Alok Kumar, Sangeeth Raj, Saurabh Singh, G. S. Ghotra, Nikhil Tiwari
INTRODUCTION Extra Corporeal Membrane Oxygenation (ECMO) has long been used for cardiorespiratory support in the immediate post-paediatric cardiac surgery period with a 2-3% success as per the ELSO registry. Success in recovery depends upon the optimal delivery of critical care to paediatric patients and a comprehensive healthcare team. METHODOLOGY The survival benefit of children placed on central veno arterial (VA) ECMO following elective cardiac surgeries for congenital heart disease (n = 672) was studied in a cohort of 29 (4.3%) cases from the period of Jan 2018 to Dec 2022 in our cardiac surgical centre. Indications for placing these patients on central VA ECMO included inability to wean from cardiopulmonary bypass (CPB), low cardiac output syndrome, severe pulmonary arterial hypertension, significant bleeding, anaphylaxis, respiratory failure and severe pulmonary edema. RESULTS The mean time to initiation of ECMO was less than 5 h and the mean duration of ECMO support was 56 h with a survival rate of 58.3%. Amongst perioperative complications, sepsis and arrhythmia on ECMO were found to be negatively associated with survival. Improvements in the pH, PaO2 levels and serum lactate levels after initiation of ECMO were associated with survival benefits. CONCLUSION The early initiation of ECMO for paediatric cardiotomies could be a beacon of hope for families and medical teams confronting these challenging situations. Improvement in indicators of adequate perfusion and ventricular recoveries like pH and serum lactate and absence of arrhythmia and sepsis are associated with good outcomes.
{"title":"Empowering Little Fighters: Post-Cardiotomy Pediatric ECMO and the Journey to Recovery.","authors":"Alok Kumar, Sangeeth Raj, Saurabh Singh, G. S. Ghotra, Nikhil Tiwari","doi":"10.4103/aca.aca_184_23","DOIUrl":"https://doi.org/10.4103/aca.aca_184_23","url":null,"abstract":"INTRODUCTION\u0000Extra Corporeal Membrane Oxygenation (ECMO) has long been used for cardiorespiratory support in the immediate post-paediatric cardiac surgery period with a 2-3% success as per the ELSO registry. Success in recovery depends upon the optimal delivery of critical care to paediatric patients and a comprehensive healthcare team.\u0000\u0000\u0000METHODOLOGY\u0000The survival benefit of children placed on central veno arterial (VA) ECMO following elective cardiac surgeries for congenital heart disease (n = 672) was studied in a cohort of 29 (4.3%) cases from the period of Jan 2018 to Dec 2022 in our cardiac surgical centre. Indications for placing these patients on central VA ECMO included inability to wean from cardiopulmonary bypass (CPB), low cardiac output syndrome, severe pulmonary arterial hypertension, significant bleeding, anaphylaxis, respiratory failure and severe pulmonary edema.\u0000\u0000\u0000RESULTS\u0000The mean time to initiation of ECMO was less than 5 h and the mean duration of ECMO support was 56 h with a survival rate of 58.3%. Amongst perioperative complications, sepsis and arrhythmia on ECMO were found to be negatively associated with survival. Improvements in the pH, PaO2 levels and serum lactate levels after initiation of ECMO were associated with survival benefits.\u0000\u0000\u0000CONCLUSION\u0000The early initiation of ECMO for paediatric cardiotomies could be a beacon of hope for families and medical teams confronting these challenging situations. Improvement in indicators of adequate perfusion and ventricular recoveries like pH and serum lactate and absence of arrhythmia and sepsis are associated with good outcomes.","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Joshi, D. Borde, Pramod Apsingekar, Swati Pande, Mangesh Tandale, Anand P Deodhar, Sachin Jangle
ABSTRACT Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.
