Daniel P. Vezina

Transthoracic Echocardiography: Training Options for Practicing Physicians

1. Burgess FW, Anderson DM, Colonna D, et al: Ipsilateral houlder pain following thoracic surgery. Anesthesiology 78:36568, 1993 2. Li WW, Lee TW, Yim AP: Shoulder function after thoracic urgery. Thorac Surg Clin 14:331-343, 2004 3. Barak M, Ziser A, Katz Y: Thoracic epidural local anesthetics are neffective in alleviating post-thoracotomy ipsilateral shoulder pain. Cardiothorac Vasc Anesth 18:458-460, 2004 4. Scawn ND, Pennefather SH, Soorae A, et al: Ipsilateral shoulder ain after thoracotomy with epidural analgesia: The influence of hrenic nerve infiltration with lidocaine. Anesth Analg 93:260-264, 001 5. Gerner P: Post-thoracotomy pain management problems. Aneshesiol Clin 26:355-367, 2008 6. Mark JB, Brodsky JB: Ipsilateral shoulder pain following thoracic perations. Anesthesiology 79:192, 1993 7. Tan N, Agnew NM, Scawn ND, et al: Suprascapular nerve block or ipsilateral shoulder pain after thoracotomy with thoracic epidural nalgesia: A double-blind comparison of 0.5% bupivacaine and 0.9% aline. Anesth Analg 94:199-202, 2002 8. Benumof JL: Routine surgical considerations that have anesthetic mplication, in Benumof JL (ed): Anesthesia for Thoracic Surgery (ed ). Philadelphia, PA, Saunders, 1994, pp 390-405 9. Johnson D, Ellis H: Pectoral girdle, shoulder region and axilla, in tandring S (ed): Gray’s Anatomy (ed 39). Spain, Elsevier Churchill ivingstone, 2005, pp 817-850 10. Mac TB, Girard F, Chouinard P, et al: Acetaminophen decreases arly post-thoracotomy ipsilateral shoulder pain in patients with thoacic epidural analgesia: A double-blind placebo-controlled study. Cardiothorac Vasc Anesth 19:475-478, 2005 11. Hazelrigg SR, Landreneau RJ, Boley TM, et al: The effect of uscle-sparing versus standard posterolateral thoracotomy on pulmoary function, muscle strength, and postoperative pain. J Thorac Cariovasc Surg 101:394-401, 1991 12. Ng KP, Chow YF: Brachial plexus block for ipsilateral houlder pain after thoracotomy. Anaesth Intensive Care 25:74-76, 997 13. Garner L, Coats RR: Ipsilateral stellate ganglion block effective or treating shoulder pain after thoracotomy. Anesth Analg 78:1195196, 1994 14. Ramamurthy S, Hickey R, Maytorena A, et al: Long thoracic erve block. Anesth Analg 71:197-199, 1990

Management of a Former Cardiac Anesthesiologist With Increasing Aortic Valve Stenosis Requiring Aortic Replacement Surgery in 2015

RANSTHORACIC ECHOCARDIOGRAPHY (TTE) is an important tool for evaluating and managing patients with worsening aortic stenosis. In almost every case, imaging is performed by a sonographer and interpreted by a cardiologist. It is rare for a patient’s cardiac pathology to be followed by an anesthesiology echocardiography team that performs and interprets the patient’s frequent TTE imaging and works as a team with the patient’s cardiologist. The authors describe a case of mild aortic stenosis discovered in a 70-year-old former cardiac anesthesiologist (T.S.) during a routine physical examination by his primary care physician (an internist/cardiologist). The aortic stenosis then was followed for 5 years by the anesthesia echocardiography team with frequent TTEs (ie, every 3-6 months) until the severity of the stenosis indicated valve replacement was required even though the patient’s symptoms were subtle and mild. Intraoperative echocardiography is an increasingly important tool, and it is now an accepted practice for anesthesiologists to perform transesophageal echocardiography (TEE) during surgery. While most anesthesia echocardiography is transesophageal, for those with sufficient skill and training, TTE can be put to good use in managing patients throughout the perioperative period, from the preoperative clinic through hospital discharge. 1 Although cardiologists usually follow patients with cardiac pathology that may require surgical correction, because of their skill and experience with TTE, some anesthesia echocardiography teams may be asked to assist in the followup imaging, management, and decisions these patients need to make about their subsequent surgical care.

CASE 9-2016: Management of a Former Cardiac Anesthesiologist With Increasing Aortic Stenosis Requiring Aortic Valve Replacement.

RANSTHORACIC ECHOCARDIOGRAPHY (TTE) is an important tool for evaluating and managing patients with worsening aortic stenosis. In almost every case, imaging is performed by a sonographer and interpreted by a cardiologist. It is rare for a patient’s cardiac pathology to be followed by an anesthesiology echocardiography team that performs and interprets the patient’s frequent TTE imaging and works as a team with the patient’s cardiologist. The authors describe a case of mild aortic stenosis discovered in a 70-year-old former cardiac anesthesiologist (T.S.) during a routine physical examination by his primary care physician (an internist/cardiologist). The aortic stenosis then was followed for 5 years by the anesthesia echocardiography team with frequent TTEs (ie, every 3-6 months) until the severity of the stenosis indicated valve replacement was required even though the patient’s symptoms were subtle and mild. Intraoperative echocardiography is an increasingly important tool, and it is now an accepted practice for anesthesiologists to perform transesophageal echocardiography (TEE) during surgery. While most anesthesia echocardiography is transesophageal, for those with sufficient skill and training, TTE can be put to good use in managing patients throughout the perioperative period, from the preoperative clinic through hospital discharge. 1 Although cardiologists usually follow patients with cardiac pathology that may require surgical correction, because of their skill and experience with TTE, some anesthesia echocardiography teams may be asked to assist in the followup imaging, management, and decisions these patients need to make about their subsequent surgical care.