Annals of Cardiac Anaesthesia最新文献

Background: Academic conferences serve as an important platform for dissemination of research and knowledge. However, there are limited data on the scientific, social, and networking benefits these conferences provide for their participants.

Methods: We conducted a Google form survey-based study to evaluate the scientific and networking benefits and assess satisfaction levels with the conduct of an acute Care conference. Pre- and postconference survey forms were sent to the participants, which were analyzed to assess the participants' expectations and satisfaction levels.

Results: A total of 116 matched pre- and postconference responses were analyzed. The residents formed the majority of the respondents. The main objective of attending the conference was to present their scientific work in a public forum (52.6%), followed by attending the workshop (25.9%). In the preconference survey, 58.6% of respondents anticipated hands-on workshop would be the most useful session. However, after attending the conference proceedings, they found other areas like panel discussions (25%) were also useful along with hands-on workshops (38.8%). Overall conference experience was favorable (41.4% excellent), with strong networking opportunities (37.1% excellent) and a high likelihood of future collaboration (31.9% excellent).

Conclusion: Research presentations and skill enhancement through hands-on workshops were the key drivers of participation in this conference. Networking opportunities were highly valued, particularly for connecting with eminent national speakers and collaborating on scientific writing.

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.

Background: Currently, there have been no studies on the relationship between the transesophageal echocardiography (TEE), an indicator of respiratory variability of the inferior vena cava diameter (ΔIVC), and the incidence of postoperative acute kidney injury (AKI) in patients undergoing coronary artery bypass grafting (CABG) surgery have been conducted. The primary objective of this study was to investigate the relationship between ΔIVC and the incidence of postoperative AKI in CABG patients.

Methods: A multicenter prospective cohort study was conducted from September 2021 to July 2022 in patients over 18 years of age who underwent elective CABG. We measured the diameter of the inferior vena cava (D-IVC) via M-mode TEE using the transgastric long axis (LAX) view (70°) of the IVC, approximately 2 cm caudal to the right atrium. All echocardiographic indicators were measured three times in a row at the following three time points: T0 (before the CABG surgery began), T2 (approximately 5-10 minutes after protamine neutralization), and T3 (after the sternum was closed), after which the values were averaged.

Results: The association between the TEE index (ΔIVC) and the incidence of postoperative AKI in patients with CABG was not statistically significant. However, multivariate logistic regression analysis revealed that the central venous pressure (CVP) at T3 was independently associated with postoperative AKI.

Conclusions: The TEE indicator ΔIVC was not significantly associated with the incidence of postoperative AKI. The clinical efficacy of TEE in isolated coronary artery bypass surgery needs further study.

Background: Accurate prediction of reintubation in pediatric patients following cardiac surgery is vital for enhancing postoperative care. This study aimed to identify key predictors of reintubation and train a multilayer perceptron (MLP) neural network model for prediction.

Methods: This retrospective analysis included clinical data from 294 pediatric patients (1-24 months of age) who underwent cardiac surgery and postoperative mechanical ventilation between January and December 2024. Patients who were successfully extubated and monitored for reintubation were included. Significant predictors were identified using Pearson Chi-square (PC²) test and binomial logistic regression analysis (BLRA). An MLP neural network was trained using clinical covariates to predict reintubation.

Results: Significant predictors of reintubation included low BMI (0.1-1 percentile, P < 0.01, PC²), emergency surgery (P < 0.01, PC²), previous infection (P < 0.01, PC²), pre-reintubation ABG levels (P < 0.001, PC²), and procedure type (aortoplasty, P = 0.05, PC²). Additionally, the duration of ventilation (P = 0.014, BLRA) and the RACHS2 score (P = 0.006, BLRA) were significant predictors. The MLP model achieved a sensitivity of 93.7% and a specificity of 90.5%, with an F1-score of 0.94. The sum of squared error was 0.152, the root mean squared error was 0.248, and the area under the receiver operating characteristic curve was 0.94 for both training and testing datasets.

Conclusion: The MLP neural network exhibited excellent predictive accuracy for identifying risk factors associated with reintubation.

Background: This retrospective observational study evaluates the effect of incorporating peripheral nerve blocks (PNBs) into an established enhanced recovery after surgery (ERAS) protocol. The PNBs used included pecto-intercostal fascial block (PIFB) and rectus sheath block, performed under ultrasound guidance with the administration of a long-acting local anesthetic, Ropivacaine. Both patient and process outcomes were assessed to determine the effect PNBs have as part of an ERAS protocol.

