The left internal mammary artery (LIMA) graft plays a pivotal role in coronary artery bypass surgery, offering unparalleled efficacy in revascularization. This review paper delves into the multifaceted considerations surrounding LIMA utilization, aiming to provide a comprehensive understanding of optimal approaches. The study encompasses the alleviation of spasm, selection of graft harvesting techniques, identification of ideal vasodilators, and exploration of optimal delivery methods. Through an analysis of extensive research spanning the past three decades, this review elucidates critical insights for cardiac surgeons and researchers alike. The review emphasizes the ubiquity of severe spasms in harvested LIMA and examines interventions to mitigate this challenge. Studies highlighting the efficacy of papaverine administration through various routes underscore the need for tailored approaches based on clinical context. The debate between skeletonized and pedicled LIMA harvests is explored, revealing the advantages and complexities associated with each technique. Findings suggest that while skeletonized grafts offer enhanced flow, the decision remains multifaceted due to potential complications. Addressing the quest for the ideal vasodilator, the review juxtaposes papaverine and sodium nitroprusside, presenting both as viable options. Despite ongoing discussions, the cost-effectiveness and accessibility of papaverine have positioned it as the favored choice among clinicians. Optimal delivery methods emerge as a crucial factor in graft success, with perivascular injection showing promise in promoting sustained and improved flow rates. The clinical implications of these findings are substantial. By integrating the evidence presented, cardiac surgeons can make informed decisions, maximizing graft patency and patient outcomes. Further, research avenues are identified, encompassing refined delivery techniques, comprehensive comparisons of vasodilators, and long-term clinical outcome evaluations. In conclusion, this review underscores the intricate considerations essential for successful LIMA utilization. By addressing spasms, selecting graft techniques, choosing vasodilators, and refining delivery methods, practitioners can tailor their strategies to the individual patient, enhancing the efficacy of coronary revascularization.
左乳内动脉（LIMA）移植在冠状动脉搭桥手术中起着举足轻重的作用，在血管重建方面具有无与伦比的功效。本综述论文深入探讨了围绕 LIMA 使用的多方面考虑，旨在提供对最佳方法的全面理解。研究内容包括缓解痉挛、选择移植物采集技术、确定理想的血管扩张剂以及探索最佳输送方法。通过对过去三十年的广泛研究进行分析，本综述为心脏外科医生和研究人员阐明了重要的见解。这篇综述强调了采自 LIMA 的严重痉挛的普遍性，并探讨了减轻这一挑战的干预措施。研究强调了通过不同途径给予木瓜碱的疗效，强调了根据临床情况采取定制方法的必要性。研究还探讨了LIMA镂空摘取和迂曲摘取之间的争论，揭示了每种技术的优势和复杂性。研究结果表明，虽然镂空移植物能增强血流，但由于潜在的并发症，决定仍然是多方面的。针对寻找理想血管扩张剂的问题，综述将木蝴蝶碱和硝普钠并列，提出这两种药物都是可行的选择。尽管讨论仍在继续，但木蝴蝶碱的成本效益和可及性已使其成为临床医生的首选。最佳给药方法是移植物成功的关键因素，血管周围注射显示出促进持续和改善血流速度的前景。这些发现的临床意义重大。通过整合所提供的证据，心脏外科医生可以做出明智的决定，最大限度地提高移植物的通畅性和患者的治疗效果。此外，还确定了研究途径，包括改进给药技术、全面比较血管扩张剂和长期临床效果评估。总之，本综述强调了成功使用 LIMA 所需的复杂考虑因素。通过解决痉挛、选择移植物技术、选择血管扩张剂和改进给药方法，医生可以根据患者的具体情况制定相应的策略，从而提高冠状动脉血运重建的疗效。
{"title":"Optimizing Internal Mammary Artery Harvest and Preparation","authors":"Rahul Bhushan, Vijay Grover","doi":"10.25259/jccc_75_2023","DOIUrl":"https://doi.org/10.25259/jccc_75_2023","url":null,"abstract":"The left internal mammary artery (LIMA) graft plays a pivotal role in coronary artery bypass surgery, offering unparalleled efficacy in revascularization. This review paper delves into the multifaceted considerations surrounding LIMA utilization, aiming to provide a comprehensive understanding of optimal approaches. The study encompasses the alleviation of spasm, selection of graft harvesting techniques, identification of ideal vasodilators, and exploration of optimal delivery methods. Through an analysis of extensive research spanning the past three decades, this review elucidates critical insights for cardiac surgeons and researchers alike. The review emphasizes the ubiquity of severe spasms in harvested LIMA and examines interventions to mitigate this challenge. Studies highlighting the efficacy of papaverine administration through various routes underscore the need for tailored approaches based on clinical context. The debate between skeletonized and pedicled LIMA harvests is explored, revealing the advantages and complexities associated with each technique. Findings suggest that while skeletonized grafts offer enhanced flow, the decision remains multifaceted due to