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  1. Article ; Online: Perioperative implications of patients with alpha gal allergies.

    Nourian, Maziar M / Stone, Cosby A / Siegrist, Kara K / Riess, Matthias L

    Journal of clinical anesthesia

    2023  Volume 86, Page(s) 111056

    Abstract: Alpha Gal Syndrome (AGS) is an emerging immune response to mammalian products (MP) containing the oligosaccharide galactose-α-1,3 galactose (α-Gal) which includes meats and inactive ingredients in certain medications. This becomes clinically important in ...

    Abstract Alpha Gal Syndrome (AGS) is an emerging immune response to mammalian products (MP) containing the oligosaccharide galactose-α-1,3 galactose (α-Gal) which includes meats and inactive ingredients in certain medications. This becomes clinically important in the perioperative realm as MPs are commonly found in the operating room, and pre- and post-operative settings, and can trigger responses as severe as anaphylaxis. In this review, authors discuss the epidemiology, diagnosis and treatment of AGS reactions. Additionally, strategies are explored in order to screen and prevent exposure to MP with a multidisciplinary approach. While this emerging allergy is still not fully understood, it is of paramount importance that all anesthesia providers recognize the implications of MP exposure in AGS patients and ultimately prevent harm in this highly vulnerable population.
    MeSH term(s) Animals ; Humans ; Galactose ; Food Hypersensitivity/epidemiology ; Anaphylaxis/diagnosis ; Anaphylaxis/epidemiology ; Anaphylaxis/etiology ; Meat/adverse effects ; Mammals
    Chemical Substances Galactose (X2RN3Q8DNE)
    Language English
    Publishing date 2023-01-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2023.111056
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  2. Article: Importance of alpha-gal syndrome in patients undergoing catheter ablation.

    Hasegawa, Kanae / Powers, Edward M / Yoneda, Zachary T / Richardson, Travis D / Siegrist, Kara K / Stevenson, William G

    HeartRhythm case reports

    2023  Volume 9, Issue 12, Page(s) 926–928

    Language English
    Publishing date 2023-10-25
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2834871-0
    ISSN 2214-0271
    ISSN 2214-0271
    DOI 10.1016/j.hrcr.2023.10.001
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  3. Article ; Online: Point-of-Care Blood Testing: The Technology Behind the Numbers.

    Siegrist, Kara K / Rice, Mark J

    Anesthesia and analgesia

    2019  Volume 129, Issue 1, Page(s) 92–98

    Abstract: Minutes count in the operating room when it comes to treatment guidance and therapies. On a daily basis, anesthesiologists make hundreds of decisions, some based on laboratory results, when guiding patient therapies. When time is crucial, point-of-care ... ...

    Abstract Minutes count in the operating room when it comes to treatment guidance and therapies. On a daily basis, anesthesiologists make hundreds of decisions, some based on laboratory results, when guiding patient therapies. When time is crucial, point-of-care testing is often utilized for expediency. However, point-of-care testing has its limitations. Providers should be aware of the limitations, including the potential for error in results-errors that could lead to improper treatment and possible patient harm. This article outlines the technical aspects and summarizes pitfalls in accuracy for 2 of the most commonly utilized point-of-care testing devices: glucose meters and hemoglobin meters.
    MeSH term(s) Biomarkers/blood ; Blood Chemical Analysis/instrumentation ; Blood Glucose/metabolism ; Hemoglobins/metabolism ; Humans ; Point-of-Care Systems ; Point-of-Care Testing ; Predictive Value of Tests ; Reproducibility of Results ; Time Factors ; Workflow
    Chemical Substances Biomarkers ; Blood Glucose ; Hemoglobins
    Language English
    Publishing date 2019-04-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000004149
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  4. Article: Defibrillator-associated gonococcal endocarditis.

    Martinez-Parachini, Jose R / Amaral, Ansel P / Yoneda, Zachary T / Siegrist, Kara K / Saavedra, Pablo J / Richardson, Travis D

    HeartRhythm case reports

    2022  Volume 9, Issue 2, Page(s) 118–120

    Language English
    Publishing date 2022-12-09
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2834871-0
    ISSN 2214-0271
    ISSN 2214-0271
    DOI 10.1016/j.hrcr.2022.12.004
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  5. Article ; Online: Erector Spinae Plane Catheter Analgesia in Minimally Invasive Mitral Valve Surgery: A Retrospective Case-Control Study for Inclusion in an Enhanced Recovery Program.

    Statzer, Nicholas J / Plackis, Andreas C / Woolard, Austin A / Allen, Brian F S / Siegrist, Kara K / Shi, Yaping / Shotwell, Matthew

    Seminars in cardiothoracic and vascular anesthesia

    2022  Volume 26, Issue 4, Page(s) 266–273

    Abstract: ... ...

