Annals of Cardiac Anaesthesia最新文献

Introduction: Diabetes mellitus (DM) is a complex carbohydrate metabolic disorder with increased levels of inflammation. Stress response to cardiac surgery manifests as a major neuroendocrine and cytokine response leading to increased levels of inflammation and subsequent hyperglycemia, contributing to significant cardiovascular morbidity and mortality. To mitigate these effects in patients undergoing off-pump coronary artery bypass grafting (OPCABG), our study focused on using dexmedetomidine infusion hypothesizing decreased stress response and thereby improved glucose variability (GV).

Methods: Patients were randomized into two groups: group D (dexmedetomidine) was administered the drug at 0.5 µg/kg/h, and group C (control) was administered an equivalent amount of saline. Preinduction C-reactive protein (CRP) and interleukin-6 (IL-6) levels were sent, and perioperative GV and mean insulin requirement were recorded in 24 h. Postoperatively, samples were sent and recorded for IL-6 and CRP levels at 12 and 24 h. The primary objective of our study was to assess the effect of injection dexmedetomidine on blood GV with secondary objectives being the assessment of the level of IL-6 and CRP at preinduction (0 h) and at 12 and 24 h postoperatively and comparison of mean insulin requirement between the groups.

Results: Eighty-nine diabetic patients were enrolled in this study, among which 21 were excluded. Sixty-eight patients, with 34 patients in each group, were selected for analysis. There was a significant difference between the two groups in terms of GV (P = 0.042) (16.44 ± 4.63 vs. 14.38 ± 3.45), mean insulin requirements (U/h) (P = 0.001) (1.38 ± 0.63 vs. 0.88 ± 0.59), CRP (mg/dL) (12 h) (P = 0.012) (2.6 ± 2.83 vs. 1.51 ± 1.13, and CRP (mg/dL) (24 h) (P = <0.001) (16.71 ± 6.45 vs. 10.19 ± 4.56). IL-6 was comparable in both groups at all points.

Conclusion: Patients receiving intraoperative dexmedetomidine infusion during OPCABG demonstrated improved GV leading to a reduction in insulin requirements and reduced CRP levels at 12 and 24 h postoperatively. We may incorporate dexmedetomidine in our routine clinical practice to ameliorate stress response in these patients.

Background: Etomidate (ET), a cardiostable drug, is preferred to propofol while inducing anesthesia in patients with cardiac disease or sepsis despite concerns of increased mortality due to adrenocortical suppression. Phenylephrine (PE) was coadministered to counteract the hypotension associated with the propofol induction with success in low-risk patients undergoing noncardiac surgery. The primary objective of this prospective observational cohort study was to compare the incidence of hypotension at induction with ET versus propofol-PE (PP) combination in patients undergoing elective cardiac surgery.

Materials and methods: Group ET patients (n = 45) received ET, and group PP patients (n = 45) received a PP mixture (20 µg PE in every 10 mg of propofol) in titrated doses for anesthesia induction. The heart rate and mean arterial pressure (MAP) were recorded at 21 time points (baseline and every 30 s for 10 min after induction). Hypotension (fall in MAP more than 20% from the baseline) was managed by administering rescue bolus PE 1 μg/kg.

Results: In groups ET and PP, respectively, there were 28 and 37 patients (P - 0.264) who had hypotension requiring 41 and 52 rescue PE doses (P - 0.254), during the first 10 min after induction of anesthesia. ET group patients had a significantly higher number of time points with hypertension (67 in group ET vs 14 in group PP; P < 0.0001) and tachycardia (124 in group ET vs 52 in group PP; P < 0.0001) after direct laryngoscopy and intubation.

Conclusion: The incidence of hypotension is comparable in both the groups with PP combination attenuating the hemodynamic response to the intubation better.

Patient with prosthetic heart valves are a challenge to the anesthesiologist. Atrial arrhythmias may occur in a patient with preexisting cardiac condition. An elderly male patient with history of double valve replacement with rate controlled atrial fibrillation was taken up for open nephrectomy. Throughout the intraoperative period, hemodynamic instability was managed using inotropes. However, at the end of the procedure, patient had sudden episode of tachyarrhythmia with hypotension which was diagnosed as unstable atrial fibrillation (AF) and direct cardioversion was done which reverted the rhythm to normal. Patient was shifted to intensive care unit for observation and further management, where he was extubated after 24 hours.

Management of angiotensin-converting enzyme inhibitors (ACEIs) overdose is historically challenging. We present the case of an overdose which was successfully managed with the utilization of venoarterial extracorporeal life support. This represents a novel mechanism of treatment. Further, the pharmacology of ACEI overdose is reviewed in the context of treatment with venoarterial extracorporeal life support.

Background: One-lung ventilation (OLV) is crucial in thoracic surgery as it ensures optimal visibility and effective isolation of the lung. Various devices, such as double-lumen tubes and bronchial blockers, help achieve effective OLV. While double-lumen tubes (DLTs) are considered the gold standard for lung isolation certain clinical scenarios may make their use challenging or contraindicated. In these cases, the EZ-Blocker® (Teleflex Medical, Morrisville, NC, USA) presents distinct advantages. This paper discusses a series of six cases where DLTs were not feasible, highlighting our experience with the EZ-Blocker® as a viable alternative.

