Annals of Cardiac Anaesthesia最新文献

Context: USG vascular probe and TEE probe can help during central venous catheterization (CVC) and can confirm the location of guide wire in the neck vessels. We proposed this study, as there are only few studies comparing between TEE probe as surface probe and USG vascular probe for right IJV cannulation.

Aims: To compare the TEE probe as a surface probe and USG vascular probe during right IJV catheterization in cardiac surgeries.

Settings and design: Prospective, comparative study.

Methods and material: One twenty-four patients of either sex posted for major elective cardiac surgery were included in this study. Patients were divided into two groups (TEE group and USG group) of 62 by assigning the study participants alternatively to each group. The goal of this study was to compare the puncture time, visualization of IJV to first successful puncture, quality of the imaging with needle tip positioning, and catheter positioning using both TEE probe and vascular probe. The primary outcome was comparison of time from visualization of the IJV to successful puncture using both TEE probe as a surface probe and vascular probe. Secondary outcome was to compare the quality of image with respect to needle tip positioning and compare quality of image with respect to catheter position using both probes.

Statistical analysis used: Statistical analyses were performed by using a statistical software package SPSS, version 20.0.

Results: The observation and results of our study clearly show the feasibility of TEE as surface probe for guiding central venous catheter in right IJV just like the vascular linear probe. There was no significant difference between the two groups (P > 0.05). No statistical differences were found in the puncture time, image quality, needle tip positioning, wire positioning, and catheter positioning between the two groups. All the P values were greater than 0.05.

Conclusions: The TEE probe can be used as an alternative method to guide IJV puncturing and catheterization when the vascular probe is not available. It is feasible especially in cardiac surgeries where the TEE monitoring machine is a must in modern anesthesia and readily available than an ultrasound machine.

Introduction: One lung ventilation (OLV) is a technique used during lung resection surgery to facilitate optimal surgical conditions. However, this may result in severe hypoxemia due to the right-to-left shunt created in the collapsed lung. Several techniques are used to overcome hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV) or split lung ventilation (SLV). In this study, we compared the efficacy of CPAP to DLV during video-assisted thoracoscopic (VATS) lung resection.

Materials and methods: In this single-center randomized controlled, cross-over study, each patient acted as his control as well as the study. Patients crossed over from SLV to CPAP (or vice versa) with an interval period during which only OLV was used (control period). The primary objective of the study was to observe the changes in oxygenation, ventilation, and the surgeons' perception of the surgical field using CPAP or SLV to the non-ventilated lung during the period of OLV in patients undergoing thoracic surgery.

Results: The study revealed that oxygenation was significantly better when using SLV to the non-ventilated lung during the period of OLV (P = 0.03). However, the surgeon found a significantly better surgical field when applying CPAP to the surgical field.

Conclusions: The study showed that using SLV to the non-ventilated lung during the period of OLV was superior in terms of oxygenation, although it interfered more with the surgical field.

WATCHMAN is a percutaneous left atrial appendage closure device that is implanted in patients who are unsuitable for anticoagulation therapy for atrial fibrillation. During WATCHMAN implantation, inducing apnea in the patient is preferable to allow stable deployment. We present three cases in which apneic oxygenation was employed to maintain oxygenation during apnea, and oxygen reserve index (ORi^TM) was measured to evaluate its safety and efficacy. Oxygen was administered continuously via the endotracheal tube during apnea. During all four apneic events in three patients (mean duration of 356 seconds), the ORi values maintained above 0.24, which is generally considered the threshold of partial pressure of arterial oxygen (PaO₂) > 100 mmHg. Transcutaneous oxygen saturation and PaO₂ remained above 99% and 300 mmHg, respectively. There were no respiratory or circulatory complications during or after the surgery.

Aim: The present study was conducted to validate cardiac output (CO) and cardiac index (CI) obtained from electrical cardiometry (EC) ICON ^® with transthoracic echocardiography (TTE) in postoperative pediatric cardiac surgical patients.

Materials and methods: A prospective observational study was conducted in 25 pediatric patients with age < 10 years who underwent elective cardiac surgery.

Data analysis: BlandAltman plot was constructed for interchangeability and Polar plot was constructed to know trending ability.

Results: A total of 250 datasets were analyzed. Spearman's correlation coefficient for CO between ICON ^® and TTE showed good positive correlation (r = 0.850, 95% confidence interval 0.81 to 0.881, P <.0001). Moderate positive correlation was observed between ICON ^® and TTE for CI (r = 0.60, 95% confidence interval 0.515 to 0.674, P <.0001). Linear regression equations for CO and CI between ICON ^® and TTE were: y = 0.5230 + 0.8078 X (R² = 0.6597, P <.001) and y = 1.8350 + 0.5869 X (R² = 0.3985, P <.001) [y- ICON ^®; X - TTE], respectively. BlandAltman plot for CO between ICON ^® and TTE showed a bias of 0.3012 with limits of agreement (LOA) being -0.69 to 1.3 and for CI bias was 0.6939 with LOA-2.1 to 3.5. Polar plot analysis showed an angular bias of 8.1750, with radial LOA being -13.74° to 30.08° for CO and angular bias of 6.6931, with radial LOA being -15.69° to 29.07° for CI.

Conclusion: ICON ^® monitor-derived parameters are not interchangeable with the values derived from TTE. However, the ICON ^® monitor demonstrated a good trending ability for both CO and CI.

Background: Classically subclavian vein catheterization is done in neutral arm position; recently, it has been done in different arm positions to compare success rate and catheter misplacement. There is a paucity of literature for comparing abducted and neutral arm position for right infraclavicular subclavian vein cannulation.

Aim: Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia.

Design: Randomized comparative study.

Materials and methods: After approval from Institutional Review Board and Ethical Committee, 100 patients of 18-70 years of age, of either sex, posted for elective neurosurgery under general anesthesia, requiring right subclavian vein cannulation were included in our study. They were randomly divided into two groups: abducted arm position (group 1-AG) and neutral arm position (group 2-NG) using sealed envelope technique.

Results: First attempt success rate was higher in AG group compared to NG group (P value- 0.741). Times taken (seconds) for cannulation in NG and AG group, catheter misplacement and hematoma (P value- 0.37, P value- 0.37, P value- 1, respectively) were lesser in AG Group.

Conclusion: For USG-guided infraclavicular subclavian vein cannulation, abducted arm position, and neutral arm position in terms of first attempt success rate, number of attempts and associated complications has comparable results; however, further studies with larger group of patients are required to assess the overall advantage of abducted arm position over neutral arm position.

Measurement of regional cerebral oxygen saturation (rSO2) using near-infrared spectroscopy (NIRS) in cardiac surgery is known to be useful in reducing postoperative neurological complications. We here present a case of a 71-year-old man in whom severe decrease in unilateral rSO2 was observed after induction of general anesthesia for percutaneous mitral valve clipping, although no neurological abnormalities were found. NIRS does not always predict postoperative neurological complications.