Annals of Cardiac Anaesthesia最新文献

Resuscitative transesophageal echocardiography (TEE) is an effective tool for managing perioperative cardiac arrest in non-cardiac surgery. We present a case of a patient, who suffered hemodynamic collapse following induction of general anesthesia for open reduction and internal fixation of a traumatic pelvic fracture. Resuscitative TEE helped make a diagnosis of acute massive pulmonary embolism leading to emergent surgical pulmonary embolectomy. Resuscitative TEE also helped guide CPR and central venous access. Our case highlights the utility of resuscitative TEE during management of intraoperative cardiac arrest.

The most common venous abnormality of the thorax is persistent left superior vena cava (LSVC), incidence being less than 0.5%. Of all the congenital heart anomalies, the sinus venosus type of atrial septal defect (SVASD) is most commonly associated with LSVC and accounts for 4-10% of all ASD. We report a 52-year-old male patient with a SVASD with LSVC and PAPVC, who underwent minimally invasive cardiac surgical (MICS) repair of the same, assisted by unique bilateral percutaneous SVC cannulation and had an uneventful course and recovery. Presence of LSVC usually requires sternotomy and its drainage either by direct cannulation or passive decompression. Bilateral percutaneous large bore cannulation of the right and left SVC for venous drainage to facilitate MICS for such case has not been reported in literature till date. Utmost care and transesophageal echocardiographic guidance has to be taken not to damage coronary sinus during cannulation.

Background: As pediatric cardiac catheterization procedures become more complex, critically ill children increasingly require postprocedure intensive care unit (ICU) admissions.

Aims primary: The primary aim was to evaluate the association between patient demographics and ICU admission after elective cardiac catheterization in children without recent surgery or pre-existing systemic illness (acute renal failure, hepatic failure, active infection).

Secondary: The secondary aim was to analyze associations between ICU admission and American Society of Anesthesiologists (ASA) physical grade, and Catheterization Risk Score for Pediatrics (CRISP) online model-based precatheterization diagnosis, physiological category, and procedure risk category.

Settings and design: A prospective cohort study conducted at a single tertiary cardiac care center.

Materials and methods: The study included 193 pediatric patients undergoing elective cardiac catheterization from June 2023 to May 2024 under general anesthesia. Postprocedure, patients were admitted to ICU or transferred to wards. Demographic data, ASA physical status, and CRISP-based categories were analyzed for ICU admission predictors using univariate and multivariate analyses.

Results: Of 193 participants, 169 met eligibility criteria, and 27 required ICU admission. Univariate analysis showed that age (P < 0.001), weight (P < 0.01), ASA Grade 4 physical status (P = 0.001), CRISP-based category 2 and 3 of precatheterization diagnosis, and physiology were factors associated with children admitted to the ICU. Multivariate analysis showed weight [odds ratio (OR): 0.816, 95% CI: 0.679-0.980, P = 0.029], ASA physical grade 4 [OR: 2.966, 95% CI: 1.155 - 7.612, P = 0.024], CRISP-based pre-catheterization diagnosis category 3 [OR: 28.304, 95% CI: 1.025 - 781.835, P = 0.048], and physiologic risk category 3 [OR: 6.816, 95% CI: 1.275 - 36.439, P = 0.025] were independently associated with ICU admissions after elective cardiac catheterization.

Conclusions: The results showed that the child's weight, ASA physical grade, and the diagnosis and physiologic categories by the CRISP model may predict the possibility of a pediatric patient requiring an ICU admission after cardiac catheterization procedures.

Introduction: Patient education significantly improves outcomes, especially in high-risk procedures. However, traditional educational resources often fail to address patient literacy and emotional needs adequately. Large language models like ChatGPT (OpenAI) and Gemini (Google) offer promising alternatives, potentially enhancing both accessibility and comprehensibility of procedural information. This study evaluates and compares the effectiveness of ChatGPT and Gemini in generating accurate, readable, and clinically relevant patient education materials (PEMs) for pulmonary artery catheter insertion.

Methodology: A comparative, single-blinded study was conducted using structured validation methods using a common prompt for both gen artificial intelligence (AI) chatbots. AI-generated PEMs were assessed by board-certified anesthesiologists and intensivists. Face validity was determined using a 5-point Likert scale evaluating appropriateness, clarity, relevance, and trustworthiness. Content validity was measured by calculating content validity index. Accuracy and completeness were evaluated by a separate expert panel using a 10-point Likert scale. Readability and sentiment analysis were assessed via automated online tools.

Results: Both chatbots achieved robust face and content validity (S-CVI = 0.91). ChatGPT scored significantly higher on accuracy [9.00 vs. 8.00; P = 0.021] and perceived trustworthiness, while Gemini outperformed in readability (Flesch Reading Ease score: 65 vs. 54; Flesch-Kincaid Grade Level: 7.58 vs. 8.64) and clarity. Both outputs maintained a neutral emotional tone.

