RESUMEN
OBJECTIVE: The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. DESIGN: A multicenter randomized control study. SETTING: At 5 tertiary care level hospitals. PARTICIPANTS: Three hundred sixty-three adult patients undergoing elective cardiac surgery. INTERVENTIONS: The patients were randomized into 2 groups-the conventional group (C group; n = 177) and the VL group (n = 186) for TEE probe insertion. MEASUREMENTS AND MAIN RESULTS: The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n = 26; 14.7%) compared to the VL group (n = 14; 7.5%; p = 0.029). The number of attempts for probe insertion was significantly lower in the VL group (p = 0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n = 88; 47%), followed by posterior (n = 77; 41%) and lateral (n = 21;12%). CONCLUSION: The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Laringoscopios , Adulto , Humanos , Laringoscopios/efectos adversos , Ecocardiografía Transesofágica/efectos adversos , Ecocardiografía Transesofágica/métodos , Procedimientos Quirúrgicos Electivos , EsófagoRESUMEN
Exclusive drainage of superior vena cava (SVC) into the left atrium (LA) is one of the rare causes of right-to-left connection. Usually, this anomaly occurs in association with other cardiac defects, and is diagnosed in early childhood. But if it remains an isolated anomaly, this connection may be underdiagnosed and could lead to systemic manifestations. We describe a case of anomalous connection of SVC to LA with drainage of right upper pulmonary vein into SVC and its implications for the perioperative physician. The patient presented with dyspnea on exertion, cyanosis, and a past history of cerebral abscess.