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Ellen Mayer Sabik - One of the best experts on this subject based on the ideXlab platform.
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benzocaine induced methemoglobinemia experience from a high volume Transesophageal Echocardiography laboratory
Journal of The American Society of Echocardiography, 2003Co-Authors: Gian M Novaro, Herbert D Aronow, Michael Militello, Mario J Garcia, Ellen Mayer SabikAbstract:Benzocaine (ethyl aminobenzoate), a topical anesthetic widely used before Transesophageal Echocardiography, has been reported to cause acquired methemoglobinemia. The incidence of benzocaineinduced methemoglobinemia in clinical practice, however, has been difficult to estimate. After systematic review of our institutional experience for clinically recognized cases of benzocaine-induced methemoglobinemia in patients undergoing Transesophageal Echocardiography, we report an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). This report also provides the largest analysis of the incidence of methemoglobinemia in readministration cases. Although controversy remains as to whether this is an idiosyncratic versus dose-related response, a description of purported patient risk factors is included. (J Am Soc Echocardiogr 2003;16:170-5.)
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benzocaine induced methemoglobinemia experience from a high volume Transesophageal Echocardiography laboratory
Journal of The American Society of Echocardiography, 2003Co-Authors: Gian M Novaro, Herbert D Aronow, Michael Militello, Mario J Garcia, Ellen Mayer SabikAbstract:Benzocaine (ethyl aminobenzoate), a topical anesthetic widely used before Transesophageal Echocardiography, has been reported to cause acquired methemoglobinemia. The incidence of benzocaine-induced methemoglobinemia in clinical practice, however, has been difficult to estimate. After systematic review of our institutional experience for clinically recognized cases of benzocaine-induced methemoglobinemia in patients undergoing Transesophageal Echocardiography, we report an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). This report also provides the largest analysis of the incidence of methemoglobinemia in readministration cases. Although controversy remains as to whether this is an idiosyncratic versus dose-related response, a description of purported patient risk factors is included.
Gian M Novaro - One of the best experts on this subject based on the ideXlab platform.
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benzocaine induced methemoglobinemia experience from a high volume Transesophageal Echocardiography laboratory
Journal of The American Society of Echocardiography, 2003Co-Authors: Gian M Novaro, Herbert D Aronow, Michael Militello, Mario J Garcia, Ellen Mayer SabikAbstract:Benzocaine (ethyl aminobenzoate), a topical anesthetic widely used before Transesophageal Echocardiography, has been reported to cause acquired methemoglobinemia. The incidence of benzocaineinduced methemoglobinemia in clinical practice, however, has been difficult to estimate. After systematic review of our institutional experience for clinically recognized cases of benzocaine-induced methemoglobinemia in patients undergoing Transesophageal Echocardiography, we report an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). This report also provides the largest analysis of the incidence of methemoglobinemia in readministration cases. Although controversy remains as to whether this is an idiosyncratic versus dose-related response, a description of purported patient risk factors is included. (J Am Soc Echocardiogr 2003;16:170-5.)
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benzocaine induced methemoglobinemia experience from a high volume Transesophageal Echocardiography laboratory
Journal of The American Society of Echocardiography, 2003Co-Authors: Gian M Novaro, Herbert D Aronow, Michael Militello, Mario J Garcia, Ellen Mayer SabikAbstract:Benzocaine (ethyl aminobenzoate), a topical anesthetic widely used before Transesophageal Echocardiography, has been reported to cause acquired methemoglobinemia. The incidence of benzocaine-induced methemoglobinemia in clinical practice, however, has been difficult to estimate. After systematic review of our institutional experience for clinically recognized cases of benzocaine-induced methemoglobinemia in patients undergoing Transesophageal Echocardiography, we report an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). This report also provides the largest analysis of the incidence of methemoglobinemia in readministration cases. Although controversy remains as to whether this is an idiosyncratic versus dose-related response, a description of purported patient risk factors is included.
Sungwon Na - One of the best experts on this subject based on the ideXlab platform.
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rigid laryngoscope assisted insertion of Transesophageal Echocardiography probe reduces oropharyngeal mucosal injury in anesthetized patients
Anesthesiology, 2009Co-Authors: Sungwon NaAbstract:Background: Intraoperative Transesophageal Echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a Transesophageal Echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a Transesophageal Echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury. Methods: Eighty patients undergoing surgery with general anesthesia were randomly allocated to either the conventional group, in which the probe was inserted blindly, or the laryngoscope group, in which a rigid laryngoscope was used to visualize the passage of the probe. The incidence of oropharyngeal mucosal injury, the number of insertion attempts, and odynophagia were assessed. Results: There was no significant difference in demographic and hemodynamic parameters between the 2 groups. The incidence of oropharyngeal mucosal injury was higher in the conventional group than in the laryngoscope group (55% vs. 5%, P < 0.05). The incidence of odynophagia was higher in the conventional group than in the laryngoscope group (32.5% vs. 2.5%, P < 0.05). The number of insertion attempts was also higher in the conventional group than in the laryngoscope group. Conclusion: Rigid laryngoscope-assisted insertion of the Transesophageal Echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.
