The year in cardiothoracic and vascular anesthesia: selected highlights from 2013

Abstract

This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance. The second major theme is the diffusion of echocardiography throughout perioperative practice. There are now guidelines and training pathways to guide its generalization into everyday practice. The third major theme is the paradigm shift in perioperative fluid management. Recent large randomized trials suggest that fluids are drugs that require a precise prescription with respect to type, dose, and duration. The final theme is patient safety in the cardiac perioperative environment. A recent expert scientific statement has focused attention on this issue because most perioperative errors are preventable. It is likely that clinical research in this area will blossom because this is a major opportunity for improvement in our specialty. The patient care processes identified in these research highlights will further improve perioperative outcomes for our patients.

Keywords: Dr Gibbon; Dr Kolff; artificial heart; balanced salt solutions; basic perioperative echocardiography; cardiopulmonary bypass; case report; clinical trial networks; colloids; crystalloids; extracorporeal membrane oxygenation; fluid prescription; goal-directed therapy; guidelines; health systems; human factors; hydroxyethyl starch; leadership; normal saline; perioperative protocol; professionalism; safety culture; surgical robotics; transesophageal echocardiography; transition of care; transthoracic echocardiography; ventricular assist device.