{"title":"Pecto-intercostal Fascial Plane Block: A Novel Technique for Analgesia in Patients with Sternal Dehiscence.","authors":"P. Joshi, D. Borde, Pramod Apsingekar, Swati Pande, Mangesh Tandale, Anand P Deodhar, Sachin Jangle","doi":"10.4103/aca.aca_107_23","DOIUrl":"https://doi.org/10.4103/aca.aca_107_23","url":null,"abstract":"ABSTRACT\u0000Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jun Honda, Keisuke Yoshida, Miho Ogawa, Yukihiro Fukuhara, Satoki Inoue
{"title":"Blood Gas Analysis Result Suggestive of Arterial Blood but no Pressure Wave: Is this an Arterial Line?","authors":"Jun Honda, Keisuke Yoshida, Miho Ogawa, Yukihiro Fukuhara, Satoki Inoue","doi":"10.4103/aca.aca_169_23","DOIUrl":"https://doi.org/10.4103/aca.aca_169_23","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"“Key Questions in Cardiac Surgery” by Narain Moorjani, Nicola Viola, and Sunil K. 2nd Edition","authors":"Ashish Katewa","doi":"10.4103/aca.aca_55_24","DOIUrl":"https://doi.org/10.4103/aca.aca_55_24","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Noninvasive Cardiac Output Monitoring by Electrical Cardiometry with Transthoracic Echocardiography in Postoperative Paediatric Cardiac Surgical Patients: Comment.","authors":"Hinpetch Daungsupawong, V. Wiwanitkit","doi":"10.4103/aca.aca_176_23","DOIUrl":"https://doi.org/10.4103/aca.aca_176_23","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pascal Laferrière-Langlois, Sean D. Jeffries, R. Harutyunyan, Thomas M. Hemmerling
ABSTRACT The potential benefits of epidural anesthesia on mortality, atrial fibrillation, and pulmonary complications must be weighed against the risk of epidural hematoma associated with intraoperative heparinization. This study aims to provide an updated assessment of the clinical risks of epidural anesthesia in cardiac surgery, focusing on the occurrence of epidural hematomas and subsequent paralysis. A systematic search of Embase, Medline, Ovid Central, Web of Science, and PubMed was conducted to identify relevant publications between 1966 and 2022. Two independent reviewers assessed the eligibility of the retrieved manuscripts. Studies reporting adult patients undergoing cardiac surgery with epidural catheterization were included. The incidence of hematomas was calculated by dividing the number of hematomas by the total number of patients in the included studies. Risk calculations utilized various denominators based on the rigor of trial designs, and the risks of hematoma and paralysis were compared to other commonly encountered risks. The analysis included a total of 33,089 patients who underwent cardiac surgery with epidural catheterization. No epidural hematomas were reported across all published RCTs, prospective, and retrospective trials. Four case reports associated epidural hematoma with epidural catheterization and perioperative heparinization. The risks of epidural hematoma and subsequent paralysis were estimated at 1:7643 (95% CI 1:3860 to 380,916) and 1:10,190 (95% CI 1:4781 to 0:1), respectively. The risk of hematoma is similar to the non-obstetric population (1:5405; 95% CI 1:4784 to 6134). The risk of hematoma in cardiac surgery patients receiving epidural anesthesia is therefore similar to that observed in some other surgical non-obstetric populations commonly exposed to epidural catheterization.
摘要硬膜外麻醉对死亡率、心房颤动和肺部并发症的潜在益处必须与术中肝素化引起的硬膜外血肿风险进行权衡。本研究旨在对心脏手术中硬膜外麻醉的临床风险进行最新评估，重点关注硬膜外血肿的发生和随后的瘫痪。研究人员对Embase、Medline、Ovid Central、Web of Science和PubMed进行了系统检索，以确定1966年至2022年间的相关出版物。两位独立审稿人对检索到的稿件进行了资格评估。报告接受硬膜外导管植入术的心脏手术成年患者的研究均被纳入其中。血肿发生率的计算方法是将血肿数量除以纳入研究的患者总数。根据试验设计的严谨性，风险计算采用了不同的分母，并将血肿和麻痹的风险与其他常见风险进行了比较。分析共纳入了 33089 名接受硬膜外导管手术的心脏手术患者。所有已发表的 RCT、前瞻性和回顾性试验均未报告硬膜外血肿。有四份病例报告称硬膜外血肿与硬膜外导管植入术和围手术期肝素化有关。硬膜外血肿和随后瘫痪的风险估计分别为1:7643（95% CI 1:3860至380,916）和1:10,190（95% CI 1:4781至0:1）。血肿风险与非产科人群相似（1:5405；95% CI 1:4784 至 6134）。因此，接受硬膜外麻醉的心脏手术患者发生血肿的风险与在其他一些常见于硬膜外导管插入术的非产科手术人群中观察到的风险相似。
{"title":"Epidural Catheterization in Cardiac Surgery: A Systematic Review and Risk Assessment of Epidural Hematoma.","authors":"Pascal Laferrière-Langlois, Sean D. Jeffries, R. Harutyunyan, Thomas M. Hemmerling","doi":"10.4103/aca.aca_160_23","DOIUrl":"https://doi.org/10.4103/aca.aca_160_23","url":null,"abstract":"ABSTRACT\u0000The potential benefits of epidural anesthesia on mortality, atrial fibrillation, and pulmonary complications must be weighed against the risk of epidural hematoma associated with intraoperative heparinization. This study aims to provide an updated assessment of the clinical risks of epidural anesthesia in cardiac surgery, focusing on the occurrence of epidural hematomas and subsequent paralysis. A systematic search of Embase, Medline, Ovid Central, Web of Science, and PubMed was conducted to identify relevant publications between 1966 and 2022. Two independent reviewers assessed the eligibility of the retrieved manuscripts. Studies reporting adult patients undergoing cardiac surgery with epidural catheterization were included. The incidence of hematomas was calculated by dividing the number of hematomas by the total number of patients in the included studies. Risk calculations utilized various denominators based on the rigor of trial designs, and the risks of hematoma and paralysis were compared to other commonly encountered risks. The analysis included a total of 33,089 patients who underwent cardiac surgery with epidural