Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr.
Despite numerous reports of cerebral damage in cardiac surgery, the subject has not been given the attention it requires. This book, with a preface by Torkel Aberg, will remedy that situation. The causes and incidence of pre- and post-operative cerebral damage are considered in the first section. Cardiac surgery patients frequently have preoperative cerebral impairment, not suprising when one considers the impaired circulation from a damaged heart and the brain's prodigious need for blood. Moreover, several perioperative aspects of surgical procedures have been considered as possible causes of cerebral dysfunction, for example: microbubbles, toxic by-products, non-pulsatile blood flow. The second section describes how imaging techniques (CT scan, MRI, regional cerebral blood flow imaging), and functional assessment techniques. (PET scan, EEG, BEAM and evoked potentials) can be used to measure cerebral damage. In the third section, psychometric and neuropsychological techniques are used to assess impaired mental abilities (abstract thinking, language, memory, visuo-spatial ability, mental flexibility, attention and concentration). The final section explores the relationship between cerebral dysfunction and psychopathology (several types of depression, anxiety, and aspects of organic brain syndrome, delirium and dementia).
Georg Rodewald University of Hamburg Hamburg, Federal Republic of Germany Allen E. Willner Hillside Hospital Glen Oaks, NY In contrast to the initial years of cardiac surgery (37 years ago), there is now increasing interest in cerebral protection. Rodewald  in 1978 was among the first to point out the surgeon's concern with "psychopathological problems" and Taylor  in 1989 stressed that" ••• the awareness of the cerebral consequences of open heart surgery has risen considerably in recent years • • • " This book reviews the evidence for neurological, psychological, and neuropsycho logical reactions to cardiac surgery. In previous studies one problem is that small samples of patients were studied with different measuring instruments so that it was difficult to ma~e sense of inconsistent findings. Considerable controversy resulted with little ability to sort out discrepant findings. It appeared that a large multi center study using uniform measures might help clarify the picture.
primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can be measured in a reproducible manner so that valid comparisons can be made. Keeping these recommendations of analysing quality of life within the context of patients who have undergone open heart surgery, it seemed appro priate to me to separate the influence of various forms of open heart surgery into five aspects of life which can comprehensively reflect the quality of life outcome of the operation. These five 'components' are (1) Physiological state, which summarises the traditionally reported incidence of operative mortality and morbidity, objectively and subjectively measured physical ca pacity, and the residual symptoms, treatment and long-term survival. (2) Intellectual functioning relates to the psychoneurolgocial deficit in memory, reasoning or judgement because of cerebral microembolism and hypo perfusion during cardiopulmonary bypass.
Part of the Monographs in Cardiac Surgery Series – Introducing ‘basic science into the cardiac operating room’. Fast systematic review of small areas of cardiac surgery including up-to-date information. This will allow more rapid publication than the alternative cardiac surgery ‘tomes’. This entry into the series will provide readers with a complete review of the current understanding in brain injury and the methods used to avoid or limit its effects on patient morbidity and mortality.
Anesthesia and the Central Nervous System is a textbook for a postgraduate course as well as a reference for all anesthesiologists which presents many of the latest concepts in anesthesiology within a brief formal presentation. An outstanding faculty presents topics relating to the biochemistry, physiology, and pharmacology of the nervous system, the anesthetic management of intracranial and spinal cord surgery, and the intensive care management of central nervous system disease. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia. This textbook is the eleventh in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City.
Hardbound. This book summarizes and reviews the current techniques and recent advances in brain protection during aortic surgery which were presented at the Symposium. Clinical application and basic mechanism of the methods of hypothermic circulatory arrest, antegrade cerebral perfusion and retrograde cerebral perfusion are discussed. This book will provide the basis of better and further understanding of brain protection in aortic surgery. It is directed not only at physicians, but all medical and allied personnel who deal with patients before, during or after aortic arch surgery. They include cardiovascular surgeons, cardiologists, neurologists and intensivists. Other potential readers are residents, nurses, medical students and paramedical personnel.
