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1. Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support?

Author

Tara A. Lenk, Carlos E. Guerra-Londono, Thomas E. Graul, Marc A. Murinson, Prabhdeep K. Hehar, George Divine, and Raj K. Modak

Subjects
inhalational agent, minimum alveolar concentration, inotrope, vasopressor, perioperative morbidity, cardiac anesthesiology, Medicine
Abstract

Background and Aims: We hypothesized that maintaining a patient on moderate–high doses of potent inhalational agent for greater than 30 min during the post-bypass period would be an independent predictor of initiation and usage of either inotropic and/or vasopressor infusions. Setting and Design: This study is a retrospective design and approved by the institutional review board. The setting was a single-center, academic tertiary care hospital in Detroit, Michigan. Materials and Methods: Three-hundred, ninety-seven elective cardiac surgery patients were identified for chart review. Electronic medical records were reviewed to collect demographics and perioperative data. Statistics used include a propensity score regression adjusted analysis utilizing logistic regression models and a multivariable model. Results: A propensity score regression adjusted analysis was performed and then applied in both univariate and multivariate logistic regression models with a p value of ISO ≥ 0.5MAC, 30 min) in the post-bypass period. After adjusting for propensity score, this was found to be a significant predictor of inotrope and/or vasoconstrictor use post-bypass (OR 2.49, 95% CI 1.15–5.38, p = 0.021). In the multivariate model, pulmonary hypertension (OR 5.9; 95% CI 1.33–26.28; p = 0.02), Euroscore II (2.73; 95% CI 1.35–5.5; p = 0.005), and cardiopulmonary bypass hours (OR 1.86; 95% CI 1.02–3.4; p = 0.042) emerged as significant. Conclusions: This study showed that an ETISO ≥ 0.5MAC, 30 min exposure during the immediate post-bypass period during elective cardiac surgery was an independent predictor of a patient being started on inotrope or vasoconstrictor infusions. Further research should consider a prospective design and examine depth of anesthesia during the post-bypass period.

Published
2021
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2. Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support?

Author

Prabhdeep K. Hehar, Thomas E. Graul, Tara A. Lenk, Raj K. Modak, George Divine, Marc A. Murinson, and Carlos E. Guerra-Londono

Subjects
cardiac anesthesiology, Inotrope, medicine.medical_specialty, lcsh:Medicine, vasopressor, inhalational agent, Logistic regression, perioperative morbidity, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, Statistical significance, Cardiopulmonary bypass, medicine, business.industry, lcsh:R, 030208 emergency & critical care medicine, Perioperative, Institutional review board, Cardiac surgery, minimum alveolar concentration, ischemic preconditioning, cardioprotection, Anesthesia, Propensity score matching, inotrope, business
Abstract

Background and Aims: We hypothesized that maintaining a patient on moderate–high doses of potent inhalational agent for greater than 30 min during the post-bypass period would be an independent predictor of initiation and usage of either inotropic and/or vasopressor infusions. Setting and Design: This study is a retrospective design and approved by the institutional review board. The setting was a single-center, academic tertiary care hospital in Detroit, Michigan. Materials and Methods: Three-hundred, ninety-seven elective cardiac surgery patients were identified for chart review. Electronic medical records were reviewed to collect demographics and perioperative data. Statistics used include a propensity score regression adjusted analysis utilizing logistic regression models and a multivariable model. Results: A propensity score regression adjusted analysis was performed and then applied in both univariate and multivariate logistic regression models with a p value of &lt, 0.05 reaching statistical significance. Fifty-six percent of the participants had an exposure of greater than 30 min of a minimum alveolar concentration of isoflurane greater than 0.5 (ETISO ≥ 0.5MAC, 30 min) in the post-bypass period. After adjusting for propensity score, this was found to be a significant predictor of inotrope and/or vasoconstrictor use post-bypass (OR 2.49, 95% CI 1.15–5.38, p = 0.021). In the multivariate model, pulmonary hypertension (OR 5.9, 95% CI 1.33–26.28, p = 0.02), Euroscore II (2.73, 95% CI 1.35–5.5, p = 0.005), and cardiopulmonary bypass hours (OR 1.86, 95% CI 1.02–3.4, p = 0.042) emerged as significant. Conclusions: This study showed that an ETISO ≥ 0.5MAC, 30 min exposure during the immediate post-bypass period during elective cardiac surgery was an independent predictor of a patient being started on inotrope or vasoconstrictor infusions. Further research should consider a prospective design and examine depth of anesthesia during the post-bypass period.