catheterization. No epidural hematomas were reported across all published RCTs, prospective, and retrospective trials. Four case reports associated epidural hematoma with epidural catheterization and perioperative heparinization. The risks of epidural hematoma and subsequent paralysis were estimated at 1:7643 (95% CI 1:3860 to 380,916) and 1:10,190 (95% CI 1:4781 to 0:1), respectively. The risk of hematoma is similar to the non-obstetric population (1:5405; 95% CI 1:4784 to 6134). The risk of hematoma in cardiac surgery patients receiving epidural anesthesia is therefore similar to that observed in some other surgical non-obstetric populations commonly exposed to epidural catheterization.","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Santonocito, Cesare Cassisi, Federica Chiarenza, Alessandro Caruso, Paolo Murabito, M. Maybauer, Shane George, Filippo Sanfilippo
BACKGROUND Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule. METHODS Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). RESULTS 339 patients (n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference -0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar (P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes (n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th (P = 0.002 and p=0.04, respectively) and 24th postoperative hours (P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively (P = 0.02). CONCLUSIONS Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.
背景术前长时间禁食可能会恶化术后效果。心脏手术的围手术期风险较高，较长的禁食期可能无法很好地耐受。我们根据患者上午或下午的时间安排，分析了接受择期冠状动脉旁路移植术（CABG）患者的术后代谢和血流动力学变量。方法在大学教学医院进行单中心回顾性研究（通过电子病历收集 1 年数据）。我们使用混合效应线性回归模型，并对几个协变量进行了调整，比较了 7 个预设时间点（进入重症监护室，术后第 1、3、6、12、18 和 24 小时）的代谢值（乳酸血症、pH 值和碱中毒 [BD]）和血流动力学值（使用血管活性支持的患者和血管活性肌力评分 [VIS]）。动脉乳酸血症和 BD 相似（总体 P = 0.11，P = 0.84），而 pH 值在上午组明显较低（总体 P < 0.05；平均差异 -0.01）。术后尿量、体液平衡、平均动脉压和中心静脉压相似（分别为 P = 0.59、P = 0.96、P = 0.58 和 P = 0.53）。对糖尿病患者（上午 n = 54，下午 n = 45）进行的亚组分析证实了相同的结果。在术后第 18 小时（P = 0.002 和 P=0.04）和第 24 小时（P = 0.003 和 P = 0.04），晨间病例的 VIS 值和接受血管活性支持的患者比例较高。结论择期接受 CABG 手术的患者在安排下午手术时，代谢和血流动力学情况相似或更好。
{"title":"Morning or Afternoon Scheduling for Elective Coronary Artery Bypass Surgery: Influence of Longer Fasting Periods from Metabolic and Hemodynamic Perspectives.","authors":"C. Santonocito, Cesare Cassisi, Federica Chiarenza, Alessandro Caruso, Paolo Murabito, M. Maybauer, Shane George, Filippo Sanfilippo","doi":"10.4103/aca.aca_204_23","DOIUrl":"https://doi.org/10.4103/aca.aca_204_23","url":null,"abstract":"BACKGROUND\u0000Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule.\u0000\u0000\u0000METHODS\u0000Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours).\u0000\u0000\u0000RESULTS\u0000339 patients (n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference -0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar (P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes (n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th (P = 0.002 and p=0.04, respectively) and 24th postoperative hours (P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively (P = 0.02).\u0000\u0000\u0000CONCLUSIONS\u0000Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Postoperative visual loss (POVL) is an infrequent yet consequential complication that can follow cardiac surgical interventions. This systematic review aims to provide a comprehensive analysis of the incidence of POVL after cardiac surgery and to delineate the associated risk factors. A comprehensive search was conducted in major medical databases for relevant studies published up to September 2022. Eligible studies reporting on the incidence of POVL and identifying risk factors in patients undergoing cardiac surgery were included. Data extraction was performed independently by two reviewers. The pooled incidence rates and the identified risk factors were synthesized qualitatively. POVL after cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per 100,000 cardiac surgical procedures. Risk factors for POVL include patient characteristics (advanced age, diabetes, hypertension, and preexisting ocular conditions), procedural factors (prolonged surgery duration, cardiopulmonary bypass time, and aortic cross-clamping), anesthetic considerations (hypotension, blood pressure fluctuations, and specific techniques), and postoperative complications (stroke, hypotension, and systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon complication, associated with factors like prolonged cardiopulmonary bypass, low hematocrit levels, excessive body weight gain, specific medications, hypothermia, anemia, raised intraocular pressure, and micro-embolization. Diabetic patients with severe postoperative anemia are at increased risk for anterior ischemic optic neuropathy (AION). Posterior ischemic optic neuropathy (PION) can occur with factors like hypertension, postoperative edema, prolonged mechanical ventilation, micro-embolization, inflammation, hemodilution, and hypothermia.While the overall incidence of POVL postcardiac surgery remains modest, its potential impact is substantial, necessitating meticulous consideration of modifiable risk factors. Notably, prolonged surgical duration, intraoperative hypotension, anemia, and reduced hematocrit levels remain salient contributors. Vigilance is indispensable to promptly detect this infrequent yet visually debilitating phenomenon in the context of postcardiac surgical care.