Martin D Abel - One of the best experts on this subject based on the ideXlab platform.
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real time three dimensional Transesophageal Echocardiography in the intraoperative assessment of mitral valve disease
Journal of The American Society of Echocardiography, 2009Co-Authors: Jasmine Grewal, Roger L. Click, Martin D Abel, Sunil V Mankad, William K Freeman, Rakesh M Suri, Jae K Oh, Patricia A Pellikka, Gillian C Nesbitt, Imran SyedAbstract:Background The aims of this study were to evaluate the feasibility of real-time 3-dimensional (3D) Transesophageal Echocardiography in the intraoperative assessment of mitral valve (MV) pathology and to compare this novel technique with 2-dimensional (2D) Transesophageal Echocardiography. Methods Forty-two consecutive patients undergoing MV repair for mitral regurgitation (MR) were studied prospectively. Intraoperative 2D and 3D Transesophageal echocardiographic (TEE) examinations were performed using a recently introduced TEE probe that provides real-time 3D imaging. Expert echocardiographers blinded to 2D TEE findings assessed the etiology of MR on 3D Transesophageal Echocardiography. Similarly, experts blinded to 3D TEE findings assessed 2D TEE findings. Both were compared with the anatomic findings reported by the surgeon. Results At the time of surgical inspection, ischemic MR was identified in 12% of patients, complex bileaflet myxomatous disease in 31%, and specific scallop disease in 55%. Three-dimensional TEE image acquisition was performed in a short period of time (60 ± 18 seconds) and was feasible in all patients, with optimal (36%) or good (33%) imaging quality in the majority of cases. Three-dimensional TEE imaging was superior to 2D TEE imaging in the diagnosis of P1, A2, A3, and bileaflet disease ( P Conclusions Real-time 3D Transesophageal Echocardiography is a feasible method for identifying specific MV pathology in the setting of complex disease and can be expeditiously used in the intraoperative evaluation of patients undergoing MV repair.
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Role of Intraoperative Transesophageal Echocardiography in Patients Having Coronary Artery Bypass Graft Surgery
The Annals of Thoracic Surgery, 2004Co-Authors: Fatema Qaddoura, Karen L. Mecklenburg, Martin D Abel, Krishnaswamy Chandrasekaran, Kenton J Zehr, Thoralf M Sundt, Roger L. ClickAbstract:Abstract Background Previous studies have shown that intraoperative Transesophageal Echocardiography provides important preoperative and postoperative information in various cardiac and noncardiac surgeries that may alter patient management and outcome. The role of intraoperative Transesophageal Echocardiography in patients in whom isolated coronary artery bypass graft surgery is anticipated has been reported only in small selected groups. This study was designed to prospectively evaluate the role of intraoperative Transesophageal Echocardiography in a large, nonselected group of patients undergoing primarily coronary artery bypass graft surgery. Methods From January 2001 to December 2003, 474 consecutive patients (76% men, 24% women) aged 30 to 89 years (mean age of 70 ± 10 years) who were undergoing coronary artery bypass graft surgery had prebypass and postbypass intraoperative Transesophageal Echocardiography. New findings and alterations in the surgical plan were documented prospectively. Results New prebypass findings were found in 10% of patients, and the surgical plan was altered in 3.4% of patients. New postbypass findings were found in 3.2% of patients, altering the surgical plan in 2% of patients. Conclusions This large consecutive, nonselected, prospective study reveals the significant impact of intraoperative Transesophageal Echocardiography in patients having coronary artery bypass graft surgery as a primary procedure. New findings (prebypass and postbypass) were found in 13% of patients overall, and the surgical plan was altered in 5.5% of patients. This study supports the use of intraoperative Transesophageal Echocardiography in patients undergoing primarily coronary artery bypass graft surgery.
