Annals of Cardiac Anaesthesia最新文献

Objectives: This study aims to compare intraoperative blood transfusion and perioperative outcomes for patients undergoing left ventricular assist device (LVAD) implantation before and after the implementation of a blood conservation protocol.

Methods: This retrospective cohort study included patients who underwent LVAD implantation from June 2017 to October 2024 at our Hospital. The primary outcome was total intraoperative transfusion volume, and secondary outcomes included intraoperative transfusion volume and rates of red blood cells (RBC), fresh frozen plasma (FFP), platelets, and reoperation due to bleeding. Exploratory outcomes included mortality and serious complications before hospital discharge.

Results: In total, 120 patients were included, with 62 receiving traditional care and 58 treated with blood conservation protocol. After protocol implementation, total intraoperative transfusion volume decreased from 3.23 ± 3.24 units to 1.74 ± 1.56 units (P = 0.002). The intraoperative RBC transfusion rate dropped from 30.6% to 8.6% (P = 0.003), and the transfusion volume fell from 1.00 ± 1.71 units to 0.31 ± 1.05 units (P = 0.009). In multivariate analysis, the protocol was significantly associated with reduced total intraoperative transfusion volume, lower RBC transfusion volume and rate, and shorter ICU and hospital stays, while not correlated with perioperative mortality or serious complications.

Conclusions: The blood conservation protocol significantly reduced intraoperative transfusion in LVAD patients and expedited recovery.

Acquired diaphragmatic eventration (DE) is an uncommon condition characterized by all or a portion of the diaphragmatic muscle replaced by a thin fibroelastic sheath, resulting in an abnormal elevation of the hemidiaphragm. Currently, the treatment of choice for symptomatic DE is a minimally invasive diaphragmatic plication via a video-assisted thoracoscopic or robotic approach. Surgical diaphragmatic plication is often associated with increased intra-abdominal pressure (IAP) and associated complications. This report describes the usefulness of lower thoracic epidural block in the management of raised IAP following surgical plication of the diaphragm.

Foreign body aspiration, particularly in the lower airway, presents unique challenges for anaesthesiologists, especially when dislodgement occurs during surgical manipulation. We report the case of a 21-year-old male who presented with an iron nail lodged in the left lower lobe of the lung, with a history of failed removal using flexible and rigid bronchoscopy. After unsuccessful attempts, the patient underwent left thoracotomy for foreign body retrieval. During the procedure, the foreign body dislodged into the tracheal wall through the Murphy eye of the endotracheal tube. A multimodal approach involving fiber-optic bronchoscopy and bronchotomy ultimately led to successful retrieval. The anesthetic strategy involved maintaining spontaneous ventilation and total intravenous anesthesia (TIVA). This case highlights the importance of coordinated management between anesthetic and surgical teams in handling complex foreign body retrievals.

Vasoplegic syndrome is a life-threatening condition characterized by uncontrolled peripheral vasodilation, leading to profound arterial hypotension. Treatments include catecholamines, vasopressin, methylene blue (MB), hydroxocobalamin, angiotensin II, and ascorbic acid. We developed a scoping review protocol according to the Joanna Briggs Institute methodology and searched PubMed, PubMed Central, Scopus, and Cochrane Library electronic databases. A total of 23 records were included in this scoping review, out of which 13 were original research studies, seven were reviews, and three were case studies. In these studies, vasopressin, MB, hydroxocobalamin, angiotensin II, and ascorbic acid were used for vasoplegic syndrome. Vasopressin, MB, hydroxocobalamin, angiotensin II, and ascorbic acid showed rapid restoration of hemodynamics and decreased vasopressor requirement. Non-catecholamine drugs such as vasopressin, angiotensin II, MB, and hydroxocobalamin appear to be promising drugs for the treatment of patients with post-cardiac surgery vasoplegic syndrome. It is demonstrated to be effective in raising blood pressure in such patients, but these agents should be used cautiously due to their associated adverse effects.

Background: In-hospital cardiac arrest demands immediate response to improve survival outcomes. The Code Blue Response System (CBRS) was designed to streamline emergency interventions by reducing response times. This study aimed to evaluate the impact of a CBRS on response times and outcomes before and after its implementation.

Materials and methods: A retrospective analysis was conducted using "Code Blue" feedback forms collected between April 2023 and March 2025. During this period, 212 patients who experienced code blue events were divided into pre-CBRS (n = 105) and post-CBRS (n = 107) groups, based on whether their code blue event occurred before or after the CBRS installation. Demographic data, response times, interventions (such as defibrillation and central venous access), and return of spontaneous circulation (ROSC) rates were analyzed.

Results: Post-CBRS implementation, the mean response time significantly decreased from 2.65 to 1.71 min (P < 0.001), reflecting a 35.5% reduction. Defibrillation and central venous access rates also increased significantly (P < 0.001 and P = 0.03, respectively), demonstrating the positive impact of CBRS on patient outcomes. Although the ROSC rate improved from 42.3% to 53.3%, the difference did not reach statistical significance (P = 0.78). No significant differences were noted in patient demographics, event location, or time of day.

Conclusion: The implementation of CBRS significantly improved code blue response times and enhanced critical interventions, contributing to better immediate patient outcomes. While the ROSC rate improvement was not statistically significant, the trend suggests a positive clinical impact. CBRS stands out as an essential strategy for improving emergency response efficiency and patient survival rates in hospitals.