Published
2021

3. Analyzing the impact of preoperative interrogation of cardiac implantable electronic devices

Author

Jose R Navas-Blanco, Raj K Modak, and Derrick V. Williams

Subjects
medicine.medical_specialty, Cohort Studies, american society of anesthesiologists, Anesthesiology, Humans, Medicine, Diseases of the circulatory (Cardiovascular) system, RD78.3-87.3, Adverse effect, Cardiac dysrhythmias, Retrospective Studies, cardiac implantable electronic devices, business.industry, Incidence (epidemiology), Arrhythmias, Cardiac, General Medicine, Perioperative, Defibrillators, Implantable, Heart Rhythm, Anesthesiology and Pain Medicine, heart rhythm society, RC666-701, Cohort, Emergency medicine, Original Article, Electronics, Cardiology and Cardiovascular Medicine, business, American society of anesthesiologists, perioperative cardiac events
Abstract

Background: Cardiac implantable electronic devices (CIED) are becoming more common for the management of underlying of cardiac dysrhythmias, and more patients with these devices are presenting for cardiac and noncardiac procedures. Methods: We performed a retrospective, cohort, single-center study at a tertiary teaching medical center, gathering 151 patients with CIED undergoing elective and emergent surgeries for the time period between November 2013 and December 2016. We aimed to determine whether patients with CIED had the device interrogated before surgery as recommended by the Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) consensus, whether this lack of compliance led to delay in the holding area before surgery and determine the presence of intra- or postoperative cardiac events in these patients. Results: A total of 76% of patients had interrogation of the device before surgery. Emergent cases were not interrogated as much as elective cases preoperatively (43% vs. 18%, respectively; P < 0.05). In total, 6% of cases had a CIED-related average holding area delay time of 54 minutes. Patients without preoperative device interrogation had more perioperative cardiac events than those who had the device checked (25% vs. 8%, respectively; odds ratio [OR] 0.26; 95% CI, 0.09–0.7, P < 0.013). Conclusions: Our findings suggest that preoperative interrogation of the device plays a significant role to minimize the incidence of perioperative cardiac adverse events. Institutional providers show a lack of compliance with HRS/ASA recommendations for preoperative CIED management. Further research is required to determine if improved compliance to recommendations will lead to enhanced outcomes.

Published
2021

4. PRO: The pulmonary artery catheter has a paramount role in current clinical practice

Author

Jose R Navas-Blanco, Maria Betances-Fernandez, Christian Szabo, and Raj K Modak

Subjects
medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Catheters, endocrine system diseases, Hemodynamic measurements, medicine.medical_treatment, Psychological intervention, Clinical settings, Physical examination, Review Article, Pulmonary Artery, hemodynamic monitoring, intensive care unit, law.invention, lcsh:RD78.3-87.3, law, Medicine, Humans, Cardiac Surgical Procedures, Intensive care medicine, medicine.diagnostic_test, business.industry, Pulmonary artery catheter, Hemodynamics, pulmonary artery catheterization, General Medicine, Cardiac surgery, Intensive care unit, humanities, Clinical Practice, critical care, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, lcsh:RC666-701, Catheterization, Swan-Ganz, Cardiology and Cardiovascular Medicine, business
Abstract

Ever since its clinical introduction, the utilization of the pulmonary artery catheter (PAC) has been surrounded by multiple controversies, mostly related to imprecise clinical indications and the complications derived from its placement. Currently, one of the most important criticisms of the PAC is the ambiguity in the interpretation of its hemodynamic measurements and therefore, in the translation of this data into specific therapeutic interventions. The popularity of the PAC stems from the fact that it provides hemodynamic data that cannot be obtained from clinical examination. The assumption is that this information would allow better understanding of the individual's hemodynamic profile which would trigger therapeutic interventions that improve patient outcomes. Nevertheless, even with the current diversity of hemodynamic devices available, the PAC remains a valuable tool in a wide variety of clinical settings. The authors present a review exposing the benefits of the PAC, current clinical recommendations for its use, mortality and survival profile, its role in goal-directed therapy, and other applications of the PAC beyond cardiac surgery and the intensive care unit.

Published
2021

5. List of Contributors

Author

Michael A. Acquaviva, Amit Bardia, Steven J. Barker, Richard A. Beers, James M. Berry, Enrico Camporesi, Jan Ehrenwerth, James B. Eisenkraft, Roger Eltringham, Varun K. Goyal, Nikolaus Gravenstein, Jayakar Guruswamy, Benjamin M. Hyers, Michael B. Jaffe, Karen Kan, Victor Lan, Wilton C. Levine, Robert G. Loeb, Katherine M. Loftus, S. Nini Malayaman, Keira P. Mason, Raj K. Modak, George Mychaskiw, Robert Neighbour, Michael A. Olympio, Ayodeji J. Omosule, Joseph Orr, David G. Osborn, Senthil Packiasabapathy, James H. Philip, William H. Rosenblatt, George Sheplock, Craig Spencer, Rajeev Subramanyam, John T. Sullivan, Felipe Urdaneta, Steven G. Venticinque, Scott G. Walker, and Matthew B. Weinger

