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Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population
BACKGROUND: Anesthesia for pulmonary endarterectomy (PEA) has always been one of the challenges of anesthesia. As one of the leading cardiothoracic institutions in Southeast Asia, our hospital has vast interest in this subject. A local multidisciplinary team was deployed to an expert center in the U...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489400/ https://www.ncbi.nlm.nih.gov/pubmed/30971599 http://dx.doi.org/10.4103/aca.ACA_63_18 |
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author | Chen, Yufan Tan, Zihui Shah, Shitalkumar S Loh, Kenny WT |
author_facet | Chen, Yufan Tan, Zihui Shah, Shitalkumar S Loh, Kenny WT |
author_sort | Chen, Yufan |
collection | PubMed |
description | BACKGROUND: Anesthesia for pulmonary endarterectomy (PEA) has always been one of the challenges of anesthesia. As one of the leading cardiothoracic institutions in Southeast Asia, our hospital has vast interest in this subject. A local multidisciplinary team was deployed to an expert center in the United Kingdom (UK), and the experience was then integrated to the care of our patients. We present a case series of ten patients undergoing anesthesia for PEA, a first for our institution, and discuss techniques as well as potential complications. METHODS: Patients with chronic thromboembolic pulmonary hypertension were reviewed by a multidisciplinary team, and those who were suitable for surgical intervention subsequently underwent PEA. A total of ten patients were identified and operated on. The perioperative management and conduction of anesthesia for all patients followed a protocol adapted from the expert center in the UK, with revisions to cater to our Asian population. RESULTS: In the ten patients operated on, eight of them were successfully extubated on the first postoperative day. Apart from one incident of prolonged ventilator usage due to reperfusion lung injury and pneumonia, there were no major respiratory or hemodynamic complications. Certainly, six of the ten patients developed subdural hemorrhage after the commencement of enoxaparin, although none of them sustained any permanent neurological deficits. CONCLUSION: We have demonstrated that with careful planning and a well-outlined protocol, anesthesia for PEA in an Asian population can be achieved with favorable outcomes. Further fine-tuning of the protocol is still required based on local expertise. |
format | Online Article Text |
id | pubmed-6489400 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-64894002019-05-03 Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population Chen, Yufan Tan, Zihui Shah, Shitalkumar S Loh, Kenny WT Ann Card Anaesth Original Article BACKGROUND: Anesthesia for pulmonary endarterectomy (PEA) has always been one of the challenges of anesthesia. As one of the leading cardiothoracic institutions in Southeast Asia, our hospital has vast interest in this subject. A local multidisciplinary team was deployed to an expert center in the United Kingdom (UK), and the experience was then integrated to the care of our patients. We present a case series of ten patients undergoing anesthesia for PEA, a first for our institution, and discuss techniques as well as potential complications. METHODS: Patients with chronic thromboembolic pulmonary hypertension were reviewed by a multidisciplinary team, and those who were suitable for surgical intervention subsequently underwent PEA. A total of ten patients were identified and operated on. The perioperative management and conduction of anesthesia for all patients followed a protocol adapted from the expert center in the UK, with revisions to cater to our Asian population. RESULTS: In the ten patients operated on, eight of them were successfully extubated on the first postoperative day. Apart from one incident of prolonged ventilator usage due to reperfusion lung injury and pneumonia, there were no major respiratory or hemodynamic complications. Certainly, six of the ten patients developed subdural hemorrhage after the commencement of enoxaparin, although none of them sustained any permanent neurological deficits. CONCLUSION: We have demonstrated that with careful planning and a well-outlined protocol, anesthesia for PEA in an Asian population can be achieved with favorable outcomes. Further fine-tuning of the protocol is still required based on local expertise. Wolters Kluwer - Medknow 2019 /pmc/articles/PMC6489400/ /pubmed/30971599 http://dx.doi.org/10.4103/aca.ACA_63_18 Text en Copyright: © 2019 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Chen, Yufan Tan, Zihui Shah, Shitalkumar S Loh, Kenny WT Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population |
title | Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population |
title_full | Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population |
title_fullStr | Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population |
title_full_unstemmed | Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population |
title_short | Perioperative Anesthesia Management for Pulmonary Endarterectomy: Adopting an Established European Protocol for the Asian Population |
title_sort | perioperative anesthesia management for pulmonary endarterectomy: adopting an established european protocol for the asian population |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489400/ https://www.ncbi.nlm.nih.gov/pubmed/30971599 http://dx.doi.org/10.4103/aca.ACA_63_18 |
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