Poonam Malhotra Kapoor, Mohit Prakash, Omer Mohammed Mujahid, Mohanish Badge, T. Thiruselvan, Sanchita Garg
Extracorporeal life support (ECLS) is a life support modality that is being used in life-threatening cardiac and/or respiratory failure; in neonates, children, and adults. The risk of bleeding and other coagulation-related issues is unavoidable. Hence, while conducting ECLS, a patient-tailored approach is better than the generalized approach for bleeding management. There are no established guidelines for heparin use and its monitoring during ECLS in a bleeding patient on VA ECMO. Likewise, heparin and its adjuncts, though mentioned in the literature, have no consensus on what exact steps to follow in an adverse condition. Having a protocol for anticoagulation and its monitoring is of paramount importance in any center practicing ECLS. This review aims to seek the incidence of bleeding and thrombosis while on ECMO with the use of routine anticoagulant heparin and justify the need for the use of viscoelastic tests on VA ECMO.
{"title":"Viscoelastic Testing on Venoarterial Extracorporeal Membrane Oxygenation: Need or Greed?","authors":"Poonam Malhotra Kapoor, Mohit Prakash, Omer Mohammed Mujahid, Mohanish Badge, T. Thiruselvan, Sanchita Garg","doi":"10.25259/jccc_47_2023","DOIUrl":"https://doi.org/10.25259/jccc_47_2023","url":null,"abstract":"Extracorporeal life support (ECLS) is a life support modality that is being used in life-threatening cardiac and/or respiratory failure; in neonates, children, and adults. The risk of bleeding and other coagulation-related issues is unavoidable. Hence, while conducting ECLS, a patient-tailored approach is better than the generalized approach for bleeding management. There are no established guidelines for heparin use and its monitoring during ECLS in a bleeding patient on VA ECMO. Likewise, heparin and its adjuncts, though mentioned in the literature, have no consensus on what exact steps to follow in an adverse condition. Having a protocol for anticoagulation and its monitoring is of paramount importance in any center practicing ECLS. This review aims to seek the incidence of bleeding and thrombosis while on ECMO with the use of routine anticoagulant heparin and justify the need for the use of viscoelastic tests on VA ECMO.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136236485","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}
Viscoelastic assays help in identifying disorders of clotting factors, platelet function, and detection of excessive fibrinolysis. Rotational thromboelastometry (ROTEM) assesses quantitative and qualitative aspects of whole blood coagulation which allows for the determination of the mechanism of hemostatic disturbance. This helps clinicians in targeting the correct blood component therapy transfusion. Now, using verify we aim to study platelet reactivity, VA ECMO which will reflect the platelet aggregation response to an aggregating agent like Aspirin and thus know the etiology of bleeding on VA ECMO, to know the right component therapy to be transfused with a Point of Care test. For extracorporeal membrane oxygenation, although the conventional laboratory tests are used to monitor anticoagulation on whole blood, viscoelastic tests reflect coagulation status like no other standard laboratory tests. They show the status of color propagation, formation, and stabilization. It was reported that platelet function was impaired over time in all parameters with different activators.
{"title":"Platelet Reactivity on ECMO: Role of VerifyNow","authors":"Omer Mohammed Mujahid, Poonam Malhotra Kapoor, Mohit Prakash, Pallavi Sharma, Mohanish Badge, Minati Choudhury, Milind Padmakar Hote","doi":"10.25259/jccc_42_2023","DOIUrl":"https://doi.org/10.25259/jccc_42_2023","url":null,"abstract":"Viscoelastic assays help in identifying disorders of clotting factors, platelet function, and detection of excessive fibrinolysis. Rotational thromboelastometry (ROTEM) assesses quantitative and qualitative aspects of whole blood coagulation which allows for the determination of the mechanism of hemostatic disturbance. This helps clinicians in targeting the correct blood component therapy transfusion. Now, using verify we aim to study platelet reactivity, VA ECMO which will reflect the platelet aggregation response to an aggregating agent like Aspirin and thus know the etiology of bleeding on VA ECMO, to know the right component therapy to be transfused with a Point of Care test. For extracorporeal membrane oxygenation, although the conventional laboratory tests are used to monitor anticoagulation on whole blood, viscoelastic tests reflect coagulation status like no other standard laboratory tests. They show the status of color propagation, formation, and stabilization. It was reported that platelet function was impaired over time in all parameters with different activators.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136236486","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}
Ujjwal K. Chowdhury, Niwin George, Sundeep Mishra, Asharam Panda, Poonam Malhotra Kapoor, B. Kanmaniyan, Shikha Goja, Chaitanya Chittimuri
A 5-week-old male child, weighing 4 kg diagnosed with d-transposition of the great arteries with multiple muscular ventricular septal defects, Yacoub’s type-A coronary arterial pattern, successfully underwent arterial switch operation with Dacron patch closure of ventricular septal defects under moderately hypothermic cardiopulmonary bypass and St. Thomas based cold blood cardioplegia under integrated extracorporeal membrane oxygenation. Postoperatively, he required mechanical circulatory assistance for 72 h. At 12 months of follow-up, there was no mitral or tricuspid regurgitation, no neoaortic valve insufficiency with good biventricular function in Ross clinical score of 2.
