The venous-to-arterial carbon dioxide difference (PCO₂ gap), defined as PcvCO₂ (taken from a central line blood gas) – PaCO₂ (taken from an arterial blood gas), answers a question that neither lactate nor ScvO₂ can typically answer directly. Whereas ScvO₂ focuses on the balance between oxygen delivery and consumption, the pCO₂…
Vitamin K (phytonadione) is an essential, fat-soluble cofactor for γ-carboxylation of clotting factors II, VII, IX, and X, as well as proteins C and S. This post-translational modification allows these proteins to bind calcium and participate in coagulation. In vitamin K deficiency or during warfarin therapy, the liver continues to…
Mitral paravalvular leaks (PVL) occur when there is dehiscence between the prosthetic sewing ring and the native annulus, allowing blood to regurgitate around the valve rather than through it. The prosthesis itself may function normally, while a high velocity eccentric jet produces significant physiologic consequences. These leaks are often associated…
One of the first things I look for when performing transesophageal echocardiography (TEE) for a mitral valve replacement is how the new valve is functioning as we prepare to separate from cardiopulmonary bypass. A mechanical mitral valve is engineered for crisp, nearly effortless leaflet excursion; however, the following 3D TEE…
Procalcitonin is a peptide precursor of calcitonin that becomes detectable in the setting of systemic bacterial infection, driven by cytokines and endotoxin released throughout the body rather than from the thyroid alone. Levels rise over 12-24 hours with bacterial sepsis and fall as the inflammatory signal resolves. This time course,…
Total pneumonectomy (removal of the entire lung) is most commonly performed for centrally located lung cancer when sleeve resection or lung-sparing surgery is not feasible. Less common indications include severe bronchiectasis, invasive infection, massive hemoptysis, or traumatic destruction of the lung. Unlike lobectomy, pneumonectomy abruptly removes half of the pulmonary…
Today, I was notified by my department leadership of my promotion to Associate Professor of Anesthesiology, effective September 1, 2026. As an attending physician in academic medicine, progress is often measured in milestones, publications, promotions, and titles, but there’s a tremendous amount of work that goes into achieving those. For…
Fibryga (human fibrinogen) is a concentrate designed to restore factor I (fibrinogen), the final substrate of clot formation. Fibrinogen is converted by thrombin into fibrin, which polymerizes and stabilizes the platelet plug. When fibrinogen levels fall, the resulting clot is weak, easily disrupted, and unable to achieve durable hemostasis. In…
In patients with extensive disease involving the aortic arch and proximal descending thoracic aorta, a frozen elephant trunk (FET) extends the repair distally by combining an open surgical ascending/transverse aortic arch replacement with deployment of a stented graft into the descending thoracic aorta. This gives my surgical colleagues a way…
After endotracheal intubation for a general anesthetic, it is not uncommon for patients to report a sore throat in the recovery area. Although it’s usually self-limited, small details in airway management can often shape a patient’s overall satisfaction with their perioperative care. In appropriate patients, I will downsize the endotracheal…