Published
2021

6. Potential for Orogastric Tube Attached Transesophageal Echocardiography to Improve Intraoperative Image Quality

Author

Hiroyuki Kinoshita, Jaber El-Bashir, Dragos Galusca, Raj K Modak, Xiaoxia Han, Kaveh Marzbani, and Yoshihisa Morita

Subjects
medicine.medical_specialty, business.industry, Image quality, Heart Ventricles, Equipment Design, Anesthesiology and Pain Medicine, ROC Curve, Surgery, Computer-Assisted, Orogastric tube, Monitoring, Intraoperative, Humans, Medicine, Radiology, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Published
2018

7. CON: Pulmonary artery catheter use should be forgone in modern clinical practice

Author

Paula Trigo Blanco, Jose R Navas-Blanco, Raj K Modak, and Ashwin Vaidyanathan

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Modern medicine, Catheters, endocrine system diseases, Critical Illness, medicine.medical_treatment, education, Review Article, Pulmonary Artery, 030204 cardiovascular system & hematology, outcomes, lcsh:RD78.3-87.3, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, health services administration, medicine, Humans, Cardiac Surgical Procedures, Intensive care medicine, business.industry, Critically ill, Hemodynamics, Pulmonary artery catheter, food and beverages, pulmonary artery catheterization, General Medicine, humanities, Cardiac surgery, Clinical Practice, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, lcsh:RC666-701, Catheterization, Swan-Ganz, Cardiology and Cardiovascular Medicine, business
Abstract

The pulmonary artery catheter (PAC) and its role in the practice of modern medicine remains to be questioned and has experienced a substantial decline in its use in the most recent decades. The complications associated to its use, the lack of consistency of the interpretation provided by the PAC among clinicians, the development of new hemodynamic methods, and the deleterious cost profile associated to the PAC are some of the reasons behind the decrease in its use. Since its introduction into clinical practice, the PAC and the data obtained from its use became paramount in the management of critically ill patients as well as for the high-risk/invasive procedures. Initially, many clinicians were under the impression that regardless the clinical setting, acquiring the information provided by the PAC justified its use, until a growing body of evidence demonstrated its lack of mortality and morbidity improvement, as well as several reports of the presence of difficulties—some of them fatal—during its insertion. The authors present an updated review discussing the futility of the PAC in current clinical practice, the complications associated to its insertion, the lack of mortality benefit in critically ill patients and cardiac surgery, as well as present alternative hemodynamic methods to the PAC.

Published
2021

8. Modified Tricuspid Annular Plane Systolic Excursion Using Transesophageal Echocardiography and Its Utility to Predict Postoperative Course in Heart Transplantation and Left Ventricular Assist Device Implantation

Author

Tura Lencho, Sharadhadevi Gunasekaran, Raj K Modak, and Yoshihisa Morita

Subjects
Male, medicine.medical_specialty, Systole, medicine.medical_treatment, 030204 cardiovascular system & hematology, Postoperative management, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Retrospective Studies, Heart transplantation, Tricuspid valve, business.industry, Retrospective cohort study, Perioperative, Middle Aged, equipment and supplies, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, 030228 respiratory system, Fractional area change, Ventricular assist device, Cardiology, Heart Transplantation, Female, Heart-Assist Devices, Tricuspid Valve, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract

Perioperative right ventricular (RV) function is important for determining the postoperative course in heart transplantation (HT) and left ventricular assist device (LVAD) implantation. The authors describe a modified tricuspid annular plane systolic excursion (m-TAPSE) using transesophageal echocardiography and assessed its clinical utility in HT and LVAD.Retrospective medical record review.A single tertiary-care medical center.Forty-eight patients who underwent successful HT and 80 patients who underwent successful LVAD placement.Statistically significant correlation between m-TAPSE and RV fractional area change (FAC) was seen for HT and LVAD (r = 0.462, p0.01 and r = 0.597, p0.01, respectively). For HT, receiver operating characteristics curve analysis yielded that m-TAPSE0.64 cm provides 100% specificity and 57.1% sensitivity in predicting postoperative nitric oxide (NO) use, whereas RV FAC24.1% provides 95.1% specificity and 71.4% sensitivity in predicting postoperative NO use (area under the curve 0.798 [95% confidence interval (CI), 0.595-1] v 0.826 [95% CI, 0.581-1], p = 0.397). For LVAD, m-TAPSE0.71 cm provides 66.7% specificity and 87.5% sensitivity in predicting postoperative NO use, whereas RV FAC16.3% provides 79.4% specificity and 62.5% sensitivity in predicting postoperative NO use (area under the curve 0.829 [95% CI, 0.732-0.927] v 0.691 [95% CI, 0.54-0.842], p0.05).m-TAPSE validated a good correlation to RV systolic function as reflected by RV FAC for both HT and LVAD. For HT, m-TAPSE was helpful for predicting postoperative NO use; whereas for LVAD, m-TAPSE was helpful for predicting postoperative NO use and RV assist device implantation. m-TAPSE should be considered as a useful parameter to decide postoperative management for these cases.

