Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach

Denault, André; Roberts, Michael; Cios, Theodore J.; Malhotra, Anita K.; Paquin, Sarto C.; Tan, Stéphanie; Cavayas, Yiorgos Alexandros; Desjardins, Georges; Klick, John

doi:10.1213/ane.0000000000005537

Cited by 8 publications

(4 citation statements)

References 132 publications

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“…The deterioration of these parameters should prompt interventions to increase oxygen delivery. Additionally, if abnormally high serum lactate levels persist intra‐operatively, evaluation of blood flow in the abdominal aortic branches using transesophageal echocardiography [10], and subsequent diagnostic laparoscopy and/or exploratory laparotomy should be considered.…”

Section: Discussionmentioning

confidence: 99%

Measuring and maintaining organ perfusion in a patient with Takayasu's arteritis undergoing cardiac surgery*

Dan¹,

Takahashi

Lefor

2023

Anaesthesia Reports

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SummaryTakayasu's arteritis is a rare vasculitis affecting the aorta and its branches. Disease progression can result in arterial stenosis and subsequent organ dysfunction. Estimating organ perfusion by measuring the peripheral blood pressure can be challenging because it may be altered by arterial stenosis. We report the case of a 61‐year‐old woman with Takayasu's arteritis with aortic and mitral regurgitation who presented for aortic valve replacement and mitral valvuloplasty. Peripheral arterial pressure was considered a less reliable surrogate for organ perfusion because the patient had diminished blood flow in both the lower and upper extremities. In addition to the bilateral radial arterial pressure, the blood pressure in the ascending aorta was monitored to estimate the patient's organ perfusion pressure during cardiopulmonary bypass. The initial target blood pressure was determined based on the pre‐operative baseline and modified by measurement of the aortic pressure. Cerebral oximetry using near‐infrared spectroscopy and mixed venous saturation was monitored to estimate oxygen supply‐demand balance, which helped evaluate cerebral perfusion and determine the transfusion threshold. The entire procedure was uneventful, and no organ dysfunction was observed postoperatively.

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Section: Discussionmentioning

confidence: 99%

Measuring and maintaining organ perfusion in a patient with Takayasu's arteritis undergoing cardiac surgery*

Dan¹,

Takahashi

Lefor

2023

Anaesthesia Reports

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“…The interpretation of these signs of venous congestion comes from data from observational studies (Table 2). The use of these extracardiac ultrasound findings is complementary to the conventional hemodynamic data obtained using a pulmonary artery catheter [58,59 ▪ ]. Although these are indirect findings, their presence should be looked for in patients suspected of right ventricular dysfunction [60,61].…”

Section: Extra-cardiac Echocardiography Assessmentsmentioning

confidence: 98%

New developments in the understanding of right ventricular function in acute care

Couture

Grønlykke

Denault

2022

Current Opinion in Critical Care

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Purpose of reviewRight ventricular dysfunction has an important impact on the perioperative course of cardiac surgery patients. Recent advances in the detection and monitoring of perioperative right ventricular dysfunction will be reviewed here. Recent findingsThe incidence of right ventricular dysfunction in cardiac surgery has been associated with unfavorable outcomes. New evidence supports the use of a pulmonary artery catheter in cardiogenic shock. The possibility to directly measure right ventricular pressure by transducing the pacing port has expanded its use to track changes in right ventricular function and to detect right ventricular outflow tract obstruction. The potential role of myocardial deformation imaging has been raised to detect patients at risk of postoperative complications.

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“…4 Transgastric abdominal ultrasound was also used to assess RV dysfunction. 32 High portal venous flow pulsatility is associated with RV dysfunction and an increased risk of postoperative complications. 33 We used portal venous flow pulsatility as a marker of RV dysfunction in the perioperative period.…”

Section: Epoprostenol and Milrinone Administration (Pharmacologic Tre...mentioning

confidence: 99%

Pulmonary Vasodilator Response of Combined Inhaled Epoprostenol and Inhaled Milrinone in Cardiac Surgical Patients

Elmi-Sarabi

Jarry

Couture

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are major complications in cardiac surgery. Intraoperative management of patients at high risk of RV failure should aim to reduce RV afterload and optimize RV filling pressures, while avoiding systemic hypotension, to facilitate weaning from cardiopulmonary bypass (CPB). Inhaled epoprostenol and inhaled milrinone (iE&iM) administered in combination before CPB may represent an effective strategy to facilitate separation from CPB and reduce requirements for intravenous inotropes during cardiac surgery. Our primary objective was to report the rate of positive pulmonary vasodilator response to iE&iM and, second, how it relates to perioperative outcomes in cardiac surgery. METHODS: This is a retrospective cohort study of consecutive patients with PH or RV dysfunction undergoing on-pump cardiac surgery at the Montreal Heart Institute from July 2013 to December 2018 (n = 128). iE&iM treatment was administered using an ultrasonic mesh nebulizer before the initiation of CPB. Demographic and baseline clinical data, as well as hemodynamic, intraoperative, and echocardiographic data, were collected using electronic records. An increase of 20% in the mean arterial pressure (MAP) to mean pulmonary artery pressure (MPAP) ratio was used to indicate a positive response to iE&iM. RESULTS: In this cohort, 77.3% of patients were responders to iE&iM treatment. Baseline systolic pulmonary artery pressure (SPAP) (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.24-2.16 per 5 mm Hg; P = .0006) was found to be a predictor of pulmonary vasodilator response, while a European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score >6.5% was a predictor of nonresponse to treatment (≤6.5% vs >6.5% [reference]: OR, 5.19; 95% CI, 1.84-14.66; P = .002). Severity of PH was associated with a positive response to treatment, where a higher proportion of responders had MPAP values >30 mm Hg (42.4% responders vs 24.1% nonresponders; P = .0237) and SPAP values >55 mm Hg (17.2% vs 3.4%; P = .0037). Easier separation from CPB was also associated with response to iE&iM treatment (69.7% vs 58.6%; P = .0181). A higher proportion of nonresponders had a very difficult separation from CPB and required intravenous inotropic drug support compared to responders, for whom easy separation from CPB was more frequent. Use of intravenous inotropes after CPB was lower in responders to treatment (8.1% vs 27.6%; P = .0052). CONCLUSIONS: A positive pulmonary vasodilator response to treatment with a combination of iE&iM before initiation of CPB was observed in 77% of patients. Higher baseline SPAP was an independent predictor of pulmonary vasodilator response, while EuroSCORE II >6.5% was a predictor of nonresponse to treatment. (Anesth Analg 2023;136:282-94) KEY POINTS• Question: Can a combination of inhaled epoprostenol and inhaled milrinone (iE&iM) administered before cardiopulmonary bypass (CPB) provide a positive pulmonary vasodilator response? • Findings: A positive pul...

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Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach

Cited by 8 publications

References 132 publications

Measuring and maintaining organ perfusion in a patient with Takayasu's arteritis undergoing cardiac surgery*

Measuring and maintaining organ perfusion in a patient with Takayasu's arteritis undergoing cardiac surgery*

New developments in the understanding of right ventricular function in acute care

Pulmonary Vasodilator Response of Combined Inhaled Epoprostenol and Inhaled Milrinone in Cardiac Surgical Patients

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