{"title":"Anatomical Correction of Transposition of the Great Arteries at the Arterial Level with Dacron Patch Closure of Multiple Ventricular Septal Defects under Integrated Extracorporeal Membrane Oxygenation: A Video Presentation","authors":"Ujjwal K. Chowdhury, Niwin George, Sundeep Mishra, Asharam Panda, Poonam Malhotra Kapoor, B. Kanmaniyan, Shikha Goja, Chaitanya Chittimuri","doi":"10.25259/jccc_37_2023","DOIUrl":"https://doi.org/10.25259/jccc_37_2023","url":null,"abstract":"A 5-week-old male child, weighing 4 kg diagnosed with d-transposition of the great arteries with multiple muscular ventricular septal defects, Yacoub’s type-A coronary arterial pattern, successfully underwent arterial switch operation with Dacron patch closure of ventricular septal defects under moderately hypothermic cardiopulmonary bypass and St. Thomas based cold blood cardioplegia under integrated extracorporeal membrane oxygenation. Postoperatively, he required mechanical circulatory assistance for 72 h. At 12 months of follow-up, there was no mitral or tricuspid regurgitation, no neoaortic valve insufficiency with good biventricular function in Ross clinical score of 2.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"341 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136236487","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}
Jonnalagadda Vihari, Abhishek Prasad Dash, Arsh Gupta, Niloy Roy, Samir Sahu, P. Sowmya, Kashmira Robin George, Alajangi Praseeda, H. R. Shabarish, Mallipeddi Vivek Vardhan
In patients with cardiogenic shock, this review compares the efficacy of percutaneous microaxial left ventricular assist devices (pLVADs) to intra-aortic balloon pumps (IABPs) or no mechanical circulatory support (MCS). End-organ hypoperfusion brought on by insufficient cardiac output characterizes the potentially fatal disease known as cardiogenic shock. Relevant papers were found by a thorough search of internet resources and were incorporated into the study. The main outcomes evaluated were: (1) Short-term mortality, (2) hemodynamic indices, (3) organ function, and (4) Length of hospital stay. Considered secondary outcomes were: (1) Adverse events, (2) quality of life, and (3) long-term survival. As shown by increased cardiac output and mean arterial pressure, the findings of this research imply that pLVADs may provide superior hemodynamic support versus IABPs or no MCS. In addition, pLVADs may have better organ function and lower short-term mortality rates than IABPs or no MCS. However, using pLVADs was also linked to a higher risk of unfavorable outcomes, such as bleeding and vascular issues. Data on long-term survival and quality-of-life outcomes were sparse and ambiguous. In conclusion, as compared to IABPs or no MCS, pLVADs may offer more effective hemodynamic support and better short-term outcomes in patients with cardiogenic shock. More investigation is required to fully comprehend the long-term advantages, hazards, and effects of pLVADs on the quality of life in this patient population.
