R. Magoon, Jes Jose, Brajesh Kaushal, R. Kaushal, Praveena Sharma
An increasing embracement of safer regional techniques as pivotal components of multimodal analgesia regimen has made fast-tracking possible following pediatric cardiac surgery. Speaking of fast-tracking in pediatrics, the feasibility of on-table extubation (OTE), and its’ potential benefits are also being ardently researched with simultaneous emphasis on appropriate patient selection and adequate perioperative safety. We report eight consecutive pediatric cases featuring a combination of serratus anterior plane block (SAPB) or erector spinae plane block (ESPB) to general anesthesia (GA) for patent ductus arteriosus (PDA) ligation through a left thoracotomy incision. Following induction of GA, the left-sided SAPB was performed in five patients and the other three patients received left-sided ESPB, each with 0.5 mL/kg of 0.2% ropivacaine. Demonstrating a mean intraoperative fentanyl requirement of 3.25 ± 0.71 µg/kg, OTE could be successfully contemplated in all the 8 patients. Subsequently, the post-operative face, leg, activity, cry, and consolability (FLACC) score was recorded at 1, 2, 4, 6, 8, and 12 h. Meanwhile, all the patients depicted acceptable pain scores till 4 h, administration of 0.5 µg/Kg rescue fentanyl was necessitated in three patients each at 6-h and 8-h postoperatively (given FLACC scores ≥4), amounting to a mean 0.375 ± 0.23 µg/kg post-operative fentanyl requirement. All patients received intravenous paracetamol at 8-h postoperatively. No block-related complication or need for reintubation was discovered. Incorporation of fascial plane blocks (SAPB or ESPB) to the conduct of GA for PDA ligation, allowed for safe OTE in our experience, due to an opioid-sparing potential.
{"title":"On-table Extubation Facilitated by Regional Analgesic Techniques Combined with General Anesthesia for PDA Ligation: A Case-series and Literature Review","authors":"R. Magoon, Jes Jose, Brajesh Kaushal, R. Kaushal, Praveena Sharma","doi":"10.25259/jccc_22_2023","DOIUrl":"https://doi.org/10.25259/jccc_22_2023","url":null,"abstract":"\u0000\u0000An increasing embracement of safer regional techniques as pivotal components of multimodal analgesia regimen has made fast-tracking possible following pediatric cardiac surgery. Speaking of fast-tracking in pediatrics, the feasibility of on-table extubation (OTE), and its’ potential benefits are also being ardently researched with simultaneous emphasis on appropriate patient selection and adequate perioperative safety.\u0000\u0000\u0000\u0000We report eight consecutive pediatric cases featuring a combination of serratus anterior plane block (SAPB) or erector spinae plane block (ESPB) to general anesthesia (GA) for patent ductus arteriosus (PDA) ligation through a left thoracotomy incision. Following induction of GA, the left-sided SAPB was performed in five patients and the other three patients received left-sided ESPB, each with 0.5 mL/kg of 0.2% ropivacaine. Demonstrating a mean intraoperative fentanyl requirement of 3.25 ± 0.71 µg/kg, OTE could be successfully contemplated in all the 8 patients. Subsequently, the post-operative face, leg, activity, cry, and consolability (FLACC) score was recorded at 1, 2, 4, 6, 8, and 12 h. Meanwhile, all the patients depicted acceptable pain scores till 4 h, administration of 0.5 µg/Kg rescue fentanyl was necessitated in three patients each at 6-h and 8-h postoperatively (given FLACC scores ≥4), amounting to a mean 0.375 ± 0.23 µg/kg post-operative fentanyl requirement. All patients received intravenous paracetamol at 8-h postoperatively. No block-related complication or need for reintubation was discovered.\u0000\u0000\u0000\u0000Incorporation of fascial plane blocks (SAPB or ESPB) to the conduct of GA for PDA ligation, allowed for safe OTE in our experience, due to an opioid-sparing potential.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83956468","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}
G. Bhavya, Apoorva Gupta, K. Nagesh, P. Murthy, P. Nagaraja, S. Ragavendran, S. Mishra, Gowthami Veera