Optimize perioperative outcomes with Kaplan’s Cardiac Anesthesia! Dr. Joel L. Kaplan and a host of other authorities help you make the best use of the latest techniques and navigate your toughest clinical challenges. Whether you are administering anesthesia to cardiac surgery patients or to cardiac patients undergoing non-cardiac surgery, you’ll have the guidance you need to avoid complications and ensure maximum patient safety. Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices. Update your understanding of cardiovascular and coronary physiology, and the latest advances in molecular biology and inflammatory response mechanisms. Master the newest approaches to perioperative assessment and management, including state-of-the art diagnostic techniques. Tap into the latest knowledge about 2D and 3D transesophageal echocardiography, anesthesia delivery for minimally invasive/robotic cardiac surgery, assist devices and artificial hearts, cardiac pacing, cardiac resynchronization therapy, ablation techniques, and more. Access the complete contents online at Expert Consult, plus additional online-only features including an ECG atlas...videos that demonstrate 2-D and 3-D TEE techniques in real time...and an Annual Year End Highlight from the Journal of Cardiovascular Anesthesia that’s posted each February. Clearly visualize techniques with over 800 full-color illustrations.
Authored by the same stellar editors and contributors responsible for Kaplan's Cardiac Anesthesia, this title presents today's most essential clinical knowledge in cardiac anesthesia in a practical, user-friendly format. A manageable size and affordable price makes this an ideal purchase for every clinician who would like an economical yet dependable resource in cardiac anesthesia. Provides the key cardiac anesthesia information you need to know by authorities you trust. Uses a concise, user-friendly format that helps you locate the answers you need quickly. Features key points boxes in each chapter to help you quickly access the most crucial information. Includes annotated references that guide you to the most practical additional resources. Features a portable size and clinical emphasis that facilitates and enhances bedside patient care. Contains the authoritative guidance of larger reference books without the expense.
This comprehensive monograph provides an understanding of cardiopulmonary bypass with discussions of such areas as pump flow ranges, methods of producing anesthesia during bypass, complement activation, stress response, and blood flow distribution. Describes the risks of neurologic and neuropsychiatric dysfunction after bypass. Covers emergence from bypass and the various uses, benefits, and drawbacks of inotropes, vasodilators, intra-aortic balloon pumps, and left ventricular assist devices.
New edition of a text discussing cardiopulmonary bypass, from the multidisciplinary perspectives that represent team effort in the clinical management of this surgery. Gravlee (anesthesiology, Ohio State U. Medical Center), Richard F. Davis (anesthesiology, Portland Veterans Administration Medical Center), Mark Kurusz (perfusionist, U. of Texas Medical Branch) and Joe R. Utley (former chief of cardiac surgery, Spartanburg Regional Medical Center) present 35 contributions that discuss history, equipment, physiology and pathology, hematology, and clinical applications. Annotation copyrighted by Book News, Inc., Portland, OR
Make informed clinical decisions with reliable, up-to-date guidance from Evidence-Based Practice of Anesthesia, 3rd Edition! Leading authority Lee A. Fleisher, MD expertly explores the full range of important issues in perioperative management, discussing the available options, examining the relevant research, and presenting practical recommendations. Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located. Make sound, evidence-based decisions on every aspect of patient care: preoperative assessment, monitoring and administration of anesthesia during surgery, postoperative intensive care management, and postoperative pain management. Master the current best practices you need to know for day-to-day practice and oral board review. Confidently navigate the latest issues thanks to new chapters on optimal airway management in GI endoscopy, the role of Ketamine for perioperative management, fast-track surgery, and hypothermia after intraoperative cardiac arrest, plus many other vital updates. Efficiently translate evidence into practice with numerous quick-reference tables and short, well-organized chapters that promote fast and effective decision making. Get practical decision-making tools you can use in both routine care and complicated or special situations.
