Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit
作者:André Y. Denault、Pierre Couture、Sylvie McKenty、Daniel Boudreault、François Plante、Roger Perron、Denis Babin、Jean Buithieu
DOI:10.1007/bf03020529
日期:2002.3
Background: The American Society of Anesthesiologists (ASA) has published practice guidelines for the use of perioperative transesophageal echocardiography (TEE) but the role and impact of TEE performed by anesthesiologists outside the cardiac operating room (OR) is still poorly explored. We report our experience in the use of TEE in the noncardiac OR, the recovery room and in the intensive care unit (ICU) in a university hospital, and analyze the impact of TEE on clinical decision making.Methods: Two hundred fourteen patients were included and TEE indications were classified prospectively according to the ASA guidelines, The examinations and data sheets were reviewed by two anesthesiologists with advanced training in TEE, For each examination, it was noted if TEE altered the management according to five groups: 1) changing medical therapy; 2) changing surgical therapy; 3) confirmation of a diagnosis; 4) positioning of an intravascular device; and 5) TEE used as a substitute to a pulmonary artery catheterResults: Eighty-nine (37%), 67 (31%) and 58 (27%) patients had category I, II and III indications, The impact was more significant in category I where TEE altered therapy 60% of the time compared with 31% and 21% for categories II and III (P < 0.001). The most frequent reason for changing management was a modification in medical therapy in 53 instances (45%).Conclusion: Our results confirm a greater impact of TEE performed by anesthesiologists on clinical management for category I compared to category II and III indications in the noncardiac OR surgical setting and in the ICU.
Zn(OTf)<sub>2</sub>-Promoted Chemoselective Esterification of Hydroxyl Group Bearing Carboxylic Acids
作者:Narsimha Mamidi、Debasis Manna
DOI:10.1021/jo302502r
日期:2013.3.15
Selective esterification of aliphatic and aromatic carboxylic acids with various alcohols is studied using triphenylphosphine, I-2, and a catalytic amount of Zn(OTf)(2). Use of this catalyst allows the formation of esters at a faster rate with good to excellent yield by activating the in situ generated acyloxyphosphonium ion intermediate. During the esterification process, both their aromatic and aliphatic hydroxyl groups are fully preserved from trans-esterification. The results show that the bulkiness and the reactivity of this doubly activated intermediate III control the selectivity and the rate of the reaction, respectively. The method is also useful for direct amidation reactions.