{"title":"Comparative Effectiveness of Mechanical Circulatory Support Devices in Cardiogenic Shock","authors":"Jonnalagadda Vihari, Abhishek Prasad Dash, Arsh Gupta, Niloy Roy, Samir Sahu, P. Sowmya, Kashmira Robin George, Alajangi Praseeda, H. R. Shabarish, Mallipeddi Vivek Vardhan","doi":"10.25259/jccc_35_2023","DOIUrl":"https://doi.org/10.25259/jccc_35_2023","url":null,"abstract":"In patients with cardiogenic shock, this review compares the efficacy of percutaneous microaxial left ventricular assist devices (pLVADs) to intra-aortic balloon pumps (IABPs) or no mechanical circulatory support (MCS). End-organ hypoperfusion brought on by insufficient cardiac output characterizes the potentially fatal disease known as cardiogenic shock. Relevant papers were found by a thorough search of internet resources and were incorporated into the study. The main outcomes evaluated were: (1) Short-term mortality, (2) hemodynamic indices, (3) organ function, and (4) Length of hospital stay. Considered secondary outcomes were: (1) Adverse events, (2) quality of life, and (3) long-term survival. As shown by increased cardiac output and mean arterial pressure, the findings of this research imply that pLVADs may provide superior hemodynamic support versus IABPs or no MCS. In addition, pLVADs may have better organ function and lower short-term mortality rates than IABPs or no MCS. However, using pLVADs was also linked to a higher risk of unfavorable outcomes, such as bleeding and vascular issues. Data on long-term survival and quality-of-life outcomes were sparse and ambiguous. In conclusion, as compared to IABPs or no MCS, pLVADs may offer more effective hemodynamic support and better short-term outcomes in patients with cardiogenic shock. More investigation is required to fully comprehend the long-term advantages, hazards, and effects of pLVADs on the quality of life in this patient population.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136192755","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}
In the era of 1950s and 60s, the mysterious entity of obstructive hypertrophic cardiomyopathy (HCM) ignited the minds of young physicians and surgeons to understand the pathophysiology of the disease. Although legends like Sir Russel Brock have contributed to the understanding of the pathophysiology and surgical techniques to obstructive HCM1, Dr. Andrew Glenn Morrow played a phenomenal role on his own, in understanding the pathophysiology, its effect on animal models, the provocative tests, angiographic studies, surgical techniques, and long-term results, along with his cardiology colleagues, Dr. Eugene Braunwald and Dr. Edwin C. Brockenbrough from National Heart Institute in Bethesda, Maryland. This trio has published countless research papers on Obstructive HCM.
在20世纪五六十年代，阻塞性肥厚性心肌病(HCM)这个神秘的实体点燃了年轻内科医生和外科医生了解这种疾病的病理生理学的思想。虽然像russell Brock爵士这样的传奇人物对阻塞性HCM1的病理生理和手术技术的理解做出了贡献，但Andrew Glenn Morrow博士与他的心脏病学同事，Bethesda国家心脏研究所的Eugene Braunwald博士和Edwin C. Brockenbrough博士一起，在理解病理生理，其对动物模型的影响，具有挑战性的测试，血管造影研究，手术技术和长期结果方面发挥了非凡的作用。马里兰州。这三人已经发表了无数关于阻塞性HCM的研究论文。
{"title":"Dr. Andrew Glenn Morrow’s Path of Petals and Thorns: A Critical Appraisal","authors":"Doniparthi Pradeep, Jaydeep Malakar, Chaitanya Chittimuri","doi":"10.25259/jccc_12_2023","DOIUrl":"https://doi.org/10.25259/jccc_12_2023","url":null,"abstract":"In the era of 1950s and 60s, the mysterious entity of obstructive hypertrophic cardiomyopathy (HCM) ignited the minds of young physicians and surgeons to understand the pathophysiology of the disease. Although legends like Sir Russel Brock have contributed to the understanding of the pathophysiology and surgical techniques to obstructive HCM1, Dr. Andrew Glenn Morrow played a phenomenal role on his own, in understanding the pathophysiology, its effect on animal models, the provocative tests, angiographic studies, surgical techniques, and long-term results, along with his cardiology colleagues, Dr. Eugene Braunwald and Dr. Edwin C. Brockenbrough from National Heart Institute in Bethesda, Maryland. This trio has published countless research papers on Obstructive HCM.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89192022","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}
Ankita Singh, Minati Choudhury, S. Chauhan, P. Kapoor
To identify the correlation between systolic time ratio(STR) measured with electrical cardiometry (EC) device ICON (Osypka Medical, Berlin, Germany) and echocardiography in patients undergoing cardiac surgery and to find a noninvasive technique for estimating left ventricular systolic function during the perioperative period. Systolic time ratio data were obtained simultaneously from the electrical cardiometry device ICON (Osypka Medical, Berlin, Germany) and transthoracic echocardiography at the following predefined timepoints— before anaesthesia induction (T0 baseline), after induction (T1), at the end of the surgery(T2), and after extubation (T3) in patients undergoing elective cardiac surgery. The agreement between the systolic time ratio measured by electrical cardiometry and transthoracic echocardiography was studied using Bland-Altman plots. Paired t-tests were used to compare systolic time ratio measurements at different time points. Mean STR by EC and Echocardiography at T0 was 0.456 (0.429-0.483) and 0.348 (0.330-.366) at T1 was 0.464 (0.442 -0.486) and 0.372 (0.344-0.401) at T2 was 0.421 (0.402 -0.439) and 0.305 (0.290-0.320) and at T3 was 0.438 (0.419-0.457) and 0.353 (0.336-0.370), P value <0.001. Bland-Altman analysis showed that EC measured STR compared with echocardiography at T0 with a mean bias of 0.108 and (with limits of agreement -0.19 ,0.14) at T1 it was 0.092 (with limits of agreement -0.21,0.40) at T2 it was 0.11 (with limits of agreement -0.04,0.28) and at T3 it was 0.085 (with limits of agreement -0.101 ,0.271). In conclusion, no association between systolic time ratio as measured by electrical cardiometry and echocardiography was found in our study. Our results do not conclusively prohibit using electrical cardiometry in the perioperative period to evaluate LV systolic function. Further work must be done to establish the role of STR as a surrogate marker of LV systolic function.