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intraoperative Transesophageal Echocardiography during surgery for congenital heart defects
The Journal of Thoracic and Cardiovascular Surgery, 2002Co-Authors: Guy R Randolph, Martin D Abel, Donald J Hagler, Heidi M Connolly, Joseph A Dearani, Francisco J Puga, Gordon K Danielson, Shane V Pankratz, Patrick W OlearyAbstract:Abstract Objective: This study was undertaken to further define the impact of intraoperative Transesophageal Echocardiography during surgery for congenital heart disease and to determine appropriate indications. Methods: The impact of Transesophageal Echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or led to a revision of the initial repair. The safety of intraoperative Transesophageal Echocardiography was evaluated by review of the prospective data sheets and the medical record. A simple relative cost analysis was also performed. Results: Patient median age was 9.9 years (range 2 days to 85 years). Transesophageal Echocardiography had prebypass or postbypass major impact in 13.8% of cases (n = 138/1002). Major impact was more frequent during reoperations ( P Conclusions: On the combined basis of the observed rates of major impact, the minimal complications, and the relative cost advantage, we believe that routine use of Transesophageal Echocardiography during most intracardiac repairs of congenital heart defects is justified, particularly for patients undergoing repeat operations for congenital cardiac malformations. J Thorac Cardiovasc Surg 2002;124:1176-82
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intraoperative evaluation of mitral valve regurgitation and repair by Transesophageal Echocardiography incidence and significance of systolic anterior motion
Journal of the American College of Cardiology, 1992Co-Authors: William K Freeman, Martin D Abel, James B. Seward, Bijoy K. Khandheria, Hartzell V Schaff, Thomas A Orszulak, Jamil A TajikAbstract:Abstract Objectives. This study was designed to delineate the utility and results of intraoperative Transesophageal Echocardiography in the evaluation of patients undergoing mural valve repair for mitral regurgitation. Background. Mitral valve reconstruction offers many advantages over prosthetic valve replacement. Intraoperative assessment of valve competence after repair is vital to the effectiveness of this procedure. Methods. Intraoperative Transesophageal Echocardiography was performed in 143 patients undergoing mitral valve repair over a period of 23 months, Before and after repair, the functional morphology of the mitral apparatus was defined by twodimensional Echocardiography; Doppler color flow imaging was used to clarify the mechanism of mitral regurgitation and to semiquantitate its severity. Results. There was significant improvement in the mean mitral regurgitation grade by composite intraoperative Transesophageal Echocardiography after valve repair (3.6 ± 0.8 to 0.7 ± 0.7; p Severe systolic anterior motion of the mitral apparatus causing grade 2 to 4 mitral regurgitation was present in 13 patients (9.1%) after cardiopulmonary bypass. In 8 patients (5.6%), systolic anterior motion resolved immediately with correction of hyperdynamic hemodynamic status, resulting in grade ≤ 1 residual mitral regurgitation without further operative intervention. Transthoracic Echocardiography before hospital discharge demonstrated grade ≤ 1 residual mitral regurgitation in 86.4% of 132 patients studied. A significant discrepancy (> 1 grade) in residual mitral regurgitation by predischarge transthoracic versus intraoperative Transesophageal Echocardiography was noted in 17 patients (12.9%). Conclusions. Transesophageal Echocardiography is a valuable adjunct in the intraoperative assessment of mitral valve repair.
Michael Militello - One of the best experts on this subject based on the ideXlab platform.
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benzocaine induced methemoglobinemia experience from a high volume Transesophageal Echocardiography laboratory
Journal of The American Society of Echocardiography, 2003Co-Authors: Gian M Novaro, Herbert D Aronow, Michael Militello, Mario J Garcia, Ellen Mayer SabikAbstract:Benzocaine (ethyl aminobenzoate), a topical anesthetic widely used before Transesophageal Echocardiography, has been reported to cause acquired methemoglobinemia. The incidence of benzocaineinduced methemoglobinemia in clinical practice, however, has been difficult to estimate. After systematic review of our institutional experience for clinically recognized cases of benzocaine-induced methemoglobinemia in patients undergoing Transesophageal Echocardiography, we report an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). This report also provides the largest analysis of the incidence of methemoglobinemia in readministration cases. Although controversy remains as to whether this is an idiosyncratic versus dose-related response, a description of purported patient risk factors is included. (J Am Soc Echocardiogr 2003;16:170-5.)
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benzocaine induced methemoglobinemia experience from a high volume Transesophageal Echocardiography laboratory
Journal of The American Society of Echocardiography, 2003Co-Authors: Gian M Novaro, Herbert D Aronow, Michael Militello, Mario J Garcia, Ellen Mayer SabikAbstract:Benzocaine (ethyl aminobenzoate), a topical anesthetic widely used before Transesophageal Echocardiography, has been reported to cause acquired methemoglobinemia. The incidence of benzocaine-induced methemoglobinemia in clinical practice, however, has been difficult to estimate. After systematic review of our institutional experience for clinically recognized cases of benzocaine-induced methemoglobinemia in patients undergoing Transesophageal Echocardiography, we report an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). This report also provides the largest analysis of the incidence of methemoglobinemia in readministration cases. Although controversy remains as to whether this is an idiosyncratic versus dose-related response, a description of purported patient risk factors is included.