potential complications. Addressing the quest for the ideal vasodilator, the review juxtaposes papaverine and sodium nitroprusside, presenting both as viable options. Despite ongoing discussions, the cost-effectiveness and accessibility of papaverine have positioned it as the favored choice among clinicians. Optimal delivery methods emerge as a crucial factor in graft success, with perivascular injection showing promise in promoting sustained and improved flow rates. The clinical implications of these findings are substantial. By integrating the evidence presented, cardiac surgeons can make informed decisions, maximizing graft patency and patient outcomes. Further, research avenues are identified, encompassing refined delivery techniques, comprehensive comparisons of vasodilators, and long-term clinical outcome evaluations. In conclusion, this review underscores the intricate considerations essential for successful LIMA utilization. By addressing spasms, selecting graft techniques, choosing vasodilators, and refining delivery methods, practitioners can tailor their strategies to the individual patient, enhancing the efficacy of coronary revascularization.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"20 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140700914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chinmaya Nanda, Sudipto Banerjee, Yatin Mehta, S. K. S. Rawat, N. Chouhan
{"title":"Central Retinal Artery Occlusion Secondary to Paradoxical Embolism Across a Patent Foramen Ovale","authors":"Chinmaya Nanda, Sudipto Banerjee, Yatin Mehta, S. K. S. Rawat, N. Chouhan","doi":"10.25259/jccc_61_2023","DOIUrl":"https://doi.org/10.25259/jccc_61_2023","url":null,"abstract":"","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"67 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140700009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rashmi Singh, Arindam Choudhury, Sandeep Chauhan, Milind P. Hote
Pain following sternotomy has always been an issue of major concern for anesthesiologists. The incidence of pain is as high as 49% at rest following coronary artery bypass grafting. We planned to utilize the sub-pecto-interfascial plane (SIP) block and erector spinae plane (ESP) block to determine its efficacy and quality of analgesia as compared to conventional intravenous analgesia. After the Institutional Ethics Committee’s approval, we recruited 105 patients and randomized them into three groups. Group 1 received conventional analgesia, group 2 SIP, and group 3 ESP block. Group 2 and Group 3 received allocated blocks after induction of balanced general anesthesia under ultrasound guidance. With high-frequency linear probe (13 MHz) planes identified, a mixture of injection ropivacaine (0.375%) and dexmedetomidine (1.1 mcg/mL) was deposited. In group 2, six injections of 6 mL each at the 2nd, 4th, and 6th intercostal spaces in the bilateral parasternal region. In group 3, two injections of 20 mL of the above-mentioned mixture on each side above the transverse process of the T5 vertebra under the erector spinae muscle plane were injected. All patients were monitored throughout the procedures, and their vitals were recorded. Heart rate, systolic blood pressure, and diastolic blood pressure were noted at baseline, at skin incision, at sternotomy, and 30 min post-extubation. Patients were followed for total fentanyl consumption, pain score (numerical rating scale [NRS] score), and peak inspiratory flow rate, which were noted at extubation and 2, 4, 6, 8, 12, and 24 hours post-extubation. Levels of C-reactive protein (CRP), cortisol, and prolactin were done at baseline and 24 h after surgery. Extubation time, time of first oral intake, and total length of intensive care unit (ICU) stay were also compared between the groups. Total fentanyl consumption was significantly lower (P < 0.005) in group 2 and group 3 compared to group 1. Patient receiving blocks were significantly lower NRS score compared to the control group. Spirometry has shown improved results in block groups catering to early discharge from ICU. Rise in levels of CRP, cortisol, and prolactin were much higher in group 1 as compared to group 2 and group 3. The application of ESP and SIP blocks is far superior than conventional parenteral analgesics in terms of pain score, total opioid’s consumption, hemodynamic maintenance, spirometry efforts, and length of ICU stays.