{"title":"Comparison of Systolic Time Ratio from Electrical Cardiometry Versus Echocardiography for Evaluation of Left Ventricular Systolic Function in Patients Undergoing Cardiac Surgery: A Prospective Observational Study","authors":"Ankita Singh, Minati Choudhury, S. Chauhan, P. Kapoor","doi":"10.25259/jccc_21_2023","DOIUrl":"https://doi.org/10.25259/jccc_21_2023","url":null,"abstract":"\u0000\u0000To identify the correlation between systolic time ratio(STR) measured with electrical cardiometry (EC) device ICON (Osypka Medical, Berlin, Germany) and echocardiography in patients undergoing cardiac surgery and to find a noninvasive technique for estimating left ventricular systolic function during the perioperative period.\u0000\u0000\u0000\u0000Systolic time ratio data were obtained simultaneously from the electrical cardiometry device ICON (Osypka Medical, Berlin, Germany) and transthoracic echocardiography at the following predefined timepoints— before anaesthesia induction (T0 baseline), after induction (T1), at the end of the surgery(T2), and after extubation (T3) in patients undergoing elective cardiac surgery. The agreement between the systolic time ratio measured by electrical cardiometry and transthoracic echocardiography was studied using Bland-Altman plots. Paired t-tests were used to compare systolic time ratio measurements at different time points.\u0000\u0000\u0000\u0000Mean STR by EC and Echocardiography at T0 was 0.456 (0.429-0.483) and 0.348 (0.330-.366) at T1 was 0.464 (0.442 -0.486) and 0.372 (0.344-0.401) at T2 was 0.421 (0.402 -0.439) and 0.305 (0.290-0.320) and at T3 was 0.438 (0.419-0.457) and 0.353 (0.336-0.370), P value <0.001. Bland-Altman analysis showed that EC measured STR compared with echocardiography at T0 with a mean bias of 0.108 and (with limits of agreement -0.19 ,0.14) at T1 it was 0.092 (with limits of agreement -0.21,0.40) at T2 it was 0.11 (with limits of agreement -0.04,0.28) and at T3 it was 0.085 (with limits of agreement -0.101 ,0.271).\u0000\u0000\u0000\u0000In conclusion, no association between systolic time ratio as measured by electrical cardiometry and echocardiography was found in our study. Our results do not conclusively prohibit using electrical cardiometry in the perioperative period to evaluate LV systolic function. Further work must be done to establish the role of STR as a surrogate marker of LV systolic function.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86695523","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":"Improving ECMO Quality Using the ELSO Registry","authors":"Peter Rycus","doi":"10.25259/jccc_27_2023","DOIUrl":"https://doi.org/10.25259/jccc_27_2023","url":null,"abstract":"","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85315423","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}
Nihar Ameta, S. Hasija, S. Chauhan, O. Mujahid, N. Naik, R. Bansal, M. Khan
Patients suffering from supraventricular tachycardia (SVT) require diagnostic or therapeutic intervention in a cardiac electrophysiology (EP) laboratory. Some anesthetic medications may adversely affect cardiac EP and conduction, altering the ability to induce the arrhythmia, and may have a negative impact on the ablation treatment. This prospective, randomized, pilot study was conducted in the cardiac EP laboratory of a tertiary care hospital with the aim to identify the ideal anesthetic agent for cardiac EP study and catheter ablation of SVT. The primary objective was to compare the effects of anesthetic agents on cardiac electrophysiological parameters and arrhythmia inducibility. The secondary objective was to compare the patient, anesthesiologist, and cardiologist satisfaction scores with respect to the anesthetic agent used. Thirty adult patients with SVT for EP study and radiofrequency catheter ablation were administered either of the anesthetic agents: midazolam, fentanyl, propofol, ketamine, or sevoflurane titrated to produce conscious sedation corresponding to bispectral index (BIS) values between 71 and 90. Electrophysiological parameters were recorded before and after administering the anesthetic agent. Arrhythmia could be induced in all patients. Although electrophysiological parameters remained stable with ketamine administration; higher values of the Richmond Agitation Sedation Scale score and BIS were recorded. Propofol and sevoflurane administration was associated with deviation in electrophysiological parameters more than fentanyl and midazolam. The highest values of patient, anesthesiologist, and cardiologist satisfaction scores were obtained in the fentanyl group and the lowest in the ketamine group (P < 0.002). In doses used to provide conscious sedation, fentanyl provided ideal conditions, and midazolam, propofol, sevoflurane, and ketamine provided satisfactory conditions for conducting EP study and catheter ablation for supraventricular tachyarrhythmias. The potential of propofol to impede cardiac conduction needs to be explored further.
