Annals of Cardiac Anaesthesia最新文献

Background: The aim of this study was to assess whether parasternal block with multihole catheters inserted before surgical incision enables to alleviate postoperative analgesia and opioid reduction in cardiac surgery patients with sternotomy.

Methods: Twenty-six adult patients scheduled for cardiac surgery with sternotomy aged between 18 and 84 olds were included in this prospective, monocentric, open, single-group trial. Two parasternal multihole catheters were inserted on each side of the sternum before the surgical skin incision for cardiac surgery and 10 mL of ropivacaine 7.5 mg mL -1 was initially administered in each catheter. Local anesthetic administration followed by continued infusion at 3 mL hr -1 of ropivacaine 2 mg mL -1 per catheter for 48 h postoperatively upon patient arrival in the intensive care unit. The efficacy of the parasternal block was assessed according to a composite endpoint including pain score at rest, pain score during movements (dynamic pain), and morphine consumption over 48 hours.

Results: The treatment failed in 11 patients and was considered effective in 15 patients. Sixteen patients out of 26 had a sternal pain score ≤≤3/10 on more than 75% of observations, and the treatment was considered successful. In 23/26 patients (88%), the mean pain score at cough was ≤≤3.5/10 and the treatment was considered successful. Morphine consumption over 48 h was significantly lower in the intervention group compared to the control group 7 mg [6; 21] versus 142 mg [116; 176] ( P < 0.001).

Conclusions: Parasternal block with multihole catheters inserted before the surgical incision is an effective technique for postoperative analgesia and opioid reduction.

Background: This study aimed to assess the accuracy of tricuspid spectral Doppler (E/A) and tissue Doppler parameters (E/E') to diagnose right ventricular diastolic dysfunction (RVDD) in comparison to American Society of Echocardiography (ASE criteria) in pediatric tetralogy of Fallot (TOF) patients after surgical repair.

Methods: This prospective, observational study was done at a tertiary care hospital involving 40 pediatric TOF patients aged less than 2 years who underwent complete intracardiac repair with cardiopulmonary bypass (CPB). Echocardiographic observations were made using a pediatric transesophageal echocardiography probe after surgical repair in the post-CPB period. The ASE-described parameters (late diastolic forward flow in the main pulmonary artery, right atrial dilatation, inferior vena cava dilatation, and hepatic venous flow reversal) were acquired to diagnose the RVDD. The tricuspid Doppler parameters (E/A and E/E') were measured, and its predictive ability to diagnose RVDD was analyzed and compared with the ASE criteria.

Results: Based on the ASE criteria, 13 patients (32.5%) were diagnosed to have RVDD. We found that an E/E' ratio of ≥ 6.26 and an E/A ratio of >1.34 can be taken as the cutoff for diagnosing the RVDD. Based on the tricuspid Doppler parameters (E/A > 1.34 and E/E' >6.26), 17 patients (42.5%) were diagnosed to have RVDD, which was comparable to that of the diagnosis by ASE criteria (P > 0.05).

Conclusion: The results suggested that the use of tricuspid Doppler parameters can be equally accurate and reproducible to the current ASE-described echocardiographic parameters for diagnosing RVDD after surgical repair of TOF.

Abstract: We report a case of a 74-year-old female with a retrosternal goiter undergoing video-assisted thoracic surgery (VATS) for a left lung lower lobectomy, necessitating one-lung ventilation (OLV). We encountered a highly unusual complication: contralateral tension pneumothorax. Forty-five minutes into the surgical procedure, a sudden cardiovascular collapse occurred. After confirming the correct positioning of the double-lumen tube and excluding mediastinal mass syndrome (MMS), tension pneumothorax was suspected. Immediate needle decompression followed by right chest tube thoracostomy resulted in a successful patient outcome. This case highlights the importance of maintaining a high index of suspicion for contralateral tension pneumothorax in patients with sudden cardiovascular collapse during OLV.

Abstract: Acute massive pulmonary thromboembolism (PTE) is a potentially life-threatening condition requiring urgent management to decrease mortality. However, in the peripheral setting, managing the emergency can be challenging. We report a case of massive PTE presenting with cardiopulmonary arrest, successfully managed with advanced cardiac life support, early initiation of anticoagulants (heparin), and thrombolytics. This case report explores the successful management of a critically ill patient presenting with massive pulmonary embolism in a peripheral healthcare facility, emphasizing the importance of a well-coordinated approach in such challenging environments. The approach in the case included recognizing the challenge with timely provisional diagnosis, initial stabilization, hemodynamic support, early consideration for anticoagulants, and thrombolysis after supporting provisional diagnosis with point-of-care ultrasonography (POCUS), team effort, and administrative support in Cas Evac to the tertiary care center. Timely administration of heparin and thrombolytics may serve as potential life-saving measures in peripheral settings, along with the availability of an ultrasound machine. Managing acute life-threatening massive PTE in peripheral settings requires a strategic and resourceful approach. Timely administration of heparin and thrombolytics may serve as potential life-saving measures. However, the administration of thrombolytics in PTE needs the support of POCUS to make quick decisions in peripheral settings. Collaboration between peripheral and advanced tertiary care healthcare facilities is crucial to ensure optimal outcomes for patients experiencing this critical condition.

Abstract: Pulmonary alveolar proteinosis (PAP) is a rare pulmonary pathology characterized by the accumulation of surfactant within type II alveolar epithelial cells. Whole lung lavage is the standard treatment for pulmonary alveolar proteinosis involving a large volume of fluid is infused into one lung and subsequently retrieved while the other lung is remains ventilated. Fast-tracking a patient undergoing whole lung lavage requires vigilant monitoring of arterial blood gases, fluid status, and respiratory mechanics. We report a case of a patient who underwent whole lung lavage for PAP, where early extubation was performed, avoiding the complications associated with prolonged mechanical ventilation.

Abstract: This narrative review discusses the various challenges associated with the presence of a left ventricular assist device (LVAD) during pregnancy. Given the hemodynamic and coagulation changes associated with pregnancy, the presence of an LVAD adds a layer of complexity with respect to optimal management. This review will discuss the anesthetic considerations when dealing with this subset of patients who may have other comorbidities alongside their advanced heart failure. Additionally, this paper aims to review successful pregnancies with an LVAD placement focusing on the mode of delivery and hemodynamic management risk.

Abstract: Donation after circulatory death is helping to expand the donor pool for heart transplantation. Nevertheless, these hearts are more susceptible to myocardial edema and decision of accepting the organ can be a challenge for the heart transplant team. Hemodynamic and echocardiographic criteria are used routinely, but there is still a lack of strong evidence that supports the decision-making in particular situations. That is why the authors found useful to analyze a case with a good outcome that could help accepting more organs in a situation of shortage.