Materials and methods: We analyzed patients aged 18 years and older who underwent various thoracic surgeries in the department of Anaesthesiology at Christian Medical College, Vellore, from January 2024 to September 2024. This study specifically focused on cases involving the intraoperative use of the EZ-Blocker® for one-lung ventilation.

Results: The EZ-Blocker® was used in challenging situations such as difficult airway management, and lung isolation in intubated patients, and in those with tracheostomies. The placement of nearly all EZ bronchial blockers was accomplished without complications, resulting in a success rate of 99%. Adequate lung collapse was achieved in all patients, with no serious airway injuries or immediate complications reported.

Conclusion: The EZ-Blocker® is an effective and safe airway device designed for one-lung ventilation, particularly in scenarios where DLTs are unsuitable. Its advantages include easy placement, adaptability to abnormal airway anatomy, reduced airway trauma, and enhanced visualization during bronchoscopy. These features make it a superior alternative to traditional double-lumen tubes for managing complex airway scenarios.

Intraoperative pulmonary embolism is a rare but life-threatening complication during cardiac surgeries involving right atrial masses. This case report details the successful management of a 62-year-old woman with a right atrial mass, utilizing transesophageal echocardiography (TEE). The patient, with a history of diabetes, hypertension, and coronary artery disease, presented with breathlessness. Preoperative echocardiography identified a mobile mass prolapsing through the tricuspid valve. Following anesthesia induction, embolization of the mass caused hemodynamic collapse, confirmed by intraoperative transesophageal echocardiography. Immediate surgery was modified to include pulmonary thrombectomy under deep hypothermic circulatory arrest, emphasizing transesophageal echocardiography critical role in guiding surgical decisions.

Background: Cardioplegia is essential for myocardial protection. Modified Del Nido and Custodiol® cardioplegia have been successfully used; however, a limited number of clinical trials compared both solutions. Our objective was to evaluate the effectiveness of Modified Del Nido cardioplegia against Custodiol® in protecting the myocardium in adult patients having open heart surgery.

Methods: In this prospective randomized double-blinded clinical trial, fifty-eight adult patients registered for elective open heart surgery at Fayoum University hospitals, Fayoum, Egypt, between February 2022 and November 2023, have enrolled. Patients were randomized to receive either a Modified Del Nido cardioplegia solution (MDN group) (n = 29) or Custodiol® cardioplegia (C group) (n = 29). The primary outcome was Troponin I (µg/L) measured 24 h after surgery.

Results: Both groups had comparable demographics. Troponin I was much lower in the MDN group (median = 2.9, IQR = 2.7-3.2) than in the C group (median = 3.6, IQR = 3.1-4.1) 24 h after surgery. Similarly, there were substantial differences in CK-MB between the two groups 24 h postoperatively. The MDN group had better results in terms of time taken for cardiac arrest, the incidence of ventricular fibrillation upon cross-removal, and the percentage of patients requiring inotropes. The MDN group shows notably reduced hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), and weaning from mechanical ventilation times.

Conclusions: Adult cardiac surgery may be performed safely and successfully using Modified Del Nido cardioplegia in comparison to Custodiol® cardioplegia.

Background: Few studies have explored the anti-inflammatory effects of drugs in cardiac surgery. Dexmedetomidine (Dex), a centrally acting alpha-agonist, is believed to possess anti-inflammatory properties. We conducted a randomized, double-blind, controlled trial to assess the anti-inflammatory effects of Dex in patients undergoing open-heart surgery with cardiopulmonary bypass.

Methods: Adult eligible patients undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to receive either standard anesthetics or De × 0.5 μg/kg/h in addition to anesthetics in a single-center, randomized, double-blinded study. The primary outcome was the change in inflammatory mediators (∆) in plasma 24 hours postsurgery compared with baseline, measured by ELISA. Secondary outcomes are defined as changes in hemodynamic and biological markers, recovery time, and Dex's safety.

Results: In total, 80 patients were included in the control and Dex groups. The Dex group increased IL-13 levels as anti-inflammatory cytokines, while it was decreased in the control group. Dex reduced the levels of interleukin (IL)-6 (P = 0.777) and IL-18 (P = 0.895) at the 24 hours postsurgery, with no statically significant difference against the control group. Both groups did not increase the levels of IL-1β and TNF-α regards to baseline (P = 0.812 and P = 0.420, respectively); however, this increase was lower in the Dex group for TNF-α and slightly higher for IL-1β. Dex provided better hemodynamic and repository stability. In addition, the incidence of common events including hypotension, bradycardia, and tachycardia was higher in the control group than in Dex.

Conclusion: We found that administering Dex at the onset of anesthesia and during cardiopulmonary bypass reduces inflammatory factors, promotes hemodynamic stability, and enhances patient safety. It may offer significant benefits for those undergoing open heart surgery.