{"title":"To Compare the Efficacy of Sub-Pecto-Interfascial Block with Erector Spinae Plane Block in Postoperative Pain Management in Patients Undergoing Cardiac Surgery","authors":"Rashmi Singh, Arindam Choudhury, Sandeep Chauhan, Milind P. Hote","doi":"10.25259/jccc_69_2023","DOIUrl":"https://doi.org/10.25259/jccc_69_2023","url":null,"abstract":"\u0000\u0000Pain following sternotomy has always been an issue of major concern for anesthesiologists. The incidence of pain is as high as 49% at rest following coronary artery bypass grafting. We planned to utilize the sub-pecto-interfascial plane (SIP) block and erector spinae plane (ESP) block to determine its efficacy and quality of analgesia as compared to conventional intravenous analgesia.\u0000\u0000\u0000\u0000After the Institutional Ethics Committee’s approval, we recruited 105 patients and randomized them into three groups. Group 1 received conventional analgesia, group 2 SIP, and group 3 ESP block. Group 2 and Group 3 received allocated blocks after induction of balanced general anesthesia under ultrasound guidance. With high-frequency linear probe (13 MHz) planes identified, a mixture of injection ropivacaine (0.375%) and dexmedetomidine (1.1 mcg/mL) was deposited. In group 2, six injections of 6 mL each at the 2nd, 4th, and 6th intercostal spaces in the bilateral parasternal region. In group 3, two injections of 20 mL of the above-mentioned mixture on each side above the transverse process of the T5 vertebra under the erector spinae muscle plane were injected. All patients were monitored throughout the procedures, and their vitals were recorded. Heart rate, systolic blood pressure, and diastolic blood pressure were noted at baseline, at skin incision, at sternotomy, and 30 min post-extubation. Patients were followed for total fentanyl consumption, pain score (numerical rating scale [NRS] score), and peak inspiratory flow rate, which were noted at extubation and 2, 4, 6, 8, 12, and 24 hours post-extubation. Levels of C-reactive protein (CRP), cortisol, and prolactin were done at baseline and 24 h after surgery. Extubation time, time of first oral intake, and total length of intensive care unit (ICU) stay were also compared between the groups.\u0000\u0000\u0000\u0000Total fentanyl consumption was significantly lower (P < 0.005) in group 2 and group 3 compared to group 1. Patient receiving blocks were significantly lower NRS score compared to the control group. Spirometry has shown improved results in block groups catering to early discharge from ICU. Rise in levels of CRP, cortisol, and prolactin were much higher in group 1 as compared to group 2 and group 3.\u0000\u0000\u0000\u0000The application of ESP and SIP blocks is far superior than conventional parenteral analgesics in terms of pain score, total opioid’s consumption, hemodynamic maintenance, spirometry efforts, and length of ICU stays.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"55 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140700586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital cardiac abnormality in which the pulmonary veins drain into the right atrium directly or the superior vena cava 90% of PAPVC are accompanied by atrial septal defect. However, PAPVC with ventricular septal defect is a rare entity.