Published
2017

9. Anesthesiology Keywords Review

Author

Raj K. Modak and Raj K. Modak

Subjects
Anesthetics, Anesthesiology--Terminology, Anesthesiology--Outlines, syllabi, etc
Abstract

The Second Edition of this handy review is formatted for ease of use. Over 300 detailed entries include key points, a discussion, and suggested readings for each keyword. Broad-based coverage addresses all areas of anesthesiology, including pediatrics. New key words have been added to this edition, and questions and answers at the end of each keyword presentation test and reinforce readers'knowledge. A companion website includes fully searchable text.

Published
2013

10. Contributors

Author

Michael A. Acquaviva, Brenton Alexander, Steven J. Barker, Richard Beers, James M. Berry, Gerardo Bosco, Sorin J. Brull, Enrico Camporesi, Maxime Cannesson, Jeffrey B. Cooper, Stephen F. Dierdorf, Jan Ehrenwerth, John H. Eichhorn, James B. Eisenkraft, Roger Eltringham, Chris R. Giordano, Nikolaus Gravenstein, Simon C. Hillier, Robert S. Holzman, Nicole Horn, Michael B. Jaffe, Ken B. Johnson, Wilton C. Levine, Robert G. Loeb, S. Nini Malayaman, Keira P. Mason, Diana G. McGregor, William L. McNiece, Raj K. Modak, George Mychaskiw, Mohamed Naguib, Jolie Narang, Michael A. Olympio, David G. Osborn, Bijal R. Parikh, James H. Philip, Timothy J. Quill, Henry Rosenberg, William H. Rosenblatt, Brian S. Rothman, Keith J. Ruskin, Harry A. Seifert, Maire Shelly, George Sheplock, David G. Silverman, Theodore Craig Smith, Craig Spencer, Collin Sprenker, Paul St. Jacques, Tracey Straker, John T. Sullivan, Elizabeth M. Thackeray, Daniel M. Thys, Steven G. Venticinque, Kyle A. Vernest, Scott G. Walker, Matthew B. Weinger, and Ross H. Zoll

Published
2013

11. Contributors

Author

Shamsuddin Akhtar, Brooke E. Albright, Sharif Al-Ruzzeh, Ferne R. Braveman, Michelle W. Diu, Samantha A. Franco, Loreta Grecu, Alá Sami Haddadin, Laura L. Hammel, Michael Hannaman, Antonio Hernandez Conte, Adriana Herrera, Zoltan G. Hevesi, Roberta L. Hines, Natalie F. Holt, Viji Kurup, William L. Lanier, Thomas J. Mancuso, Katherine E. Marschall, Veronica A. Matei, Raj K. Modak, Tori Myslajek, Adriana Dana Oprea, Jeffrey J. Pasternak, Wanda M. Popescu, Ramachandran Ramani, Robert B. Schonberger, Denis Snegovskikh, Gail A. Van Norman, Hossam Tantawy, Russell T. Wall, and Kelley Teed Watson

Published
2013

13. Pertussis (Whooping Cough)

Author

Raj K. Modak

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Pertussis/whooping cough, Medicine, business
Published
2011

