supply/demand discrepancy continues to be the main catalyst for the research and development of other therapies for the failing heart. This review addresses perioperative considerations, monitoring modalities, and perioperative therapeutic interventions that may help guide the cardiac anesthesiologist through the challenges presented by implantation of total replace ment hearts in end-stage cardiac patients.
Operating room management structures and interrelationships both within the operating suite and with other departments in the hospital can be extremely complex. Several different professional and support groups are represented that often have infrastructures of their own that may compete or conflict with the operating room's management hierarchy. Often, there really is little actual management of the operating suite as an entity. Because the units must interact effectively to provide a high level of patient care, it is important that areas of conflict be resolved. Many problems can be averted by implementation of specific policies and procedures, after appropriate action by the medical staff outlining operating room goals and objectives, and the establishment of realistic lines of authority and communication. More important than the actual structure of the management components in developing an efficient and successful operating room is the ability of key management personnel to understand the dynamics of people and situations as they evolve. Management must also continually monitor and objectively evaluate the system so that areas of deficiency of conflict may be identified and policies or procedures adapted to adequately meet the changing needs of staff and patients. Anesthesiologists are in unique positions to deal with many of these problems and should play an active role in their resolution. As physicians and consultants, we have an understanding of the burden faced by surgeons relative to patient care. Because the majority of our working time is spent in the operating room, we have an opportunity to develop an effective working relationship with nursing staff.(ABSTRACT TRUNCATED AT 250 WORDS)
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