{"title":"Partial Anomalous Pulmonary Venous Connection with Ventricular Septal Defect and Intact Atrial Septum","authors":"Mayank Yadav, Chava Harshanth Sairam","doi":"10.25259/jccc_62_2023","DOIUrl":"https://doi.org/10.25259/jccc_62_2023","url":null,"abstract":"Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital cardiac abnormality in which the pulmonary veins drain into the right atrium directly or the superior vena cava 90% of PAPVC are accompanied by atrial septal defect. However, PAPVC with ventricular septal defect is a rare entity.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An electrocardiogram (ECG) is a diagnostic tool that can identify heart conditions and offer valuable information about electrical activity and age-related changes. Our primary concern is studying ECG changes related to age, gender, and body mass index (BMI) for the benefit of researchers and clinicians. A comprehensive search for relevant literature was conducted in the PubMed, Embase, and Scopus databases. The selection criteria were limited to original papers published between January 1, 2015, and December 31, 2022, that were deemed eligible. We executed a meticulous selection process that involved eliminating duplicates, screening abstracts and full texts, and manually adding some articles. During the full-text screening process, we excluded articles that were not relevant to our study. Ultimately, we included only nine observational studies that fulfilled our eligibility criteria. Our primary objective was to determine the factors that influence the ECG pattern in children and adolescents. This review systematically highlights the significance of identifying ECG patterns that could be correlated to factors such as age, gender, and BMI. Identifying such patterns may play a crucial role in improving the diagnostic accuracy of ECG. Physicians who fail to recognize these patterns may mistakenly endanger their patients’ lives.
{"title":"Factors Influencing Electrocardiogram Pattern in Children and Adolescents: A Systematic Review for Future Research","authors":"E. Thirumurugan, Edwin Dias, Karthick R","doi":"10.25259/jccc_74_2023","DOIUrl":"https://doi.org/10.25259/jccc_74_2023","url":null,"abstract":"An electrocardiogram (ECG) is a diagnostic tool that can identify heart conditions and offer valuable information about electrical activity and age-related changes. Our primary concern is studying ECG changes related to age, gender, and body mass index (BMI) for the benefit of researchers and clinicians. A comprehensive search for relevant literature was conducted in the PubMed, Embase, and Scopus databases. The selection criteria were limited to original papers published between January 1, 2015, and December 31, 2022, that were deemed eligible. We executed a meticulous selection process that involved eliminating duplicates, screening abstracts and full texts, and manually adding some articles. During the full-text screening process, we excluded articles that were not relevant to our study. Ultimately, we included only nine observational studies that fulfilled our eligibility criteria. Our primary objective was to determine the factors that influence the ECG pattern in children and adolescents. This review systematically highlights the significance of identifying ECG patterns that could be correlated to factors such as age, gender, and BMI. Identifying such patterns may play a crucial role in improving the diagnostic accuracy of ECG. Physicians who fail to recognize these patterns may mistakenly endanger their patients’ lives.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"327 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shelly Sharma, S. Kalra, R. Rai, Afsha Parveen, Deepak Raghav, Ruchika Naswa
Menopause is a normal life stage that frequently brings with it emotional and physical difficulties that affect women’s Quality of life (QoL) and interfere with their ability to sleep. The objective of this study was to examine how postmenopausal women (PMWs) responded to supervised aerobic exercise training versus unsupervised Walking in terms of sleep, QoL, and depression. In addition, the impact on body composition was also assessed as a secondary outcome measure. Fifty PMWs (aged 45–60) were divided into two groups at random: The control group (n = 25) performed standard unsupervised Walking, and the experimental group (n = 25) performed scheduled supervised aerobic exercise training. The Pittsburgh sleep quality index (PSQI), the 36-item short-form survey, the beck depression inventory (BDI), and the body mass index (BMI) were among the evaluations used in the 6-week, 3-day program. Remarkable advancements (P < 0.05) were noted in the aerobic training cohort. The experimental group increased total sleep duration by 37.9% and fell asleep 44.8% faster, resulting in a noteworthy 61.7% improvement in the PSQI score. BDI scores improved by 55.6%, and there was a 6.8% variation in BMI between the groups. A 6-week aerobic intervention can improve sleep quality, reduce menopausal symptoms, and enhance life quality in PMW. Furthermore, the results revealed that a regulated exercise group may offer more benefits than an unregulated one. This observation underscores the potential advantages of structured and monitored aerobic exercise program in achieving specific health and fitness goals.