15. Contributors

Author

Sanjib Adhikary, Jorge Aguilar, Charles Ahere, Moustafa Ahmed, Jane C. Ahn, Shamsuddin Akhtar, David B. Albert, Nasrin N. Aldawoodi, John T. Algren, Gracie Almeida-Chen, David Amar, Zirka H. Anastasian, Stephen Aniskevich, Solomon Aronson, Harendra Arora, Amit Asopa, Joshua H. Atkins, John G. Augoustides, Mohammad Fareed Azam, Catherine R. Bachman, Douglas R. Bacon, Andrew D. Badley, Emily Baird, Alethia Baldwin, Ryan Ball, Amir Baluch, David Bandola, Shawn Banks, Paul G. Barash, Kathleen E. Barrett, Shawn T. Beaman, Jonathan C. Beathe, Christopher D. Beatie, W. Scott Beattie, Perry S. Bechtle, G. Richard Benzinger, Lauren Berkow, Jeffrey M. Berman, Wendy K. Bernstein, Arnold J. Berry, Frederic Berry, Ulrike Berth, Walter Bethune, Sumita Bhambhani, Shobana Bharadwaj, Neil Bhatt, Frederic T. Billings, Wendy B. Binstock, David J. Birnbach, Michael Bishop, Stephanie Black, Mary A. Blanchette, James M. Blum, Krishna Boddu, Lara Bonasera, Richard L. Boortz-Marx, Cecil O. Borel, Gregory H. Botz, Charles D. Boucek, William Bradford, Jason C. Brainard, Michelle Braunfeld, Ferne R. Braveman, Caridad Bravo-Fernandez, Peter H. Breen, Marjorie Brennan, Tricia Brentjens, Megan A. Brockel, Jay B. Brodsky, Todd A. Bromberg, Adam J. Broussard, Chris Broussard, Carmen Labrie-Brown, Robert H. Brown, Charles S. Brudney, Sorin J. Brull, Claude Brunson, Trent Bryson, Jacob M. Buchowski, Stefan Budac, Zachary D. Bush, John Butterworth, Lisbeysi Calo, Christopher Canlas, Ayana Cannon, Shawn M. Cantie, Lisa Caplan, Marco Caruso, Davide Cattano, Charles B. Cauldwell, Laura Cavallone, Maurizio Cereda, Thomas M. Chalifoux, Susan Chan, Theodore G. Cheek, Alexander Chen, Samuel A. Cherry, Albert T. Cheung, Grace L. Chien, Peter T. Choi, Christopher Ciarallo, Franklyn Cladis, Anthony J. Clapcich, Richard B. Clark, Mindy Cohen, Neal H. Cohen, Robert I. Cohen, Stephan J. Cohn, Aisling Conran, Richard I. Cook, Randall F. Coombs, David M. Corda, Daniel Cormican, Darren Cousin, Vincent S. Cowell, Lyndsey Cox, Paula A. Craigo, Richard C. Cross, Roy F. Cucchiara, William H. Daily, Gaurang Dalal, Priti Dalal, Michael Danekas, Ahmed M. Darwish, Ribal Darwish, Suanne M. Daves, Kathleen Davis, Peter J. Davis, Bracken J. De Witt, Ellise Delphin, Seema Deshpande, Dawn P. Desiderio, Tricia Desvarieux, Laura K. Diaz, Christian Diez, Sanjay Dixit, Meenakshi Dogra, Karen B. Domino, Kathryn Dorhauer, Todd Dorman, Don D. Doussan, James Duke, Ann C. Duncan, Frank W. Dupont, Andrew Dziewit, L. Jane Easdown, R. Blaine Easley, Thomas J. Ebert, David M. Eckmann, Talmage D. Egan, Seth Eisdorfer, Nabil M. Elkassabany, Ryan P. Ellender, Logan S. Emory, Monique Espinosa, Lucinda L. Everett, Nauder Faraday, James J. Fehr, James M. Feld, Lynn A. Fenton, Laura H. Ferguson, Matthew Fiegel, Aaron M. Fields, Gordon N. Finlayson, Alan Finley, Gregory W. Fischer, Gary Fiskum, Molly Fitzpatrick, Russell Flatto, Lee A. Fleisher, Ronda Flower, Annette G. Folgueras, Patrick J. Forte, Joseph F. Foss, Charles J. Fox, William R. Furman, Robert Gaiser, David R. Gambling, Scott Gardiner, Matthew L. Garvey, Abraham C. Gaupp, Steven Gayer, Jeremy M. Geiduschek, Frank Gencorelli, Eric Gewirtz, Ghaleb A. Ghani, Charles P. Gibbs, Jeremy L. Gibson, Lori Gilbert, Kevin J. Gingrich, Gregory Ginsburg, Christopher Giordano, Christine E. Goepfert, Hernando Gomez, Santiago Gomez, Alanna E. Goodman, Stephanie R. Goodman, Alexandru Gottlieb, Ori Gottlieb, Allan Gottschalk, Basavana Gouda Goudra, Harry J. Gould, Nikolaus Gravenstein, Megan Graybill, William J. Greeley, Patrick Guffey, Ala Sami Haddadin, John