{"title":"Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review.","authors":"Bhavna Gupta, Deepak Singla, Anish Gupta, Ranjay Mahaseth","doi":"10.4103/aca.aca_85_23","DOIUrl":"https://doi.org/10.4103/aca.aca_85_23","url":null,"abstract":"ABSTRACT\u0000Postoperative visual loss (POVL) is an infrequent yet consequential complication that can follow cardiac surgical interventions. This systematic review aims to provide a comprehensive analysis of the incidence of POVL after cardiac surgery and to delineate the associated risk factors. A comprehensive search was conducted in major medical databases for relevant studies published up to September 2022. Eligible studies reporting on the incidence of POVL and identifying risk factors in patients undergoing cardiac surgery were included. Data extraction was performed independently by two reviewers. The pooled incidence rates and the identified risk factors were synthesized qualitatively. POVL after cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per 100,000 cardiac surgical procedures. Risk factors for POVL include patient characteristics (advanced age, diabetes, hypertension, and preexisting ocular conditions), procedural factors (prolonged surgery duration, cardiopulmonary bypass time, and aortic cross-clamping), anesthetic considerations (hypotension, blood pressure fluctuations, and specific techniques), and postoperative complications (stroke, hypotension, and systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon complication, associated with factors like prolonged cardiopulmonary bypass, low hematocrit levels, excessive body weight gain, specific medications, hypothermia, anemia, raised intraocular pressure, and micro-embolization. Diabetic patients with severe postoperative anemia are at increased risk for anterior ischemic optic neuropathy (AION). Posterior ischemic optic neuropathy (PION) can occur with factors like hypertension, postoperative edema, prolonged mechanical ventilation, micro-embolization, inflammation, hemodilution, and hypothermia.While the overall incidence of POVL postcardiac surgery remains modest, its potential impact is substantial, necessitating meticulous consideration of modifiable risk factors. Notably, prolonged surgical duration, intraoperative hypotension, anemia, and reduced hematocrit levels remain salient contributors. Vigilance is indispensable to promptly detect this infrequent yet visually debilitating phenomenon in the context of postcardiac surgical care.","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saravana Babu, Dodda Brahmam, Sabarinath Menon, Thomas Koshy, MS SaravanaBabu
Aortic root abscess formation is one of the most dangerous complications of infective endocarditis. It can occur in both native and prosthetic heart valves. Treatment includes a multidisciplinary team approach focusing on antibiotic coverage and adequate surgical treatment. The surgical repair is extremely challenging in these subset of patients due to fragile tissue and involvement of adjacent cardiac structures. We report a case of aortic root abscess where the preoperative computed tomography and intraoperative transesophageal echocardiography imaging described the exact anatomical details and demarcated the extension of the abscess cavity which helped in a successful surgical repair
{"title":"A Copybook Multimodal Imaging in a Case of Aortic Root Abscess—Computed Tomography, Surgical, and Intraoperative Echocardiography Imaging","authors":"Saravana Babu, Dodda Brahmam, Sabarinath Menon, Thomas Koshy, MS SaravanaBabu","doi":"10.4103/aca.aca_84_23","DOIUrl":"https://doi.org/10.4103/aca.aca_84_23","url":null,"abstract":"Aortic root abscess formation is one of the most dangerous complications of infective endocarditis. It can occur in both native and prosthetic heart valves. Treatment includes a multidisciplinary team approach focusing on antibiotic coverage and adequate surgical treatment. The surgical repair is extremely challenging in these subset of patients due to fragile tissue and involvement of adjacent cardiac structures. We report a case of aortic root abscess where the preoperative computed tomography and intraoperative transesophageal echocardiography imaging described the exact anatomical details and demarcated the extension of the abscess cavity which helped in a successful surgical repair","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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