Microcirculation is bound to be altered during cardiac surgery due to multiple factors, mainly the intense systemic inflammatory response syndrome which peaks in the first 24-h postoperatively. Decreased microvascular flow associated with increased postoperative morbidity has been reported. The literature suggests a potential independence of macrocirculation and microcirculation during fluid loading. The present study was conducted to assess thenar muscle tissue oxygen saturation (StO2) changes during vascular occlusion test (VOT) in response to hypovolemia and to assess the dynamic responses of the StO2 variables post-volume expansion (VE). Thirty-five adult post-cardiac surgical patients, with stroke volume (SV) variation >12% were included in the study. Fifty-two fluid challenges were studied. Functional evaluation of microcirculation using VOT and near infrared spectroscopy (NIRS) variables along with monitoring of macrocirculatory indices was performed before and after VE. Statistical analysis was done using Student t-test. Post-VE, 34 were responders with increase in SV ≥15% and 18 were non-responders (SV <15%). Rate of resaturation was significantly faster in responders compared to non-responders after VE (P = 0.0293 vs. P = 0.1480). However, macrocirculatory indices including cardiac output, SV, and delivery of oxygen showed significant improvement in both responders and non-responders. Preload dependence is associated with significant change in the StO2 recovery slope measured at the thenar eminence in volume responders. Functional evaluation of microcirculation using VOT and StO2 can be a useful complimentary tool along with the macrocirculatory indices for optimal fluid rescuscitaion in adult post-cardiac surgical patients.
由于多种因素的影响，心脏手术过程中微循环必然发生改变，主要是强烈的全身炎症反应综合征，在术后最初24小时达到高峰。微血管流量减少与术后发病率增加有关。文献表明，在流体加载过程中，大循环和微循环可能是独立的。本研究旨在评估血管闭塞试验(VOT)期间大鱼际肌肉组织氧饱和度(StO2)在低血容量下的变化，并评估容量扩张(VE)后StO2变量的动态反应。35例卒中容积(SV)变化>12%的成人心脏手术后患者纳入研究。研究了52种流体挑战。采用VOT和近红外光谱(NIRS)指标评价VE前后微循环功能，并监测大循环指标。统计学分析采用学生t检验。ve后，34例为应答者，SV升高≥15%，18例为无应答者(SV <15%)。经VE治疗后，有反应者的恢复速度明显快于无反应者(P = 0.0293 vs. P = 0.1480)。然而，包括心输出量、SV和氧气输送在内的大循环指标在应答者和无应答者中均有显著改善。预负荷依赖性与体积应答者在鱼际隆起处测量的StO2恢复斜率的显着变化有关。利用VOT和StO2对成人心脏手术后患者的微循环功能进行评估，可以与大循环指标一起作为一种有用的补充工具，用于最佳的液体抢救。
{"title":"Functional Evaluation of Microcirculation in Response to Fluid Resuscitation in Hypovolemic Adult Post-cardiac Surgical Patients","authors":"G. Bhavya, Apoorva Gupta, K. Nagesh, P. Murthy, P. Nagaraja, S. Ragavendran, S. Mishra, Gowthami Veera","doi":"10.25259/mm_jccc_308","DOIUrl":"https://doi.org/10.25259/mm_jccc_308","url":null,"abstract":"\u0000\u0000Microcirculation is bound to be altered during cardiac surgery due to multiple factors, mainly the intense systemic inflammatory response syndrome which peaks in the first 24-h postoperatively. Decreased microvascular flow associated with increased postoperative morbidity has been reported. The literature suggests a potential independence of macrocirculation and microcirculation during fluid loading. The present study was conducted to assess thenar muscle tissue oxygen saturation (StO2) changes during vascular occlusion test (VOT) in response to hypovolemia and to assess the dynamic responses of the StO2 variables post-volume expansion (VE).\u0000\u0000\u0000\u0000Thirty-five adult post-cardiac surgical patients, with stroke volume (SV) variation >12% were included in the study. Fifty-two fluid challenges were studied. Functional evaluation of microcirculation using VOT and near infrared spectroscopy (NIRS) variables along with monitoring of macrocirculatory indices was performed before and after VE. Statistical analysis was done using Student t-test.\u0000\u0000\u0000\u0000Post-VE, 34 were responders with increase in SV ≥15% and 18 were non-responders (SV <15%). Rate of resaturation was significantly faster in responders compared to non-responders after VE (P = 0.0293 vs. P = 0.1480). However, macrocirculatory indices including cardiac output, SV, and delivery of oxygen showed significant improvement in both responders and non-responders.\u0000\u0000\u0000\u0000Preload dependence is associated with significant change in the StO2 recovery slope measured at the thenar eminence in volume responders. Functional evaluation of microcirculation using VOT and StO2 can be a useful complimentary tool along with the macrocirculatory indices for optimal fluid rescuscitaion in adult post-cardiac surgical patients.\u0000","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85545964","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}
VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.