G. Hagen, Karim Abdel Hakim, Michael Hall, N. James Halliday, Raafat S. Hannallah, Jeremy Hansen, C. William Hanson, Charles B. Hantler, Andrew P. Harris, Jonathan Hastie, Henry A. Hawney, Stephen O. Heard, James E. Heavner, James G. Hecker, Elizabeth A. Hein, Eugenie Heitmiller, Mark Helfaer, Lori B. Heller, Andrew Hemphill, Adrian Hendrickse, Frederick A. Hensley, Ian A. Herrick, Douglas Hester, Eric J. Heyer, Michael S. Higgins, Roberta Hines, Charles W. Hogue, Kenneth J. Holroyd, Natalie F. Holt, Simon J. Howell, Faisal Huda, Keith E. Hude, Hayden R. Hughes, James M. Hunter, Brad J. Hymel, James W. Ibinson, Karen E. Iles, Robert M. Insoft, Shiroh Isono, Yulia Ivashkov, Bozena R. Jachna, Anna Jankowska, Norah Janosy, Arun L. Jayaraman, Nathalia Jimenez, Judy G. Johnson, Lyndia Jones, Edmund H. Jooste, Zeev N. Kain, Maudy Kalangie, Philip L. Kalarickal, Ihab Kamel, Mia Kang, Ivan Kangrga, Ravish Kapoor, Helen W. Karl, Christopher Karsanac, Swaminathan Karthik, Jeffrey A. Katz, Alan Kaye, Adam M. Kaye, A. Murat Kaynar, Nancy B. Kenepp, Miklos D. Kertai, Mary A. Keyes, Sarah Khan, Swapnil Khoche, David Y. Kim, Jerry H. Kim, Kimberly M. King, Jeffrey Kirsch, Matthew A. Klopman, Paul R. Knight, Donald D. Koblin, W. Andrew Kofke, Vincent J. Kopp, Joseph R. Koveleskie, Courtney Kowalczyk, Valeriy V. Kozmenko, Kaylyn Krummen, Sapna R. Kudchadkar, Nathan Kudrick, Adrienne Kung, C. Dean Kurth, Robert Kyle, J. Lance LaFleur, Jason G. Lai, Kirk Lalwani, William L. Lanier, Dawn M. Larson, Richard M. Layman, Chris C. Lee, Mark J. Lema, W. Casey Lenox, Jacqueline M. Leung, Roy C. Levitt, Jerrold H. Levy, J. Lance Lichtor, Charles Lin, Sharon L. Lin, Karen S. Lindeman, Lesley Lirette, Ronald S. Litman, Qianjin Liu, Renyu Liu, Wen-Shin Liu, Justin Lockman, Stanley L. Loftness, Martin J. London, Philip D. Lumb, M. Concetta Lupa, Anne Marie Lynn, Devi Mahendran, Jeffrey Mako, Anuj Malhotra, Vinod Malhotra, Andrew M. Malinow, Mark G. Mandabach, Dennis T. Mangano, Sobia Mansoor, Inna Maranets, Jonathan B. Mark, Sinisa Markovic, H. Michael Marsh, Choendal Martin, Nicole D. Martin, Douglas Martz, Veronica A. Matei, Letha Mathews, Lynne G. Maxwell, Philip McArdle, John P. McCarren, Brenda C. McClain, Brian McClure, William A. McDade, Kathryn E. McGoldrick, Brian J. McGrath, Gregory L. McHugh, David McIlroy, Jason McKeown, Thomas M. McLoughlin, R. Yan McRae, William L. Meadow, Sameer Menda, William T. Merritt, David G. Metro, Berend Mets, Hosni Mikhaeil, David W. Miller, Jessica Miller, Mohammed Minhaj, Marek A. Mirski, Nanhi Mitter, Alexander J.C. Mittnacht, Raj K. Modak, Pierre Moine, Constance L. Monitto, Richard C. Month, Richard E. Moon, Laurel E. Moore, Roger A. Moore, Thomas A. Moore, Debra E. Morrison, Jonathan Moss, John R. Moyers, Jesse J. Muir, Adam J. Munson-Young, Stanley Muravchick, John M. Murkin, Peter Nagele, Peter A. Nagi, Daniel A. Nahrwold, Michael L. Nahrwold, Madhavi Naik, Manchula Navaratnam, Stephan P. Nebbia, Priscilla Nelson, Thai T. Nguyen, Viet Nguyen, Stavroula Nikolaidis, Zoulfira Nisnevitch, Dolores B. Njoku, Mary J. Njoku, Edward J. Norris, Omonele O. Nwokolo, Daniel Nyhan, William T. O'Byrne, Edward A. Ochroch, Andrew Oken, Nathan Orgain, Nancy E. Oriol, Pedro Orozco, Andreas M. Ostermeier, Andranik Ovassapian, Mehmet S. Ozcan, Ira Padnos, Sheela S. Pai, Nirvik Pal, Dhamodaran Palaniappan, Susan K. Palmer, Howard D. Palte, Wei Pan, Oliver Panzer, Sibi Pappachan, Anthony Passannante, Dennis A. Patel, Dilipkumar K. Patel, Kirit M. Patel, Samir Patel, Shalin Patel, Sanup Pathak, Minda L. Patt, Ronald W. Pauldine, Olga Pawelek, Tim Pawelek, Kiarash