Conclusion: AI chatbots show promise as innovative tools for patient education. By leveraging the strengths of both AI-driven technologies and human expertise, healthcare providers can enhance patient education and empower individuals to make informed decisions about their health and medical care involving complex clinical procedures.

Objective: To study the use of post-systolic shortening (PSS) and global longitudinal strain (GLS) in predicting immediate postoperative adverse events after coronary artery bypass grafting (CABG).

Design: A prospective observational study.

Setting: Conducted in a single tertiary care hospital.

Participants: A total of 71 patients undergoing elective CABG were included in our study. Our patients were aged between 45 and 75 years and included both off-pump and on-pump cases. We excluded patients with left ventricular function less than 30%, severe diastolic dysfunction, severe right ventricular dysfunction, concomitant more than moderate valve dysfunction, arrhythmias, left or right bundle branch blocks, and unwillingness to participate in the study.

Methods: Preoperative echocardiogram included left ventricular post-systolic index (LV PSI) and GLS. Postoperatively, composite adverse events were documented by measuring the vasoactive-inotrope score (VIS) of ≥ 10 at 24 h, total duration of inotropes >40 h, intensive care unit (ICU) stay >7 days, and adverse events like low cardiac output, acute kidney injury, ventilation requirement of >24 h, and any mortality.

Measurements and main results: Left ventricular global longitudinal strain (LV GLS) and LV PSI values were analyzed using receiver operating characteristic (ROC) curves, and the area under the curve (AUC) was used to compare the prediction and to derive a cutoff. AUC for LV GLS and LV PSI was 0.92 each and showed good prediction. We got a cutoff of -14.6 for LV GLS and a cutoff of 10.5 for LV PSI.

Conclusion: We conclude that GLS and PSI can effectively predict immediate postoperative adverse events effectively in patients undergoing CABG.

Background: Hemodynamic instability and respiratory distress are leading causes of intensive care unit (ICU) admissions following cesarean section (CS). Focused transthoracic echocardiography (FTTE) may help diagnose or rule out a cardiac cause of the clinical dilemma. We studied the diagnostic and therapeutic impact of FTTE in post-CS patients in the ICU.

Patients and methods: In this prospective observational study, 60 post-CS patients in the ICU requiring FTTE were studied for indications for FTTE. Following FTTE, the hemodynamic cause of hypotension was differentiated as hypovolemia, cardiac failure due to underlying cardiac conditions such as cardiomyopathy or valvular heart disease, sepsis, pulmonary embolism, and myocardial infarction. In respiratory distress, FTTE differentiated pulmonary edema secondary to cardiac causes from non-cardiac causes. FTTE was considered to have a diagnostic impact whenever, in a clinically unsuspected case, it diagnosed a new cardiac disorder, thus helping to narrow down to a single cause out of multiple differential diagnoses or ruled out a cardiac cause in a clinically suspected case. FTTE was considered to have a therapeutic impact whenever it led to an alteration in management.

Results: FTTE diagnosed a new cardiac pathology in 18 (30%) patients and ruled out a worsening of existing cardiac function in 18 (30%) patients with known cardiac disease. An underlying cardiac condition was ruled out in 22 (36.66%) patients, supporting an alternate diagnosis. FTTE led to a change in the management of 45 (75%) patients.

Conclusion: FTTE had a high diagnostic impact of 96.66% and a management impact of 75% in post-CS ICU admissions.

Assessment of diastolic dysfunction is a cardiac anesthesiologist' holy grail, considering the increasing recognition of diastolic dysfunction (DD) in cardiac surgical patient and its' impact on the associated outcomes. Withstanding, there is a growing recent emphasis on the accurate, reliable, and reproducible echocardiographic measurement of left ventricular filling pressure (LVFP) for the quantification of DD; which essentially denotes an intrinsic relaxation abnormality. Despite a comprehensive 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guideline for echocardiographic evaluation of the diastolic function, a definitive consensus on the echocardiographic parameters that correlate well with a wide range of intraoperative LVFP is lacking. The recent guidelines continue to focus mainly on the qualitative parameters. However, prompted by the limitation of the existing technique in predicting the quantitative diastolic function across diverse clinical scenario, a range of upcoming echocardiographic modalities are being evaluated with regards to their potential as surrogates of filling pressure in comparison to existing technique. These advanced echocardiographic techniques include speckle tracking echocardiography and pulmonary vein diastolic wave deceleration time, with the evolving role of former being categorically stated in the recent 2025 ASE documents outlining context-specific recommendations on LVDD. The index article, hence aims to review the existing and upcoming echocardiographic modalities as diastolic function assessment correlates particularly with regards to the technique, advantages, limitations, clinical application, and the relevant associated literature.