Annals of Cardiac Anaesthesia最新文献

Arteriovenous fistula (AVF) results in the shunting of blood from the arterial system into the venous system. The magnitude of the shunt depends on the site, (peripheral vs. central) and the size of the communication(s). The large central shunts are invariably associated with low diastolic blood pressure and congestive heart failure but the smaller ones are challenging to diagnose as they do not have overt clinical features. We describe perioperative implications of recently developed femoral AVFs in a patient undergoing redo aortic surgery (Bentall Procedure) where the ipsilateral femoral vein (femoral vein involved in arteriovenous communications) was used for the establishment of peripheral cardiopulmonary bypass. The patient developed acute limb ischemia and renal failure in the immediate postoperative period and could not be saved. The diagnosis of femoral AVFs was made during the reexploration of the femoral artery for acute limb ischemia.

Background and objectives: This study aimed to observe whether transesophageal echocardiography (TEE)-guided measurement of mitral annular displacement (MAD) value predicts left ventricular (LV) systolic function in patients posted for coronary artery bypass grafting (CABG) surgeries. The primary objective was to observe the correlation between MAD and LV ejection fraction (EF) derived by Simpson's biplane method, whereas the secondary objective was to examine the correlation between MAD and global longitudinal strain (GLS) derived by speckle tracking echocardiography.

Methods and material: This was a prospective observational study conducted at a tertiary care level hospital in 46 patients undergoing CABG. TEE-guided measurements of MAD, EF, and GLS were obtained after induction of anesthesia but prior to the surgical incision.

Results: The Pearson correlation coefficient test and independent t-tests were used for the analysis. The correlation coefficients (95% CI) of the average value of EF with the septal MAD was 0.67 (0.477-0.807), with the lateral MAD was 0.63 (0.418-0.779), and that with the average MAD was 0.68 (0.487-0.811). The correlation coefficients (95% CI) of the average GLS with the septal MAD was 0.74 (0.577-0.850), with the lateral MAD was 0.79 (0.643-0.877), and that with the average MAD was 0.80 (0.658-0.883). All values were statistically significant (P < 0.001). The mean MAD (in mm) calculated in patients with EF <=40% was -5.38 ± 1.54, and that in patients with EF >40% was -7.17 ± 1.88 (P < 0.001).

Conclusion: TEE-guided MAD could serve as a dependable estimate of LV systolic function. However, larger trials with a greater sample size are needed for a more conclusive assessment.

Background: To observe the compliance rate for enhanced recovery after cardiac surgery (ERACS) protocols and various barriers involved in its non-compliance.

Methods: A Prospective observational study conducted in a single quaternary teaching hospital. Patients older than 18 years undergoing major cardiac surgery were asked to follow an ERACS protocol in the perioperative period. A 19-point ERACS protocol was implemented in 577 patients, involving 8,041 active interventions. The barriers involved in its noncompliance were studied.

Results: The overall compliance rate was 66.7%, with complete adherence to the preoperative checklist. However, debriefing had the lowest compliance and was omitted entirely. Analysis of non-compliance revealed nine key barriers, with the most common being resistance to changing established practices (46.1%), followed by lack of motivation (13.7%) and insufficient knowledge or training (12%). The least frequent barrier was lack of conflict resolution (0.6%). Proper handover significantly reduced mechanical ventilation duration (9.4 vs. 14.1 hours, p = 0.002) and ICU stay (4.9 vs. 6.1 days, p < 0.001).

Conclusions: Nine key barriers to adherence were identified. Mental inertia (46.1%) is the most common barrier to practice change found in our study, followed by a lack of motivation among staff members (13.7%). Addressing these challenges is crucial for improving ERACS implementation and optimizing patient outcomes.

Myxomas are rarely located in the right ventricle (RV). They may cause tricuspid valve (TV) destruction or RV outflow tract obstruction. Transesophageal echocardiography (TEE) is useful in delineating the mass, its hemodynamic effect, and the ventricular and valvular function post mass excision. Three dimensional echocardiography is complimentary to two dimensional echocardiography for better evaluation of the mass, including the site of attachment and its extent. In addition, TEE provides relevant information regarding TV and RV function and guides the perioperative management. We report a case of RV myxoma in which TEE was fundamental in managing the case.

Background: Guidewire loss during central venous catheterization (CVC) can lead to significant life-threatening complications. This systematic analysis reviews the published cases of guidewire loss during CVC in India, highlighting the causes, detection methods, and management strategies.

Methods: We searched multiple online databases, including PubMed, BMJ Case Reports, the Cochrane Database, Clinical Key, and Google Scholar, for studies published from inception to December 31, 2023. We found 18 published case studies comprising 19 cases reported from various regions in India. These studies included a diverse patient population ranging from pediatric to elderly individuals with varying clinical conditions such as cardiopulmonary diseases, infections, and trauma. The review focused on the reasons for guidewire loss, the methods of detection, removal techniques, and the involvement of specialized medical teams in managing these cases.

Results: The most common reasons for guidewire loss were post-dilatation. Issues like lack of operator supervision, overburden, inadvertent patient movement, inattention during placement, and nonadherence to procedural guidelines were the main causes. Assistants often detected guidewire loss immediately post-procedure while cross-checking the sterile tray. All lost guidewires can be successfully retrieved. Endovascular snaring was the most commonly used and least invasive technique.

Conclusion: Guidewire loss during CVC is a less-reported complication in the Indian scenario. This review depicts causes like inadequate supervision and overburden and underscores the importance of thorough training, strict procedural protocols, and multidisciplinary collaboration to curtail this preventable complication.