Paydar, Ronald G. Pearl, Christine Peeters-Asdourian, Padmavathi R. Perela, Charise T. Petrovitch, Patricia H. Petrozza, Dennis Phillips, Mark C. Phillips, Christine Piefer, Edgar J. Pierre, S. William Pinson, Evan G. Pivalizza, Raymond M. Planinsic, Don Poldermans, Joel M. Pomerantz, Jason E. Pope, Wanda M. Popescu, Vivian H. Porche, Jahan Porhomayon, Dmitry Portnoy, Corinne K. Postle, Paul J. Primeaux, Donald S. Prough, Ferenc Puskas, Carlos A. Puyo, Forrest Quiggle, Mary Rabb, Bronwyn R. Rae, Muhammad B. Rafique, Jesse M. Raiten, Arvind Rajagopal, Srinivasan Rajagopal, Gaurav Rajpal, Chandra Ramamoorthy, Ira J. Rampil, James G. Ramsay, James A. Ramsey, Vidya N. Rao, Joana Ratsiu, Selina Read, Ronjeet Reddy, Leila L. Reduque, David L. Reich, Karene Ricketts, Cameron Ricks, Bernhard Riedel, Jyotsna Rimal, Joseph Rinehart, James M. Riopelle, Stacey A. Rizza, Amy C. Robertson, Stephen Robinson, Peter Rock, Yillam F. Rodriguez-Blanco, Michael F. Roizen, Daniel M. Roke, Ryan Romeo, Joseph Rosa, David A. Rosen, Kathleen Rosen, Stanley H. Rosenbaum, Andrew D. Rosenberg, Andrew L. Rosenberg, Henry Rosenberg, Meg A. Rosenblatt, Steven Roth, Brian Rothman, Justin L. Rountree, Matthew J. Rowan, Marc Rozner, Ryan Rubin, Stephen M. Rupp, W. John Russell, Thomas A. Russo, Alecia L. Sabartinelli, Tetsuro Sakai, Orlando J. Salinas, Paul L. Samm, Jibin Samuel, Tor Sandven, Ted J. Sanford, Joshua W. Sappenfield, Ponnusamy Saravanan, Subramanian Sathishkumar, R. Alexander Schlichter, Eric Schnell, David L. Schreibman, Armin Schubert, Peter Schulman, Todd A. Schultz, Alan Jay Schwartz, Jamie McElrath Schwartz, Jeffrey J. Schwartz, Benjamin K. Scott, Joseph L. Seltzer, Tamas Seres, Daniel I. Sessler, Navil F. Sethna, Amar Setty, Paul W. Shabaz, Pranav Shah, Saroj Mukesh Shah, Milad Sharifpour, Joanne Shay, Jay Shepherd, Jeffrey S. Shiffrin, Marina Shindell, Daniel Siker, Richard Silverman, Brett A. Simon, Nina Singh, Ashish C. Sinha, Robert N. Sladen, Kieran A. Slevin, Tod B. Sloan, Kathleen Smith, Timothy E. Smith, Victoria Smoot, Denis Snegovskikh, Betsy Ellen Soifer, Molly Solorzano, James M. Sonner, Aris Sophocles, James A. Sparrow, Joan Spiegel, Bruce D. Spiess, Ramprasad Sripada, Stanley W. Stead, Joshua D. Stearns, Kelly Stees, Clinton Steffey, Christopher Stemland, John Stene, Christopher T. Stephens, Tracey L. Stierer, O. Jameson Stokes, Bryant W. Stolp, David F. Stowe, Ted Strickland, Suzanne Strom, Erin A. Sullivan, Michele Sumler, Dajin Sun, Lena Sun, Esther Sung, Veronica C. Swanson, Judit Szolnoki, Joe Talarico, Gee Mei Tan, Darryl T. Tang, Paul Tarasi, René Tempelhoff, John E. Tetzlaff, Alisa C. Thorne, Arlyne Thung, Vasanti Tilak, Kate Tobin, Joseph R. Tobin, Michael J. Tobin, R. David Todd, Matthew Tomlinson, Thomas J. Toung, Lien B. Tran, Minh Chau Joe Tran, Kevin K. Tremper, Sanyo Tsai, George S. Tseng, Kenneth J. Tuman, Avery Tung, Cynthia Tung, Rebecca Twersky, Mark Twite, John A. Ulatowski, Michael Urban, Manuel C. Vallejo, Andrea Vannucci, Albert J. Varon, Anasuya Vasudevan, Susheela Viswanathan, Alexander A. Vitin, Wolfgang Voelckel, Ann Walia, Russell T. Wall, Terrence Wallace, Shu-Ming Wang, David C. Warltier, Lucy Waskell, Scott Watkins, Denise Wedel, Stuart J. Weiss, Charles Weissman, Nathaen Weitzel, Gregory Weller, Gina Whitney, Robert A. Whittington, Danny Wilkerson, Nancy C. Wilkes, Michael Williams, Jimmy Windsor, Bernard Wittels, Gregory A. Wolff, Andrew K. Wong, Stacie N. Woods, A.J. Wright, Zheng Xie, Christopher C. Young, Ian Yuan, Francine S. Yudkowitz, James R. Zaidan, Paul Zanaboni, Warren M. Zapol, Angela Zimmerman, and Maurice S. Zwass