{"title":"POCUS and Fluid Responsiveness on Venoarterial ECMO","authors":"Sanchita Garg, P. Kapoor","doi":"10.25259/jccc_4_2023","DOIUrl":"https://doi.org/10.25259/jccc_4_2023","url":null,"abstract":"VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85628994","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}
Extra corporeal membrane oxygenation (ECMO) has become an important modality in ICU for treating patients with severe hemodynamic and respiratory failure. It helps clinicians gain time for the primary disease to recover with definitive treatment, and aids in cardio pulmonary recovery of the patient. Most of the patients who require ECMO support are quite sick and fragile. Nosocomial infection is second most common complication after hemorrhage in ECMO patients.It affects about two-third of patients receiving ECMO. There is a lack of sufficient knowledge in this particular area. More focused efforts should be made in future to combat nosocomial infection in ECMO patients.
{"title":"Nosocomial Infections in Extracorporeal Membrane Oxygenation","authors":"Chitra Mehta, Y. Mehta","doi":"10.25259/mm_jccc_302","DOIUrl":"https://doi.org/10.25259/mm_jccc_302","url":null,"abstract":"Extra corporeal membrane oxygenation (ECMO) has become an important modality in ICU for treating patients with severe hemodynamic and respiratory failure. It helps clinicians gain time for the primary disease to recover with definitive treatment, and aids in cardio pulmonary recovery of the patient. Most of the patients who require ECMO support are quite sick and fragile. Nosocomial infection is second most common complication after hemorrhage in ECMO patients.It affects about two-third of patients receiving ECMO. There is a lack of sufficient knowledge in this particular area. More focused efforts should be made in future to combat nosocomial infection in ECMO patients.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82657481","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}
Pub Date : 2023-01-30DOI: 10.25259/mm_jccc_ujjwal-partial-av-canal(video)
U. Chowdhury, Niwin George, B. Sushamagayatri, Sai Manjusha, Sraddha Gupta, S. Goja, S. Sharma, P. Kapoor
A 26-year-old male patient diagnosed with partial type of atrioventricular septal defect in sinus rhythm, cleft left atrioventricular valve with mild pulmonary arterial hypertension, and severe left atrioventricular valvular regurgitation successfully underwent reconstruction of the left atrioventricular valve and pericardial patch closure of the atrial septal defect using UKC’s modification. The technical details of the surgical procedure have been elaborated in detail.
{"title":"Reconstruction of the Left Atrioventricular Valve with Pericardial Patch Closure of the Ostium Primum Atrial Septal Defect in a Patient with Partial Atrioventricular Septal Defect under Mild Hypothermic Extracorporeal Circulation and Cardioplegic Arrest (UKC’s Modification): A Video Presentation","authors":"U. Chowdhury, Niwin George, B. Sushamagayatri, Sai Manjusha, Sraddha Gupta, S. Goja, S. Sharma, P. Kapoor","doi":"10.25259/mm_jccc_ujjwal-partial-av-canal(video)","DOIUrl":"https://doi.org/10.25259/mm_jccc_ujjwal-partial-av-canal(video)","url":null,"abstract":"A 26-year-old male patient diagnosed with partial type of atrioventricular septal defect in sinus rhythm, cleft left atrioventricular valve with mild pulmonary arterial hypertension, and severe left atrioventricular valvular regurgitation successfully underwent reconstruction of the left atrioventricular valve and pericardial patch closure of the atrial septal defect using UKC’s modification. The technical details of the surgical procedure have been elaborated in detail.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74540620","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}
Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options.
