• Does CVP Correlate with Transesophageal Echocardiographic Evaluation of Right Heart Function?

      Arthur, Mary E.; Reddy, Satish V.; Mehta, Anand R.; Castresana, Manuel R.; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2009-10)
      Important goals in the management of cardiac patients under general anesthesia include accurate evaluation of right heart function, preload status, and assessment of fluid responsiveness. Central venous pressure (CVP) recorded from the right atrium or superior vena cava is said to reflect intravascular volume. The ability of the CVP to predict fluid responsiveness, i.e., an increase in stroke index/cardiac index following a fluid challenge, has indirectly advanced the idea that CVP is a measure of right heart function and that patients with right ventricular failure may exhibit elevated CVP. Several echocardiographic parameters including right ventricular ejection fraction, amplitude of the tricuspid annular plane systolic excursion (TAPSE) assessed by M-mode, and tricuspid annular systolic velocity recorded by Doppler tissue imaging have been used to evaluate right ventricular function.
    • TEE to facilitate anesthetic management during thoracotamy in a patient with severe pulmonary hypertension and pulmonary venous obstruction

      Aryal, Anuj; Mehta, Anand; Arthur, Mary E.; Castresana, Manuel R.; Medical College of Georgia; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2009-10)
      The lateral decubitus position, use of one-lung ventilation, and the prevention and treatment of hypoxemia continue to present challenges to the anesthesiologist, particularly in the patient with pulmonary hypertension. We describe the utility of intraoperative transesophageal echocardiography in the management of a patient with severe pulmonary hypertension and pulmonary vein stenosis undergoing thoracotomy for tissue diagnosis.
    • Unanticipated Acute Adrenal Insufficiency During Emergency Thoracotomy Re-Exploration

      Rawlings, J Lee; Spivey, Jerry A; Castresana, Manuel R.; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      For the last 50 years there has been a debate over the management of corticosteroid supplementation in the context of surgical or critically ill patients. At a minimum, clinicians agree that chronic corticosteroids should be continued in the perioperative or ICU setting, however in patients without a history of steroid use, acute adrenal insufficiency as the cause of hemodynamic compromise can be an elusive diagnosis. We present a case report.