Published
2011

16. CONTRIBUTORS

Author

Shamsuddin Akhtar, Michael S. Avidan, Bruno Bissonnette, Ferne R. Braveman, Susan Garwood, Marbelia Gonzalez, Alá Sami Haddadin, Adriana Herrera, Zoltan G. Hevesi, Roberta L. Hines, Viji Kurup, William L. Lanier, Charles Lee, Igor Luginbuehl, Inna Maranets, Katherine E. Marschall, Linda J. Mason, Raj K. Modak, Jeffrey J. Pasternak, Wanda M. Popescu, Christine S. Rinder, Jeffrey J. Schwartz, Hossam Tantawy, Nalini Vadivelu, Russell T. Wall, Matthew C. Wallace, and Kelley Teed Watson

Published
2008

17. CON: Pulmonary artery catheter use should be forgone in modern clinical practice

Author

Jose R Navas-Blanco, Ashwin Vaidyanathan, Paula Trigo Blanco, and Raj K Modak

Subjects
hemodynamics, outcomes, pulmonary artery catheterization, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The pulmonary artery catheter (PAC) and its role in the practice of modern medicine remains to be questioned and has experienced a substantial decline in its use in the most recent decades. The complications associated to its use, the lack of consistency of the interpretation provided by the PAC among clinicians, the development of new hemodynamic methods, and the deleterious cost profile associated to the PAC are some of the reasons behind the decrease in its use. Since its introduction into clinical practice, the PAC and the data obtained from its use became paramount in the management of critically ill patients as well as for the high-risk/invasive procedures. Initially, many clinicians were under the impression that regardless the clinical setting, acquiring the information provided by the PAC justified its use, until a growing body of evidence demonstrated its lack of mortality and morbidity improvement, as well as several reports of the presence of difficulties—some of them fatal—during its insertion. The authors present an updated review discussing the futility of the PAC in current clinical practice, the complications associated to its insertion, the lack of mortality benefit in critically ill patients and cardiac surgery, as well as present alternative hemodynamic methods to the PAC.

Published
2021
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18. PRO: The pulmonary artery catheter has a paramount role in current clinical practice

Author

Christian Szabo, Maria Betances-Fernandez, Jose R Navas-Blanco, and Raj K Modak

Subjects
cardiac surgery, critical care, hemodynamic monitoring, intensive care unit, pulmonary artery catheterization, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Ever since its clinical introduction, the utilization of the pulmonary artery catheter (PAC) has been surrounded by multiple controversies, mostly related to imprecise clinical indications and the complications derived from its placement. Currently, one of the most important criticisms of the PAC is the ambiguity in the interpretation of its hemodynamic measurements and therefore, in the translation of this data into specific therapeutic interventions. The popularity of the PAC stems from the fact that it provides hemodynamic data that cannot be obtained from clinical examination. The assumption is that this information would allow better understanding of the individual's hemodynamic profile which would trigger therapeutic interventions that improve patient outcomes. Nevertheless, even with the current diversity of hemodynamic devices available, the PAC remains a valuable tool in a wide variety of clinical settings. The authors present a review exposing the benefits of the PAC, current clinical recommendations for its use, mortality and survival profile, its role in goal-directed therapy, and other applications of the PAC beyond cardiac surgery and the intensive care unit.

Published
2021
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19. Perioperative care of heart transplant recipients undergoing non-cardiac surgery

Author

Jose R Navas-Blanco and Raj K Modak

Subjects
anesthesia, heart transplantation, non-cardiac surgery, outcomes, perioperative care, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since its original introduction into the medical practice in 1967. Substantial advances in post-operative intensive care, surgical prophylaxis, and anti-rejection drugs have clearly impacted survivability after OHT, therefore the volume of patients presenting for non-cardiac surgical procedures is expected to continue to escalate in the upcoming years. There are a number of caveats associated with this upsurge of post-OHT patients requiring non-cardiac surgery, including presenting to healthcare facilities without the resources and technology necessary to manage potential perioperative complications or that may not be familiar with the care of these patients, facilities in which a cardiac anesthesiologist is not available, patients presenting for emergency procedures and so forth. The perioperative care of patients after OHT introduces several challenges to the anesthesiologist including preoperative risk assessments different to the general population and intraoperative management of a denervated organ with altered response to medications and drug-drug interactions. The present review aims to synopsize current data of patients presenting for non-cardiac surgery after OHT, surgical aspects of the transplant that may impact perioperative care, physiology of the transplanted heart as well as anesthetic considerations.

Published
2021
Full Text
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