Through seven successful editions, Sabiston & Spencer Surgery of the Chest has set the standard in cardiothoracic surgery references. Now, the new 8th Edition, edited by Frank W. Sellke, MD, Pedro J. del Nido, MD, and Scott J. Swanson, MD, carries on this tradition with updated coverage of today's essential clinical knowledge from leaders worldwide. Guidance divided into three major sections—Adult Cardiac Surgery, Congenital Heart Surgery, and Thoracic Surgery—lets you quickly find what you need, while new and revised chapters reflect all of the important changes within this rapidly evolving specialty. Expert Consult functionality—new to this edition—enables you to access the complete contents of the 2-volume set from anyplace with an Internet connection for convenient consultation where and when you need it. This is an ideal source for mastering all of the most important current knowledge and techniques in cardiac and thoracic surgery—whether for specialty board review or day-to-day practice. Features short, focused chapters that help you find exactly what you need. Presents the work of international contributors who offer a global view of the entire specialty. Covers thoracic surgery as well as adult and pediatric cardiac surgery for a practical and powerful single source. Includes nearly 1,100 illustrations that help to clarify key concepts. Features online access to the complete contents of the 2-volume text at expertconsult.com for convenient anytime, anywhere reference. Covers the hottest topics shaping today's practice, including the latest theory and surgical techniques for mitral valve disease, advances in the treatment of congenital heart disease, minimally invasive surgical approaches to the treatment of adult and congenital cardiac disease and thoracic disease, stent grafting for aortic disease, and cell-based therapies. Your purchase entitles you to access the web site until the next edition is published, or until the current edition is no longer offered for sale by Elsevier, whichever occurs first. Elsevier reserves the right to offer a suitable replacement product (such as a downloadable or CD-ROM-based electronic version) should access to the web site be discontinued.
Provide the latest in superior quality care for critically ill children with the full-color, updated 4th Edition of Fuhrman and Zimmerman’s Pediatric Critical Care. In print, and now online, Drs. Bradley P. Fuhrman and Jerry J. Zimmerman use a comprehensive, organ-systems approach to help you manage a full range of disease entities. Get up-to-the-minute knowledge of topics such as acute lung injury, multiple organ dysfunction syndrome, and more. Implement new clinical techniques and diagnostic tests, weigh the varying perspectives of six associate editors with expertise in the field, reference 1,000+ illustrations to aid diagnosis, and keep sharp with online access to board-style review questions. This definitive title will ensure that you consistently deliver the very best intensive care to your pediatric patients. Focus on the development, function, and treatment of a wide range of disease entities with the text’s clear, logical, organ-system approach. Keep all members of the pediatric ICU team up to date with coverage of topics particularly relevant to their responsibilities. Keep current with the latest developments in palliative care, mass casualty/epidemic disease, acute respiratory failure, non-invasive ventilation, neurocritical care, neuroimaging, hypoxic-ischemic encephalopathy, stroke and intracerebral hemorrhage, systemic inflammatory response syndrome, acute lung injury, multiple organ dysfunction syndrome, and much more. Quickly find the information you need with sections newly reorganized for easier access. Gain the perspectives of six expert associate editors on all the new developments in the field. Understand complex concepts quickly and conclusively with a brand new full-color format and more than 1,000 illustrations. Search the full text, download the image library, and access online board review questions targeting every relevant topic, all at www.expertconsult.com.
The most widely used clinical reference in cardiac anesthesia, A Practical Approach to Cardiac Anesthesia, provides complete information on drugs, monitoring, cardiopulmonary bypass, circulatory support, and anesthetic management of specific cardiac disorders. This large handbook incorporates clinically relevant basic science into a practical "what-to-do" approach and is written in an easy-to-read outline format. Designed for practicing anesthesiologists, as well as anesthesia residents, fellows in cardiothoracic anesthesia, perfusionists, and all other anesthesia practitioners, this handbook delivers comprehensive and expertly presented views of the discipline – with outstanding color graphics and the practical, how-to style of a manual.