Anesthesiology and Intensive Care

     Transesophageal Echocardiography (TEE) is often  performed by a cardiac anesthesiologist to evaluate, diagnose, and treat patients in the perioperative period. TEE is very useful during many cardiac surgical procedures (e.g., mitral valve repair, off-pump and on-pump CABG).  It helps to detect and quantify the disease preoperatively as well as to assess the results of surgery immediately after the procedure.  If the repair is found to be inadequate,

Amazing Demonstration of Arterial Line Placement INDICATIONS: Continuous direct BP monitoring Inability to use indirect BP monitoring (eg, in patients with severe burns or morbid obesity) Frequent blood sampling Frequent arterial blood gas sampling CONTRAINDICATIONS: Absent pulse Thromboangiitis obliterans (Buerger disease) Full-thickness burns over the cannulation site, infection Inadequate circulation to the extremity Raynaud syndrome Synthetic vascular graft COMPLICATIONS: Temporary radial artery occlusion (19.7%) Hematoma/bleeding (14.4%) Localized catheter site infection (0.72%) - The risk increases with the length of time the catheter is in place  Hemorrhage (0.53%) Sepsis (0.13%) Permanent ischemic damage (0.09%) Pseudoaneurysm formation (0.09%) Thrombosis Arteriovenous fistula Air embolism Compartment syndrome Carpal tunnel syndrome...

INDICATIONS: Major operative procedures involving large fluid shifts and/or blood loss Intravascular volume assessment when urine output is not reliable orunavailable (e.g. renal failure) Major trauma Surgical procedures with a high risk of air embolism, such as sitting position craniotomies. In addition to monitoring, the central venous pressure (CVP) catheter may also be used to aspirate intracardiac air Frequent venous blood sampling Administration of medications that require central access e.g. amiodarone, inotropes, high concentration electrolytes Chronic drug administration Unavailable peripheral IV access Rapid infusion of IV fluids Peripheral blood stem cell collections Special Uses: (i) Insertion of PA catheters; (ii) Insertion of transvenous pacing wires; (iii) Hemodialysis/plasmapheresis. CONTRAINDICATIONS: SVC syndrome Infection at the site of insertion Traumatised site (eg. clavicle fracture and subclavian line) Burned site Coagulopathies Newl...

           INDICATIONS FOR ECMO Non-cardiogenic respiratory failure . Potentially reversible (Pneumothorax / large pleural effusion drained, trial of diuresis).                 IF : Optimal ventilation (including PEEP >10cmH2O)                  Consider PCV or CMV: VT < 8ml /kg (ideal body weight), prone ventilation, recruitment                    manouevre.               BUT : PaO2 / FiO2 < 80mmHg or pH < 7.25 for > 2 hours Cardiogenic shock of any aetiology . Potentially reversible OR candidate for destination therapy. Refractory to maximal medical Rx.   Fulminant myocarditis  requiring inotropes or IABP at any time( left heart failure + aseptic febrile illness < 2 weeks, marked troponin elevation, abnormal ECG and / or arrhythmia) ...