Lumbar drains are a mainstay for spinal cord protection when patients undergo operations like thoracoabdominal aortic aneurysm (TAAA) repairs and thoracic endovascular aortic repairs (TEVAR) with subclavian artery debranching. Why? Because the anterior spinal artery receives contributions from paired intercostal arteries that can be disrupted by the aortic pathology itself…
“Wind, water, wound, walking, wonder drugs” are described as the “Ws” of post-operative fevers (atelectasis, UTI, wound infection, DVTs, and drug fevers, respectively). As a medical student, all of these made sense to me except the mechanism by which atelectasis, something applicable to ALL patients under general anesthesia, causes a…
Deep hypothermic circulatory arrest (“circ arrest”) is often required for partial or total aortic arch reconstructions. At this point in the surgery, there is no blood flow anywhere. Because of systemic cooling, we mitigate the anaerobic and calcium-mediated apoptotic pathways that are implicated in neuronal dysfunction and can safely perform…
Orthotopic heart transplantations (OHTs) are some of my favorite procedures as a cardiothoracic anesthesiologist! After establishing general endotracheal anesthesia (GETA) with standard monitors, an arterial line, a central line (often with pulmonary artery catheter), large-bore peripheral intravenous (PIV) access, and transesophageal echocardiography (TEE), the remainder of the procedure is carefully…
In my first year of anesthesiology residency, I had the opportunity to do a very unique aortic valve replacement (AVR) case for aortic stenosis – the Ozaki repair performed by Dr. Ozaki himself! This incredible surgeon pioneered a technique using the patient’s own pericardium (lining that surrounds the heart) treated…
Cardiac arrest is one of the most feared complications in medicine as it tends to usually precede death despite appropriate interventions. However, a controlled cardiac arrest is routinely utilized as part of cardiopulmonary bypass (CPB) to facilitate complex heart and lung surgeries.
This post outlines the steps in traditional, central cannulation for cardiopulmonary bypass (CPB). Depending on the nature of the surgery and the patient’s comorbidities, other sites are often cannulated (left heart bypass, femoral-femoral peripheral cannulation, etc.)
During my surgery and pediatrics rotations, I wrote down things related to practice questions I did and compiled them into a PDF for anyone who wants to review the “high yield” topics without having to go through hundreds of questions again. I’ve done my best to minimize errors, but by…
I’m continuing to enjoy an incredible breadth of cases in neurosurgery – deep brain stimulation in Parkinson’s, the orbitozygomatic approach for a middle fossa tumor, ventricular explorations, and laminectomies are some of the latest cases I scrubbed into. With only a week left before two months of pediatrics, I’m hoping…
The first day of any new rotation is always tough, but today was utterly painful from a logistics standpoint. We started rounding at 5:30am, but instead of being able to reset my password for computer access, I had to wait till later in the morning to redo all the paperwork…