{"title":"Effect of Aerobic Exercise on Sleep, Depression, and Quality of Life in Postmenopausal Women","authors":"Shelly Sharma, S. Kalra, R. Rai, Afsha Parveen, Deepak Raghav, Ruchika Naswa","doi":"10.25259/jccc_72_2023","DOIUrl":"https://doi.org/10.25259/jccc_72_2023","url":null,"abstract":"\u0000\u0000Menopause is a normal life stage that frequently brings with it emotional and physical difficulties that affect women’s Quality of life (QoL) and interfere with their ability to sleep. The objective of this study was to examine how postmenopausal women (PMWs) responded to supervised aerobic exercise training versus unsupervised Walking in terms of sleep, QoL, and depression. In addition, the impact on body composition was also assessed as a secondary outcome measure.\u0000\u0000\u0000\u0000Fifty PMWs (aged 45–60) were divided into two groups at random: The control group (n = 25) performed standard unsupervised Walking, and the experimental group (n = 25) performed scheduled supervised aerobic exercise training. The Pittsburgh sleep quality index (PSQI), the 36-item short-form survey, the beck depression inventory (BDI), and the body mass index (BMI) were among the evaluations used in the 6-week, 3-day program.\u0000\u0000\u0000\u0000Remarkable advancements (P < 0.05) were noted in the aerobic training cohort. The experimental group increased total sleep duration by 37.9% and fell asleep 44.8% faster, resulting in a noteworthy 61.7% improvement in the PSQI score. BDI scores improved by 55.6%, and there was a 6.8% variation in BMI between the groups.\u0000\u0000\u0000\u0000A 6-week aerobic intervention can improve sleep quality, reduce menopausal symptoms, and enhance life quality in PMW. Furthermore, the results revealed that a regulated exercise group may offer more benefits than an unregulated one. This observation underscores the potential advantages of structured and monitored aerobic exercise program in achieving specific health and fitness goals.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"22 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Chowdhury, Niwin George, B. Kanmaniyan, Sundeep Mishra, Chaitanya Chittimuri, Poonam Malhotra Kapoor, Sikha Goja, N. Pandey
We describe herein the surgical technique on a 2.5-years-old male child weighing 10 kilograms diagnosed with a functionally univentricular heart, disproportionately small right subclavian artery, and hypoplastic pulmonary arteries (Mc Goon’s ratio of less than 1.0).5 We interposed a short segment of polytetrafluroethylene graft between the right brachiocephalic artery and the intrapericardial portion of the right pulmonary artery closest to the bifurcation of the pulmonary trunk on the right side.
{"title":"Technical Details of a Novel Surgical Procedure for Construction of the Modified Blalock–Taussig Shunt (UKC’s Modification): A Video Presentation","authors":"U. Chowdhury, Niwin George, B. Kanmaniyan, Sundeep Mishra, Chaitanya Chittimuri, Poonam Malhotra Kapoor, Sikha Goja, N. Pandey","doi":"10.25259/jccc_63_2023","DOIUrl":"https://doi.org/10.25259/jccc_63_2023","url":null,"abstract":"We describe herein the surgical technique on a 2.5-years-old male child weighing 10 kilograms diagnosed with a functionally univentricular heart, disproportionately small right subclavian artery, and hypoplastic pulmonary arteries (Mc Goon’s ratio of less than 1.0).5 We interposed a short segment of polytetrafluroethylene graft between the right brachiocephalic artery and the intrapericardial portion of the right pulmonary artery closest to the bifurcation of the pulmonary trunk on the right side.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"29 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Chowdhury, Niwin George, B. Kanmaniyan, Sundeep Mishra, Chaitanya Chittimuri, Poonam Malhotra Kapoor, Sikha Goja, N. Pandey
We present here-in the technical details of harvesting the left radial artery in a 50-year- old man undergoing coronary artery bypass grafting. The radial artery has been harvested atraumatically using a Harmonic scalpel (Ethicon Endosurgery LLC, Johnson & Johnson Company, Guaynaba, Puerto Rico, USA) and two vessel loops by “No touch” technique, thereby preventing perioperative spasm. The postoperative recovery was uneventful.
