Annals of Cardiac Anaesthesia最新文献

Background: Congenital heart diseases (CHDs) are not rare and often require an intervention at some point of time. Pediatric cardiac catheterization, a minimally invasive procedure, is performed to diagnose and to correct many cardiac abnormalities. Deep sedation with spontaneously breathing patients is the preferred technique for pediatric catheterization in the pediatric population. Therefore, the author aimed to find the best combination of drugs for pediatric cardiac catheterization procedures using dexmedetomidine-propofol (DP) and ketamine-propofol (KP).

Materials and methods: Cyanotic and acyanotic CHD children, weighing 5-20 kg and undergoing sedation for cardiac catheterization, were randomly assigned into two groups. DP group children received a bolus intravenous (IV) propofol at 1 mg/kg body weight followed by 1 mcg/kg dexmedetomidine over 10 minutes. KP group children received a bolus IV propofol 1 mg/kg followed by ketamine 1 mg/kg over 10 minutes. For maintenance in the DP group, propofol infusion at 1.5 to 2 mg/kg/h and dexmedetomidine at 0.5 mcg/kg/h was started. In the KP group, propofol infusion at 1.5 to 2 mg/kg/h and ketamine at 1 mg/kg/h was started as maintenance. The bispectral index (BIS) was monitored throughout the procedure, and the BIS value was maintained between 60 and 80. Propofol top of 1 mg/kg was administered when the BIS value became more than 80 or when the child moved during the femoral vessel puncture or when the child moved during the procedure.

Results: The mean time for regain of consciousness was faster (P < 0.005) in the KP group (11.02 ± 11.98) compared to the DP group (21.62 ± 18.68). BIS was monitored throughout the procedure; BIS values were lower (P < 0.001) in the DP group (60.0 ± 11.1) as compared to the KP group (73.7 ± 5.6). The cumulative doses of propofol in the KP group and DP group were comparable. Total fentanyl consumptions in the intraoperative period in the KP group and DP group were comparable (P > 0.001). There was no difference in drug side effects between the groups.

Conclusion: The KP combination had fast and early recovery compared to the DP combination in children who underwent the cardiac catheterization procedure under sedation in children undergoing cardiac catheterization procedures requiring sedation.

Abstract: Intercostal artery aneurysms are a type of vascular abnormality that poses a potential risk of rupture, which could lead to life-threatening hemothorax. This case report presents a young male who experienced a rupture of an intercostal artery aneurysm and subsequently suffered from a massive hemothorax after engaging in strenuous physical activity. The current case study sheds light on the difficulties and lessons learned in managing such cases in peripheral settings, including the dilemma of whether to insert an intercostal chest drain (ICD). The patient was ultimately diagnosed with a rare clinical entity known as rupture of right posterior intercostal artery aneurysm with massive hemothorax.

Background: The role of left ventricular global longitudinal strain (LVGLS) in coronary artery bypass grafting (CABG) and outcomes such as low cardiac output syndrome (LCOS) is not well established. The authors investigated the relationship between LVGLS before and after induction of anesthesia, their differences, and their relationship with LCOS and other outcomes.

Methodology: A prospective observational study was conducted in a public/private hospital with 50 adult patients scheduled for on-pump CABG with normal left ventricular ejection fraction (LVEF). Acoustic windows necessary to obtain the 2D-LVGLS were acquired with transthoracic echocardiography (TTE) before induction of anesthesia (LVGLSBI) and after with mechanical ventilation (LVGLSAI) using transesophageal echocardiography (TEE). LCOS was defined as the use of epinephrine, dobutamine, and/or milrinone at minimum IV doses of 1 μg/min-1, 2.5 μg/kg-1/min-1, and 0.375 μg/kg-1/min-1, respectively, for a minimum of 24 h after cardiopulmonary bypass.

Results: A dedicated workstation (EchoPAC Software v203, GE) was used for offline calculation of LVGLS. LVGLSBI did not have a significant correlation with LCOS (mean difference, 1.66; 95% CI, --3.63 to 3.05; P = 0.862), nevertheless, it was an independent risk factor of in-hospital mortality (OR, 0.74; 95% CI, 0.57-0.95; P = 0.02), 3-month mortality (OR, 0.80; 95% CI, 0.64-0.99; P = 0.05), and delirium (OR, 0.65; 95% CI, 0.43-0.97; P = 0.03) in the multivariate analysis. LVGLSAI was also an independent risk factor for 3-month mortality (OR, 0.78; 95% CI, 0.62-0.99; P = 0.04).

Conclusions: In CABG surgeries, LVGLS was a predictor of adverse outcomes in both awake and anesthetized patients with normal LVEF.

Objectives: We aim to assess right ventricular function in patients undergoing mitral valve repair using trans-esophageal echocardiography, focusing on the predictive value of right ventricular longitudinal strain compared to other echocardiographic measures.

Design: Retrospective analysis.

Setting: Toronto General Hospital.

Participants: Thirty elective patients undergoing mitral valve repair.

Interventions: Quantitative assessment of right ventricular function using transesophageal echocardiography images pre- and post-mitral valve repair, including right ventricular longitudinal strain, fractional area change, tricuspid annular plane systolic excursion, and systolic peak velocity (S').

Measurements and main results: 3 patterns of RV strain were identified with right ventricular longitudinal strain emerging as the most significant discriminator among right ventricular functional subgroups, with 43% of cases showing worsening, 20% showing no change, and 37% showing improvement. No correlation was found between right ventricular performance parameters and the need for vasopressors post-cardiopulmonary bypass. There was also no association between initial right ventricular longitudinal strain and difficulty in weaning off bypass or increased demand for pressors. Changes in tricuspid annular plane systolic excursion across all cases warrant further investigation with a larger cohort.

Conclusions: Right ventricular longitudinal strain is a valuable tool for assessing right ventricular function post-mitral valve repair, offering insights into immediate postoperative outcomes and long-term right ventricular remodeling. Despite limitations like single-surgeon experience and institution-specific choice of pressors, our study provides useful insights into right ventricular function post-mitral repair surgery, paving the way for future research in larger patient populations.