{"title":"Extracorporeal Membrane Oxygenation in Cardiogenic shock – A Review","authors":"Prajesh M. Nambiar, Jeetendra Sharma, Y. Mehta","doi":"10.25259/jccc_7_2023","DOIUrl":"https://doi.org/10.25259/jccc_7_2023","url":null,"abstract":"Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"362 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80153691","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}
Pub Date : 2023-01-30DOI: 10.25259/mm_jccc_ujjwalsenning(video)
U. Chowdhury, Niwin George, B. Sushamagayatri, Sai Manjusha, Sraddha Gupta, S. Goja, S. Sharma, P. Kapoor
A 3-year-old male child diagnosed as D-transposition of the great arteries and intact atrial septum with regressed left ventricle, Yacoub’s Type-B coronary arterial pattern, successfully underwent modified Senning operation under moderately hypothermic cardiopulmonary bypass and St. Thomas based cold blood cardioplegia. At 8 months of follow-up, there was no mitral or tricuspid regurgitation with good biventricular function in Ross clinical score of 2.
{"title":"Atrial Correction (Modified Senning) of Transposition of the Great Arteries and Intact Atrial Septum with Regressed Left Ventricle and Pulmonary Hypertension: A Video Presentation","authors":"U. Chowdhury, Niwin George, B. Sushamagayatri, Sai Manjusha, Sraddha Gupta, S. Goja, S. Sharma, P. Kapoor","doi":"10.25259/mm_jccc_ujjwalsenning(video)","DOIUrl":"https://doi.org/10.25259/mm_jccc_ujjwalsenning(video)","url":null,"abstract":"A 3-year-old male child diagnosed as D-transposition of the great arteries and intact atrial septum with regressed left ventricle, Yacoub’s Type-B coronary arterial pattern, successfully underwent modified Senning operation under moderately hypothermic cardiopulmonary bypass and St. Thomas based cold blood cardioplegia. At 8 months of follow-up, there was no mitral or tricuspid regurgitation with good biventricular function in Ross clinical score of 2.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"247 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75907939","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}
ECMO/ECLS is now a days very common modality for saving patient life in ICU. ECMO is unphysiological circulation which hampers the multiorgan function. Direct impact by releasing of pro-inflammatory cytokinin leads to impact on the many organ homeostasis. The anaesthetist/intensivist must have enough knowledge of pKa/Pd and most importantly still we do not have ideal guidelines for drug dosing.
{"title":"Pharmacology of Drugs and Their Kinetics and Dynamicity during Extracorporeal Life Support","authors":"N. Shastri","doi":"10.25259/jccc_6_2023","DOIUrl":"https://doi.org/10.25259/jccc_6_2023","url":null,"abstract":"ECMO/ECLS is now a days very common modality for saving patient life in ICU. ECMO is unphysiological circulation which hampers the multiorgan function. Direct impact by releasing of pro-inflammatory cytokinin leads to impact on the many organ homeostasis. The anaesthetist/intensivist must have enough knowledge of pKa/Pd and most importantly still we do not have ideal guidelines for drug dosing.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83953956","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}
Coronavirus (COVID) pandemic has affected the majority of people worldwide. Patients with COVID infection might require emergent or elective surgeries. COVID-related perioperative considerations to reduce infection spread include changing the workflow to include protective gear for patients and health-care personnel, COVID-dedicated operating rooms, and appropriate perioperative management of the patient with or presumed COVID infection. COVID-specific changes to operating room environment are done. Disinfection guidelines are followed. Anesthesia considerations pertaining to pre-operative optimization of patient’s condition and prevention of spread of infection to others are foremost.
{"title":"COVID and Perioperative Considerations","authors":"Kapil Gupta","doi":"10.25259/jccc_2_2023","DOIUrl":"https://doi.org/10.25259/jccc_2_2023","url":null,"abstract":"Coronavirus (COVID) pandemic has affected the majority of people worldwide. Patients with COVID infection might require emergent or elective surgeries. COVID-related perioperative considerations to reduce infection spread include changing the workflow to include protective gear for patients and health-care personnel, COVID-dedicated operating rooms, and appropriate perioperative management of the patient with or presumed COVID infection. COVID-specific changes to operating room environment are done. Disinfection guidelines are followed. Anesthesia considerations pertaining to pre-operative optimization of patient’s condition and prevention of spread of infection to others are foremost.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73449911","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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