Annals of Cardiac Anaesthesia最新文献

Background and aims: Post-sternotomy pain management remains a key concern in adult cardiac surgery. This study evaluated the efficacy and safety of ropivacaine infiltration via a presternal multi-orifice catheter for postoperative analgesia.

Design: A prospective randomized controlled trial.

Setting: A single tertiary care center.

Material and methods: A total of 175 adult patients undergoing cardiac surgery via median sternotomy were randomized into three groups: Group A (n = 58): Received 0.375% ropivacaine as continuous infusion at 5 mL/hour, Group B (n = 58): Received 5 mL of 0.375% ropivacaine as intermittent boluses every 8 hours, and Group C (n = 59): Received conventional intravenous tramadol. Pain was assessed using the visual analogue scale (VAS) for 48 hours post-extubation. Intravenous tramadol was used as rescue analgesia if VAS≥3.

Results: Group B reported significantly lower VAS scores and rescue tramadol requirements (56 ± 35 mg) compared to Group A (155 ± 32 mg) and Group C (135 ± 45 mg). No significant differences were observed among the groups regarding hemodynamic parameters, catheter-related infections, time to extubation, or intensive care unit (ICU) stay.

Conclusion: Presternal infiltration of 0.375% ropivacaine is safe and effective for post-sternotomy analgesia. The intermittent bolus technique provides superior pain relief and reduces opioid consumption compared to continuous infusion and standard intravenous analgesia.

Pediatric one-lung ventilation (OLV) is always challenging for the anesthesiologist. Despite a plethora of options in the present era, there still remains a concern regarding the choice and success of the modality to isolate the lungs in the pediatric age group especially for thoracoscopic procedures. Bronchial blockers provide an effective way to achieve OLV in patients below 6 years. With smaller-sized endotracheal tubes (ETTs) being used in this age group, a physical check of the fit between the equipment (bronchoscope and the blocker inside the ETT) is strongly recommended. In the present case report of a 3.5-year-old child requiring lung isolation for robotic-assisted thoracoscopic surgery, we went a step ahead by using this entire assembly to intubate the patient. This innovative combo approach was chosen considering the anticipated struggle with manoeuvring the two components together. It was quick and safe in terms of decreased airway manipulation of pediatric airway.

Penetrating tracheal injuries in children are uncommon and present significant diagnostic and airway challenges. We report the case of a 3-year-old boy who sustained an accidental penetrating neck trauma and was taken up for tracheal repair. Initial radiological evaluation did not reveal any tracheal/bronchial injury, but there was extensive pneumomediastinum. The child exhibited signs of airway compromise along with a deep penetrating injury on the anterior neck, extensive subcutaneous and musculofascial emphysema in the neck and anterior chest wall. Anesthetic management required careful induction, avoiding hemodynamic and airway compromise, smooth and atraumatic intubation, and positive pressure ventilation to localize the rent intraoperatively, via visible bubbling. Pneumothorax, wound infection, and mucus plugging prolonged the postoperative course. This report highlights the role of multidisciplinary coordination, tailored anesthetic strategies, and postoperative care in pediatric airway trauma.

Nasogastric tube (NGT) insertion is a common procedure, often performed blindly. We report a rare, near-fatal complication in a 44-year-old woman where an NGT traversed the internal jugular vein, superior vena cava, and perforated the right atrium into the pericardial cavity. Prompt imaging and surgical retrieval via sternotomy prevented tamponade or exsanguination. No esophageal injury was found; the likely entry point was the nasopharynx. A sealed duodenal perforation was managed conservatively. This case emphasizes the importance of verifying NGT placement before use and the role of confirmatory X-ray.

Traumatic papillary muscle rupture is an uncommon cause of acute mitral regurgitation (MR). We report the perioperative management of a case of severe MR due to the posteromedial papillary muscle rupture in a 33-year-old man who had blunt chest trauma caused by fall of an electric lamp post over him. He also had an additional finding of a Ventricular Septal Defect (VSD). He successfully underwent a mitral valve replacement (MVR) with a VSD repair surgery and was discharged on the sixth day of the surgical correction. Sometimes respiratory symptoms because of hemothorax, rib fractures can mask the cardiac trauma and pose diagnostic dilemma. Careful examination and imaging of the heart can detect a serious problem to address it.

In patients with severe mitral regurgitation (MR), mitral valve repair is the preferred and recommended treatment; thus, precise diagnosis of the mechanism, location, and the specific scallop causing MR is decisive and paramount. Occasionally, mitral valve repair is inadequate (residual MR), or result in mitral stenosis, or is associated with systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction. Two- and three-dimensional Transesophageal echocardiography (2D and 3D TEE) can precisely diagnose the mechanisms, location and scallops causing MR, identify the mechanisms of repair failure, identify the predictors of SAM, and help decide when to return to bypass and address the residual lesion. The review comprehensively describes 2D and 3D TEE imaging methods relevant for evaluating the mechanisms of MR, identification of the location of MR, and the predictors of SAM prior to valve repair; and describes imaging methods to identify the presence of mitral stenosis and SAM post-repair. Further, the review discusses the importance of more-than-mild residual MR, describes the evaluation of residual MR and discusses pitfalls in differentiating mild and more- than-mild residual MR.