Myxoma is the most common primary benign cardiac tumor, which could lead to some fatal complications because of its strategic position. Although any age can be affected, it predominates in the age group of 30-60 years of age with more than 75% of the affected being women. The occurrence of myxomas in left and right atrium are 75% and 20% respectively.The majority of myxomas present with systemic emboli, fever and/or weight loss, or intracardiac obstruction to blood flow.1 A ‘tumor plop’ is a sound that typically occurs during early diastole and is believed to be caused by motion of the tumor striking the wall of the endocardium. The treatment is surgical excision and key aims of anesthesia care include constant monitoring of systemic blood pressure, adequate IV fluids, and judicious use of vasoactive medications to prevent a fall in systemic vascular resistance.3
Assess patient symptomatology: SOB, chest pain, changes in pulse pressure/CVP with positioning, heart sounds
Adequate PIV access
Vasopressors to help with SVR and heart rate control – mass can act as stenotic valve
Induction: maintain SVR and consider slowing heart rate if mass blocking valves
I chose to stay calm. I was upset, but things needed to be handled at that moment. I called the person directly and gave other options of contacting me other than text. I closed the loop and asked if this person was having a tough day or had issues with me, but, they said they didn’t have an issue with me and that it was a technical error with poor cell phone signal. That seemed reasonable and rational to me. They noted my requests for other contact means. Life moved on. Maybe it won’t always be this easy, but I prefer to make direct contact with the person of interest and make sure I have the full story.
Methadone for perioperative pain #methadone #pain #ERAS
There’s a lot of great data that methadone use decreases postoperative narcotics use in cardiac surgery patients, and I believe it would really be a beneficial drug in an ERAS pathway for early extubation, decreased LOS in ICU and hospital, and better patient satisfaction. Please see the articles below/attached for references.
Today, I hurt. I’ve been talking about this pandemic for well over a month. My friend list is dwindling, and there are several people I don’t plan on catching up with when this pandemic is over—and now entire communities. America’s privilege is showing, in a terrible way. Rural areas that have been luckily unaffected are […]
Did you know? I am blessed to be based at a hospital that has had a decent supply of PPE this entire time. And when we got close to getting too short, friends of mine donated N95s and made cloth masks, button headbands, face shields, and scrub caps in a matter of days. Our hospital…
I’m going to take a stand on something that really gets my blood boiling… health insurance companies. People want to blame physicians for bad outcomes (I’m looking at you NRA supporters that are claiming we, as physicians, need to fix our own lane first). They want to blame hospitals for long wait times, they want […]