    Abstract Background
    MeSH term(s) Humans ; Nerve Block/methods ; Analgesics, Opioid ; Pain, Postoperative/prevention & control ; Anesthetics, Local ; Retrospective Studies ; Prospective Studies ; Mitral Valve/surgery ; Ropivacaine ; Case-Control Studies ; Analgesia/methods ; Morphine ; Catheters
    Chemical Substances Analgesics, Opioid ; Anesthetics, Local ; Ropivacaine (7IO5LYA57N) ; Morphine (76I7G6D29C)
    Language English
    Publishing date 2022-05-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012371-1
    ISSN 1940-5596 ; 1089-2532
    ISSN (online) 1940-5596
    ISSN 1089-2532
    DOI 10.1177/10892532221104420
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  6. Article ; Online: The Electrophysiology Laboratory: Anesthetic Considerations and Staffing Models.

    Siegrist, Kara K / Fernandez Robles, Claudia / Kertai, Miklos D / Oprea, Adriana D

    Journal of cardiothoracic and vascular anesthesia

    2021  Volume 35, Issue 9, Page(s) 2775–2783

    Abstract: The electrophysiology laboratory facilitates complex procedures on patients, many of whom have advanced disease processes and extensive comorbidities. Historically, nurses administered sedation as required, but in recent years a shift to anesthesiologist- ...

    Abstract The electrophysiology laboratory facilitates complex procedures on patients, many of whom have advanced disease processes and extensive comorbidities. Historically, nurses administered sedation as required, but in recent years a shift to anesthesiologist-led sedation has been promoted for patient safety and advanced therapeutic considerations. Uncertainty remains, however, regarding whether the electrophysiology laboratory is best staffed with general or cardiothoracic anesthesiologists. In this article, the authors discuss the anesthetic considerations of some commonly performed electrophysiology and structural cardiac procedures and the pros and cons of staffing with general or cardiothoracic anesthesiologists.
    MeSH term(s) Anesthesia ; Anesthetics ; Electrophysiology ; Humans ; Laboratories ; Workforce
    Chemical Substances Anesthetics
    Language English
    Publishing date 2021-02-26
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2021.02.050
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  7. Article ; Online: Severe Cardiopulmonary Disease in a Parturient With Noonan Syndrome.

    Siegrist, Kara K / Deegan, Robert J / Dumas, Susan D / Eagle, Susan S

    Seminars in cardiothoracic and vascular anesthesia

    2020  Volume 24, Issue 4, Page(s) 364–368

    Abstract: Noonan syndrome is a relatively common genetic disorder and the second most common cause of congenital heart disease after trisomy 21. The spectrum of cardiac anomalies in Noonan syndrome typically involves pulmonary valve stenosis occasionally in ... ...

    Abstract Noonan syndrome is a relatively common genetic disorder and the second most common cause of congenital heart disease after trisomy 21. The spectrum of cardiac anomalies in Noonan syndrome typically involves pulmonary valve stenosis occasionally in conjunction with hypertrophic cardiomyopathy. Mitral valve involvement is a rare finding in Noonan syndrome and is most commonly associated with either mitral valve prolapse or abnormal valvular insertion causing left ventricular outflow tract obstruction. Patients with Noonan syndrome typically have preserved fertility and, given the success of cardiac surgery and medical management of heart failure in this population, are beginning to present more commonly as parturients in adulthood. Maternal physiologic changes during pregnancy introduce an added complexity to hemodynamic management and anesthetic considerations during labor and delivery. In this article, we present a case of a patient with Noonan syndrome with severe mitral stenosis, pulmonary valve insufficiency, and severe restrictive and obstructive pulmonary disease who presented preterm for delivery due to increased dyspnea at rest. Here we review the pathophysiology behind Noonan syndrome and peripartum management strategies in a patient with severe combined cardiac and pulmonary disease.
    MeSH term(s) Adult ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/diagnostic imaging ; Cardiomyopathy, Hypertrophic/physiopathology ; Cesarean Section ; Dyspnea/complications ; Dyspnea/physiopathology ; Echocardiography, Transesophageal/methods ; Female ; Humans ; Lung Diseases, Obstructive/complications ; Lung Diseases, Obstructive/diagnostic imaging ; Lung Diseases, Obstructive/physiopathology ; Mitral Valve Stenosis/complications ; Mitral Valve Stenosis/diagnostic imaging ; Mitral Valve Stenosis/physiopathology ; Noonan Syndrome/complications ; Noonan Syndrome/physiopathology ; Pregnancy ; Pregnancy Complications/physiopathology ; Premature Birth ; Pulmonary Valve Insufficiency/complications ; Pulmonary Valve Insufficiency/diagnostic imaging ; Pulmonary Valve Insufficiency/physiopathology ; Ultrasonography/methods
    Language English
    Publishing date 2020-08-04
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2012371-1
    ISSN 1940-5596 ; 1089-2532
    ISSN (online) 1940-5596
    ISSN 1089-2532
    DOI 10.1177/1089253220945918
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  8. Article ; Online: An Unusual Finding in a Patient Presenting for Pulmonary Thromboendarterectomy: Pulmonary Venous Thrombosis.

    Siegrist, Kara K / Woolard, Austin A / Hillenbrand, Karl D / Shah, Ashish S / Eagle, Susan S

    Journal of cardiothoracic and vascular anesthesia

    2021  Volume 36, Issue 7, Page(s) 2046–2050

    Abstract: Pulmonary venous thrombosis (PVT) is a rare but potentially devastating disease state with a largely unknown incidence. The most common etiologies of PVT are secondary to complications of lung surgery, malignancy, catheter ablation for atrial ... ...