{"title":"Ideal Anesthetic Agent for Cardiac Electrophysiology Study and Catheter Ablation – A Pilot Study","authors":"Nihar Ameta, S. Hasija, S. Chauhan, O. Mujahid, N. Naik, R. Bansal, M. Khan","doi":"10.25259/jccc_18_2023","DOIUrl":"https://doi.org/10.25259/jccc_18_2023","url":null,"abstract":"\u0000\u0000Patients suffering from supraventricular tachycardia (SVT) require diagnostic or therapeutic intervention in a cardiac electrophysiology (EP) laboratory. Some anesthetic medications may adversely affect cardiac EP and conduction, altering the ability to induce the arrhythmia, and may have a negative impact on the ablation treatment. This prospective, randomized, pilot study was conducted in the cardiac EP laboratory of a tertiary care hospital with the aim to identify the ideal anesthetic agent for cardiac EP study and catheter ablation of SVT. The primary objective was to compare the effects of anesthetic agents on cardiac electrophysiological parameters and arrhythmia inducibility. The secondary objective was to compare the patient, anesthesiologist, and cardiologist satisfaction scores with respect to the anesthetic agent used.\u0000\u0000\u0000\u0000Thirty adult patients with SVT for EP study and radiofrequency catheter ablation were administered either of the anesthetic agents: midazolam, fentanyl, propofol, ketamine, or sevoflurane titrated to produce conscious sedation corresponding to bispectral index (BIS) values between 71 and 90. Electrophysiological parameters were recorded before and after administering the anesthetic agent.\u0000\u0000\u0000\u0000Arrhythmia could be induced in all patients. Although electrophysiological parameters remained stable with ketamine administration; higher values of the Richmond Agitation Sedation Scale score and BIS were recorded. Propofol and sevoflurane administration was associated with deviation in electrophysiological parameters more than fentanyl and midazolam. The highest values of patient, anesthesiologist, and cardiologist satisfaction scores were obtained in the fentanyl group and the lowest in the ketamine group (P < 0.002).\u0000\u0000\u0000\u0000In doses used to provide conscious sedation, fentanyl provided ideal conditions, and midazolam, propofol, sevoflurane, and ketamine provided satisfactory conditions for conducting EP study and catheter ablation for supraventricular tachyarrhythmias. The potential of propofol to impede cardiac conduction needs to be explored further.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"33 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82774784","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}
Remimazolam is a novel intravenous ultrashort acting benzodiazepine that has a potential for safe and effective sedative. This recent addition in anesthesia armamentarium has a great role in procedural sedation and general anesthesia which is well-approved. The main beauty of this drug is, if needed its effects can be reversed by flumazenil which allows prompt termination of sedation. Remimizolam has fast predictive effect and recovery time, high procedural success rate, and minor respiratory and hemodynamic fluctuation when used for procedural sedation and general anesthesia. Although has a great potential for sedation in patients admitted to intensive care unit (ICU), some randomized trials are necessary to prove its long-term efficacy and safety in patients admitted to ICU.
{"title":"Remimazolam: A New Ingress in Cardiac Surgical Intensive Care Unit","authors":"Minati Choudhury, P. Kapoor","doi":"10.25259/jccc_25_2023","DOIUrl":"https://doi.org/10.25259/jccc_25_2023","url":null,"abstract":"Remimazolam is a novel intravenous ultrashort acting benzodiazepine that has a potential for safe and effective sedative. This recent addition in anesthesia armamentarium has a great role in procedural sedation and general anesthesia which is well-approved. The main beauty of this drug is, if needed its effects can be reversed by flumazenil which allows prompt termination of sedation. Remimizolam has fast predictive effect and recovery time, high procedural success rate, and minor respiratory and hemodynamic fluctuation when used for procedural sedation and general anesthesia. Although has a great potential for sedation in patients admitted to intensive care unit (ICU), some randomized trials are necessary to prove its long-term efficacy and safety in patients admitted to ICU.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72943076","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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