Case-Based Anesthesia: Clinical Learning Guides by George Shorten MD, Stephen F. Dierdorf MD, Gabriella Iohom

By George Shorten MD, Stephen F. Dierdorf MD, Gabriella Iohom MD DEAA FCARCSI PhD, Christopher J. O'Connor MD, Charles W. Hogue Jr. MD

This brief textbook provides sixty instances with the aspect and patient-specific facts encountered in genuine medical perform. situations disguise the most important issues emphasised within the in-training examination and in written and oral boards.

The circumstances are carefully constructed utilizing types. The built Case version contains a step by step structure that highlights the choices made at every one step. The Case mirrored image version contains a brief narrative, through research of ways the administration and final result could have been enhanced. circumstances are referenced with present articles in help of specific innovations. every one case features a boxed Key issues part and self-assessment questions.

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7 KEY MESSAGES 1. Patients with severe atherosclerosis of the ascending aorta benefit from OPCAB because aortic cross clamping is not necessary. 2. During OPCAB, “full” heparinization (ACT Ͼ400 seconds) is not required because patients are not exposed to the foreign surface of the CPB circuit. However, the patient’s coagulation system will be activated by local vascular endothelial injury. Therefore, some degree of anticoagulation is required. Heparin in a dose of 100 to 200 units per kilogram is given before dissecting the LIMA targeting an ACT of 250 to 300 seconds.

9. Unlu Y, Velioglu Y, Kocak H, et al. Brachial plexus injury following median sternotomy. Interact Cardiovasc Thorac Surg 2007;6:235–237. qxd 30 3/14/09 5:10 PM Page 30 CHAPTER 8 • POSTOPERATIVE NEUROPATHY AFTER CARDIAC SURGERY 10. Hickey C, Gugino LD, Aglio LS, et al. Intraoperative somatosensory evoked potential monitoring predicts peripheral nerve injury during cardiac surgery. Anesthesiology 1993;78:29–35. 11. DeVita MA, Robinson LR, Rehder J, et al. Incidence and natural history of phrenic neuropathy occurring during open heart surgery.

Patients with severe atherosclerosis of the ascending aorta benefit from OPCAB because aortic cross clamping is not necessary. 2. During OPCAB, “full” heparinization (ACT Ͼ400 seconds) is not required because patients are not exposed to the foreign surface of the CPB circuit. However, the patient’s coagulation system will be activated by local vascular endothelial injury. Therefore, some degree of anticoagulation is required. Heparin in a dose of 100 to 200 units per kilogram is given before dissecting the LIMA targeting an ACT of 250 to 300 seconds.

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