    Abstract Pulmonary venous thrombosis (PVT) is a rare but potentially devastating disease state with a largely unknown incidence. The most common etiologies of PVT are secondary to complications of lung surgery, malignancy, catheter ablation for atrial fibrillation, and idiopathic causes. Diagnosis can be challenging because presenting symptoms often are vague and nonspecific, or even asymptomatic, and traditional diagnostic modalities, such as chest radiography and arterial phase computed tomography scans, are poor techniques for diagnosis. The authors present a case of a patient presenting for pulmonary thromboendarterectomy for a presumed diagnosis of chronic thromboembolic pulmonary hypertension who was found incidentally to have a PVT, on intraoperative transesophageal echocardiography. Due to significant thrombus burden, the new finding of PVT, and known association of PVT and malignancy, a biopsy of mediastinal lymph nodes was obtained, which revealed metastatic cervical carcinoma. The pulmonary endarterectomy procedure was aborted.
    MeSH term(s) Endarterectomy/methods ; Humans ; Hypertension, Pulmonary/diagnostic imaging ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/surgery ; Lung ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/surgery ; Venous Thrombosis/complications ; Venous Thrombosis/diagnostic imaging
    Language English
    Publishing date 2021-06-22
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2021.06.019
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  9. Article ; Online: Robotic Adrenalectomy for Pheochromocytoma in a Patient with Fontan Physiology.

    Cummings, Jared J / Siegrist, Kara K / Deegan, Robert J / Solórzano, Carmen C / Eagle, Susan S

    Journal of cardiothoracic and vascular anesthesia

    2020  Volume 34, Issue 9, Page(s) 2446–2451

    MeSH term(s) Adrenal Gland Neoplasms/diagnostic imaging ; Adrenal Gland Neoplasms/surgery ; Adrenalectomy ; Humans ; Laparoscopy ; Pheochromocytoma/diagnostic imaging ; Pheochromocytoma/surgery ; Robotic Surgical Procedures
    Language English
    Publishing date 2020-03-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2020.02.050
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  10. Article ; Online: Perioperative Characteristics and Outcomes of Fontan Versus Non-Fontan Patients Undergoing Combined Heart-Liver Transplantation: A Retrospective Cohort Study.

    Wu, Wei Kelly / Siegrist, Kara K / Ziogas, Ioannis A / Mishra, Kelly L / Matsuoka, Lea K / Menachem, Jonathan N / Izzy, Manhal / Shingina, Alexandra / Do, Nhue L / Bacchetta, Matthew / Shah, Ashish S / Alexopoulos, Sophoclis P

    Journal of cardiothoracic and vascular anesthesia

    2023  Volume 38, Issue 3, Page(s) 745–754

    Abstract: Objectives: Combined heart-liver transplantation (CHLT) is becoming increasingly frequent as a maturing population of patients with Fontan-palliated congenital heart disease develop advanced liver fibrosis or cirrhosis. The authors present their ... ...

    Abstract Objectives: Combined heart-liver transplantation (CHLT) is becoming increasingly frequent as a maturing population of patients with Fontan-palliated congenital heart disease develop advanced liver fibrosis or cirrhosis. The authors present their experience with CHLT for congenital and noncongenital indications, and identify characteristics associated with poor outcomes that may guide intervention in high-risk patients.
    Design: This was a single-center retrospective cohort study.
    Setting: This study was conducted at Vanderbilt University Medical Center in Nashville, Tennessee.
    Participants: The study included 16 consecutive adult recipients of CHLT at the authors' institution between April 2017 and February 2022.
    Interventions: Eleven patients underwent transplantation for Fontan indications, and 5 were transplanted for non-Fontan indications.
    Measurements and main results: Compared with non-Fontan patients, Fontan recipients had longer cardiopulmonary bypass duration (199 v 119 minutes, p =m0.002), operative times (786 v 599 minutes, p = 0.01), and larger blood product transfusions (15.4 v 6.3 L, p = 0.18). Six of 16 patients required extracorporeal membrane oxygenation (ECMO), of whom 4 were Fontan patients who subsequently died. Patients who required ECMO had lower 5-hour lactate clearance (0.0 v 3.5 mmol/L, p = 0.001), higher number of vasoactive infusions, lower pulmonary artery pulsatility indices (0.58 v 1.77, p = 0.03), and higher peak inspiratory pressures (28.0 v 18.5 mmHg, p = 0.01) after liver reperfusion.
    Conclusions: Combined heart-liver transplantation in patients with Fontan-associated end-organ disease is particularly challenging and associated with higher recipient morbidity compared with non-Fontan-related CHLT. Early hemodynamic intervention for signs of ventricular dysfunction may improve outcomes in this growing high-risk population.
    MeSH term(s) Adult ; Humans ; Liver Transplantation ; Retrospective Studies ; Fontan Procedure ; Heart Transplantation ; Heart Defects, Congenital/surgery ; Liver/surgery
    Language English
    Publishing date 2023-12-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2023.11.043
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