Materials and methods: Adult patients undergoing cardiac surgery with midline sternotomy who were expected to be extubated within 6 hours of arrival to the intensive care unit (ICU) between October 2022 and June 2023 were included. Patients were dichotomized by whether they received a PNB or not. Outcomes included opioid consumption as measured by morphine milligram equivalents (MME), ICU length of stay (LOS), postoperative mobility, and the incidence of postoperative atrial fibrillation (POAF).

Results: 431 patients were included: 170 (39.4%) received a PNB, and 243 (60.6%) did not (non-PNB group). Patients who received a PNB required a significantly shorter time to achieve first ambulation as measured from bed to chair (15.2 hours PNB vs. 18.5 hours non-PNB, P = 0.037), significantly lower rates of atrial fibrillation (26.5% PNB vs. 32.9% non-PNB, P = 0.045), shorter LOS in the ICU (44.4 hours PNB vs. 49.7 hours non-PNB, P = 0.024).

Conclusion: Incorporating PNBs as part of a multimodal analgesic strategy for patients undergoing cardiac surgical procedures is associated with improved patient and process outcomes. Our finding of a reduction in POAF warrants further investigation in an adequately powered randomized controlled trial.

Although thoracic epidural analgesia and paravertebral blocks have well-documented benefits in cardiac surgery, the theoretical risk of neuraxial hematoma in anticoagulated patients limits their use. Fascial plane blocks are recently described techniques in regional anesthesia that have provided relatively safe and efficacious alternatives to treating postoperative pain following cardiac surgery. There are techniques such as erector spinae plane blocks, deep and superficial parasternal intercostal blocks, and serratus anterior plane blocks. Alternative therapies, such as transcutaneous electrical nerve stimulation, acupuncture, cryoablation, ascorbic acid, magnesium, and turmeric, have shown some promise as adjunctive pain therapies but need to be studied in further detail.

Background and aims: Formulae for the determination of size of the left-sided double-lumen tubes (DLTs) have not been validated in the Indian population. This audit was carried out to examine the sizes of the left-sided DLTs (L-DLTs), commonly used in the Indian patients, to identify the adequacy of lung isolation and problems during lung isolation.

Methods: This was a retrospective cohort study at a high-volume tertiary-care cancer centre in India. We included patients over 15-years-old, who required lung isolation using a L-DLT, operated between January 2017 and March 2022. We collected data from anesthesia records and electronic medical records on patient height, size of L-DLT used, difficulty in L-DLT insertion and intra-operative problems. Data were reported as means (or medians) for numerical data, and proportions for categorical data.

Results: Of 564 patients, sizes of L-DLTs used versus size predicted by height were smaller in 388 (69%), larger in 9 (2%), and same as predicted in 167 (29%). Patients receiving larger L-DLT had higher failure rate for L-DLT insertion than patients who received smaller or predicted size L-DLTs [3/9 (33%) versus 11/555 (2%); P = 0.001)]. Sixty-nine (12.4%) patients (50 with smaller size and 19 with predicted-size L-DLTs) had minor intraoperative problems including malposition, high airway pressures, inadequate cuff seal, intraoperative desaturation, and hypercarbia.

Conclusion: The use of smaller-sized L-DLTs did not affect success of lung isolation, quality of lung collapse or ease of one-lung ventilation. The use of DLTs larger than predicted for height was associated with higher insertion failure rates.

To summarize the evidence on the hemodynamic effects and vasopressor requirements of adult patients with known pulmonary hypertension (PH) undergoing cardiac surgery treated with intravenous and inhaled milrinone. A total of 400 patients in 5 prospective (4 RCT) studies were included for pooled analysis. There was no significant difference in the primary outcome; mean pulmonary artery pressure (MPAP) between groups (MD: -4.80, 95% CI -10.57 to 0.98). Inhaled milrinone was associated with a greater systemic vascular resistance index (SVRI) (MD: 259.21, 95% CI 168.70 to 349.72) and reduction in pulmonary capillary wedge pressure (MD: -4.64, 95% CI -5.47 to -3.81). There were no observable differences in mean arterial pressure, pulmonary vascular resistance, cardiac index, or central venous pressure. All studies included were assessed to be moderate/some concern risk of bias. Inhaled milrinone has not been shown to have a significant beneficial effect on MPAP and SVR when compared to intravenous milrinone in patients with known PH undergoing cardiac surgery. However, it has shown some benefits in maintaining MAP and improving oxygenation in this patient cohort. The study is limited by the bias of the included studies and the variability of inhaled drug dosage and administration timing, further well-powered randomized controlled trials are required.