我们在此介绍一位 50 岁男性接受冠状动脉旁路移植手术时采集左侧桡动脉的技术细节。我们使用 Harmonic 手术刀（Ethicon Endosurgery LLC, Johnson & Johnson Company, Guaynaba, Puerto Rico, USA）在腔内采集了桡动脉，并采用 "不接触 "技术采集了两个血管环，从而避免了围手术期的痉挛。术后恢复顺利。
{"title":"Step-by-Step Atraumatic Technique of Harvesting of the Radial Artery using Harmonic Scalpel: A Video Presentation","authors":"U. Chowdhury, Niwin George, B. Kanmaniyan, Sundeep Mishra, Chaitanya Chittimuri, Poonam Malhotra Kapoor, Sikha Goja, N. Pandey","doi":"10.25259/jccc_65_2023","DOIUrl":"https://doi.org/10.25259/jccc_65_2023","url":null,"abstract":"We present here-in the technical details of harvesting the left radial artery in a 50-year- old man undergoing coronary artery bypass grafting. The radial artery has been harvested atraumatically using a Harmonic scalpel (Ethicon Endosurgery LLC, Johnson & Johnson Company, Guaynaba, Puerto Rico, USA) and two vessel loops by “No touch” technique, thereby preventing perioperative spasm. The postoperative recovery was uneventful.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"23 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140435769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Implementation of Patient Blood Management – A Long and Winding Road but Worth Doing!","authors":"Klaus Görlinger","doi":"10.25259/jccc_24s1_kgie","DOIUrl":"https://doi.org/10.25259/jccc_24s1_kgie","url":null,"abstract":"","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"14 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The growing concerns around the judicious use of blood components have paved the way for the dissemination of awareness around the best practices related to the use of this precious resource. With the World Health Organization issuing a policy brief on the urgent implementation of Patient Blood Management (PBM), there has been an accelerated impetus within the healthcare ecosystem to imbibe and implement the principles and practices of PBM. This research work aims to understand the current level of understanding, adequacy, and appropriateness of practices and readiness toward the universal and standardized implementation of PBM. This article summarizes the findings of an online survey. The survey consisted of a Google Form questionnaire with responses in multiple-choice, open and closed ends, as well as short notes. The survey responses were analyzed and summed up graphically. The survey established that there is still a huge gap in the “multispecialty approach” to setting up of the safe tolerance limits to anemia, optimal cutoffs, and thresholds for transfusion and shifting focus from “blood product” safety to “patient” safety. A lot of guidance- and evidence-based recommendations on transfusion practices are available in developed economies; the developing world still continues to weigh the advantages against the availability of and access to resources needed for implementation. Within these economies, and among different strata of healthcare infrastructure, there is still a significant difference in the perceptions and practices around blood transfusion and bleeding management.
{"title":"Blood and Bleeding Management in Developing Economies: Perceptions, Preparedness, and the Evolving Practices","authors":"Anurag Kumar Mishra, Atul K. Agarwal, Ajay Gandhi","doi":"10.25259/jccc_24s1_ag1","DOIUrl":"https://doi.org/10.25259/jccc_24s1_ag1","url":null,"abstract":"\u0000\u0000The growing concerns around the judicious use of blood components have paved the way for the dissemination of awareness around the best practices related to the use of this precious resource. With the World Health Organization issuing a policy brief on the urgent implementation of Patient Blood Management (PBM), there has been an accelerated impetus within the healthcare ecosystem to imbibe and implement the principles and practices of PBM. This research work aims to understand the current level of understanding, adequacy, and appropriateness of practices and readiness toward the universal and standardized implementation of PBM.\u0000\u0000\u0000\u0000This article summarizes the findings of an online survey. The survey consisted of a Google Form questionnaire with responses in multiple-choice, open and closed ends, as well as short notes. The survey responses were analyzed and summed up graphically. The survey established that there is still a huge gap in the “multispecialty approach” to setting up of the safe tolerance limits to anemia, optimal cutoffs, and thresholds for transfusion and shifting focus from “blood product” safety to “patient” safety.\u0000\u0000\u0000\u0000A lot of guidance- and evidence-based recommendations on transfusion practices are available in developed economies; the developing world still continues to weigh the advantages against the availability of and access to resources needed for implementation. Within these economies, and among different strata of healthcare infrastructure, there is still a significant difference in the perceptions and practices around blood transfusion and bleeding management.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139606685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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