Postoperative ICU management of vascular surgery patients.
Anesthesiology clinics
Crimi, E., Hill, C. C.
2014; 32 (3): 735-757
Abstract
Critical care management of vascular surgical patients poses significant challenges owing to patients' comorbidities and the magnitude of the surgical procedures. The primary goals of the anesthesiologist and intensivist are reestablishing preoperative homeostasis, optimizing hemodynamics until return of normal organ function, and managing postoperative complications promptly and effectively. Postoperative critical care management demands a detailed knowledge of the various vascular surgical procedures and the potential postoperative complications. In this review, the authors describe the postoperative complications related to the major specific vascular surgical procedures and their perioperative management.
View details for DOI 10.1016/j.anclin.2014.05.001
View details for PubMedID 25113730
CASE 4-2014Ascending Aortic Pseudoaneurysm Repair With Deep Hypothermic Circulatory Arrest in an Adult Congenital Heart Disease Patient With Heparin-Induced Thrombocytopenia.
Journal of cardiothoracic and vascular anesthesia
Maxwell, B. G., Harrington, K. B., Hill, C. C., Banayan, J. M., Spiess, B. D.
2014; 28 (3): 810-818
Tricuspid regurgitation jet velocity suggestive of severe pulmonary hypertension.
Journal of cardiothoracic and vascular anesthesia
Maxwell, B. G., Oakes, D. A., Lobato, R. L., Hill, C. C.
2014; 28 (2): 433-434
Open aortic valve replacement in a patient with Glanzmann's thrombasthenia: a multidisciplinary strategy to minimize perioperative bleeding.
Transfusion
Sheikh, A. Y., Hill, C. C., Goodnough, L. T., Leung, L. L., Fischbein, M. P.
2014; 54 (2): 300-305
Abstract
BACKGROUND: Glanzmann thrombasthenia (GT) is an autosomal recessive disorder in which the platelet (PLT) glycoprotein IIb/IIIa complex is either deficient or dysfunctional. In its most severe form, GT may result in spontaneous bleeding, although most cases are first detected in the setting of an invasive procedure. CASE REPORT: A 59-year-old male with Type I GT and a history of transfusion reactions to PLT infusions developed severe aortic stenosis secondary to bicuspid valve disease. He successfully underwent open aortic valve replacement with cardiopulmonary bypass without perioperative bleeding complications. RESULTS: A multidisciplinary team (anesthesia, hematology, cardiac surgery, and transfusion medicine) was established to optimize perioperative hematologic management. Bleeding risk was assessed given the patient's prior history and a dosing timeline for administration of blood products and recombinant clotting factors was established. Successful management was achieved during the operation by prophylactic administration of HLA-matched PLTs and Factor VIIa. Prophylactic PLT administration was continued through the immediate postoperative period and no bleeding complications occurred. Thromboelastograms (TEGs) were used in conjunction with traditional hematologic laboratory analysis to optimize clinical management. CONCLUSION: Patients with GT requiring cardiac surgical procedures are at high risk for perioperative bleeding complications. This case report illustrates the importance of multidisciplinary planning, TEG analysis, and the judicious use of recombinant factors to minimize operative bleeding risk.
View details for DOI 10.1111/trf.12275
View details for PubMedID 23710629
Airway Management and Perioperative Decision Making in the Patient With Severe Pulmonary Hypertension Who Requires Emergency Noncardiac Surgery
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
Maxwell, B. G., Pearl, R. G., Kudelko, K. T., Zamanian, R. T., Hill, C. C.
2012; 26 (5): 940-944
Use of point-of-care testing for plasma therapy
TRANSFUSION
Goodnough, L. T., Hill, C. C.
2012; 52: 56S-64S
Abstract
Use of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a tool for decisions for transfusions of blood components. Clinical settings such as liver transplantation, cardiothoracic surgery, and trauma are particularly in need of such diagnostic tests because of the complex coagulopathies that can develop in these settings of substantial hemorrhage and need for blood component support. Successful implementation of POCT requires collaboration between surgery, anesthesia, critical care, and the laboratory to ensure proper quality control of equipment, operator training and competency, medical records test results, billing procedures, and consensus-derived transfusion algorithms for cost-effective, targeted blood component transfusion support. In this review we summarize clinical evidence for the effectiveness of POCT, along with some future directions for this strategy.
View details for DOI 10.1111/j.1537-2995.2012.03624.x
View details for PubMedID 22578372
Comparison between RapidTEG (R) and conventional thromboelastography in cardiac surgery patients
BRITISH JOURNAL OF ANAESTHESIA
Thai, J., REYNOLDS, E. J., Natalia, N., Cornelissen, C., Lemmens, H. J., Hill, C. C., van der Starre, P. J.
2011; 106 (4): 605-606