Annals of Cardiac Anaesthesia最新文献

Abstract: Sensitized lung transplantation recipients are at an increased risk for complications. Therapies such as plasma exchange (PLEX) exist to lessen the antibody burden in hopes of mitigating acute and chronic complications. Although the use of PLEX has been shown to be an effective immunomodulation for many diseases, its benefit in lung transplantation has been debated, and the fear of PLEX-induced coagulopathy has curtailed its use more broadly. Although the type of fluid used for exchange can determine the severity of coagulopathy, even the use of fresh frozen plasma (FFP) can disrupt the coagulation cascade. We present the case of severe perioperative coagulopathy following PLEX with FFP during bilateral lung transplantation.

Introduction: Invasive blood pressure monitoring is the clinical reference during perioperative patient management. It is usually performed by cannulating the radial artery. Different clinical conditions make arterial cannulation difficult using the conventional palpation (CP) method. This study compares the ultrasonography (USG)-guided dynamic needle tip positioning (DNTP) technique with the CP method to assess the first-pass success rate of radial artery cannulation.

Methods: In the operation theater of a university hospital, a total of 52 adult patients requiring arterial cannulation were randomized into two equal groups. Arterial cannulation was performed using the CP method in one group and the ultrasound-guided DNTP method in the other group. The first-pass success rate was the primary objective. The 5-minute success rate, the time required for successful cannulation, the number of skin punctures, and the number of cannulae used were also compared using the Chi-square test, an independent sample t-test, and the Mann-Whitney U test.

Results: The first-pass success rate was significantly higher in the USG-guided DNTP method (88.5%) compared to the CP method (46.2%) (P 0.001). The overall 5-minute success rate was 96.2% in the USG-guided DNTP and 65.4% (P 0.005) in the CP method. The median time for successful cannulation was significantly lesser in the USG-guided DNTP group [44 s (IQR: 35-72)] compared to the CP group [134 s (IQR: 28-378)] (P 0.007). The mean number of skin punctures in the USG-guided DNTP group was 1.15 ± 0.46 and 2.04 ± 1.18 in the CP group (P 0.001).

Conclusion: USG-guided DNTP method of radial artery cannulation increased the first-pass success rate.

Introduction: Postoperative atrial fibrillation (POAF), which occurs in almost 20-40% of cardiac surgeries, is associated with life-threatening complications. Serum hypomagnesemia, a frequent finding after cardiac surgeries, is a predictor for POAF. In this study, we investigated the effect of continuous magnesium infusion to prevent POAF in patients undergoing off-pump coronary artery bypass grafting (OP-CABG).

Materials and methods: A prospective, randomized controlled study was conducted on 110 patients undergoing OP-CABG. Patients were classified into two groups after reaching the intensive care unit (ICU). Group M was started on magnesium (Mg) infusion at 750 mg/h for 3 days after an initial bolus dose of 1.5 g of magnesium sulfate, to target a serum magnesium level of 1.5 to 2 mmol/L. The control group (Group C) did not receive any infusion. The incidence of POAF, magnesium values, duration of ICU stay, number of patients who required pharmacotherapy and cardioversion, and maximum vasoactive-inotropic score (VIS max) were recorded. A P <.05 was taken as statistically significant.

Results: 104 patients were analyzed. The incidence of POAF (19.2% vs 1.9%, P = .008) and the number of patients requiring pharmacotherapy other than magnesium (15.4% vs 1.9%, P = .0310) were significantly higher in group C. Mean of peak magnesium values (1.624 ± 0.136 vs 0.710 ± 0.147, P < .001) was significantly higher in Group M. The number of patients requiring cardioversion (P = .618), duration of ICU stay (P = .121), and the VIS max (P = .360) were not significantly different between groups.

Conclusion: Postoperative continuous magnesium infusion after a bolus was effective in preventing POAF in patients undergoing OP-CABG by maintaining serum magnesium levels (1.5-2 mmol/).

Purpose: Assessment of LV diastolic dysfunction (LVDD) poses challenges due to the dynamic changes of loading conditions in the perioperative course. Diastolic strain-based measures showed to be less load dependent, but data in aortic valve replacement (AVR) surgery remains sparse to date. Therefore, we aimed to explore the feasibility to assess these measurements and to describe the intraoperative course in this patient population.

Methods: Prospective observational study including 30 adult patients. Intraoperative transesophageal echocardiography (TEE) was performed after induction of anesthesia [T1], after termination of cardiopulmonary bypass [T2], and after sternal closure [T3]. TEE assessment included the evaluation of peak longitudinal strain rate during isovolumetric relaxation (SR-IVR), early (SR-E) and late (SR-A) LV filling, as well as of conventional echocardiographic measurements and LVDD grading algorithms.

Results: Diastolic strain analysis was feasible in 27 (90%) AVR patients at all time points of assessment. LV diastolic strain improved significantly after AVR [T1 vs T3] as measured by SR-IVR (0.31 s-1 (IQR 0.22; 0.38) vs. 0.4 s-1 (IQR 0.33; 0.43); P = 0.01), SR-E (1.13 s-1 (IQR 0.89;1.28) vs. 1.35 s-1 (IQR 1.10;1.52); P = 0.035), and E/SR-IVR (2.2 m (IQR 1.7;2.8) vs. 1.6 m (IQR 1.3;2.2); P = 0.013). In contrast, conventional echocardiographic measurements and grading algorithms were not able to detect these changes in the same period.

Conclusion: Assessment of LV diastolic strain was feasible in our group of selected AVR patients. LV relaxation and filling improved during the intraoperative course of AVR as measured by diastolic strain, while most conventional grading algorithms were not able to detect these alterations.

Abstract: Pain in the context of cardiothoracic surgery can be attributed to multiple factors. Furthermore, cardiothoracic procedure-related pain can be significant and can lead to multiple morbidities including chronic pain syndromes when left undertreated. Even though opioids remain mainstay of treatment for these procedures, opioid-sparing techniques utilizing a well-developed multimodal regimen can be important in the proper pain management of this patient population. It is imperative for the anesthesiologist to understand the multiple pharmacological and non-pharmacological modalities available, the benefits and adverse effects, and the literature supporting the utility of these methods.

Abstract: Lung isolation is essential for optimal surgical exposure and prevents contamination of normal lung. It is challenging in pediatric patients due to the anatomical and physiological differences. The most common methods of achieving lung isolation include the use of double-lumen endotracheal tubes (DLTs) or bronchial blockers (BBs). However, in pediatric patients, the size of the airways often restricts the use of DLTs, and in some cases, specific BBs may not be available or feasible due to the anatomy. Here, we report a case of right lower lobectomy in a two-and-half-year-old child using a pulmonary artery (PA) catheter to isolate the lung.