Pulse pressure variation (PPV), which quantifies the changes in arterial pulse pressure during mechanical ventilation, is one of the dynamic variables that can predict fluid responsiveness. The underlying hypothesis is that large respiratory changes in left ventricular stroke volume, and thus pulse pressure, occur in cases of biventricular preload responsiveness.1
One of the most important concepts in resuscitation is volume responsiveness, or the ability of the cardiac output to increase in response to a fluid challenge.2
To measure the PPV in a given patient, that patient must have consistent and demonstrable cardiopulmonary interactions. This means that the patient must:
Be in normal sinus rhythm
Be intubated and be mechanically ventilated, making no spontaneous respiratory efforts
Be ventilated with at least 8mL/kg of tidal volume
Have no significant alternations to chest wall compliance, such as an open chest2
With an opioid crisis at its peak, physicians need to be more cognizant of the various pain modalities available to patients. Gabapentinoids are one of the many non-opioid options to help with acute and chronic pain.
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
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 […]