Annals of Cardiac Anaesthesia最新文献

Background: Postoperative bleeding is a major concern in cardiovascular surgery, leading to an increased need for blood transfusions and a longer hospital stay. Between 30% and 70% of open-heart surgery patients will require blood product transfusion. The use of the cardiopulmonary bypass machine (CPB) often leads to bleeding due to complement activation, platelet activation, and hyperfibrinolysis. Antifibrinolytic drugs, like ε-aminocaproic acid, aprotinin, and tranexamic acid (TXA) are used to decrease postoperative bleeding in cardiac surgery. According to the Society of Thoracic Surgeons guidelines, TXA is class I recommendation to reduce the risk of bleeding.

Aims: Compare the efficacy and safety of TXA in the mist form to reduce postoperative bleeding.

Settings and design: Prospective, Randomized, Single-Centre, Interventional Study.

Material and methods: The study included sixty participants undergoing on-pump CABG randomized into two groups. Group T and Group C received topical TXA and 20 mL NS in mist form, respectively. The mist was blown over the pericardium, LIMA bed, and sternotomy sites before chest closure. The primary objectives were to compare the 48th hour drain collection and need for blood transfusion.

Statistical analysis used: Simple t-test, Chi-square test and Mann-Whitney U test.

Results: The experimental group had significantly less 48-hour drain (P value 0.001), reduced need of blood and blood products (P value 0.001) and less duration of postoperative ventilation (P value 0.001).

Conclusion: The topical application of TXA in mist form significantly reduced postoperative bleeding, the necessity for blood transfusion, and the duration of mechanical ventilation in on-pump CABG procedures.

Abstract: The pecto-intercostal fascia plane block (PIFB) is gaining recognition for its potential to reduce postoperative opioid use after cardiac surgery. This study aimed to evaluate the effectiveness of PIFB compared with conventional intravenous regimens in reducing total postoperative opioid consumption in patients undergoing cardiac surgery involving sternotomy. A meta-analysis of relevant studies, published up to August 13, 2024, retrieved from the PubMed and CENTRAL databases was performed. The inclusion criteria were studies involving a superficial parasternal block or PIFB for patients undergoing cardiac surgery involving sternotomy. Studies comparing PIFB with other blocks or local anesthetic regimens were excluded. Data analysis was performed using an inverse variance random-effects model using RevMan 5.4.1 software, with the effect measure expressed as standardized mean difference (SMD) to account for the different opioids used. Of 88 studies retrieved in the literature search, 16 fulfilled the inclusion criteria [ten ultrasound (US)-guided and six non-US-guided]. PIFB significantly reduced total opioid consumption [SMD -1.55 (95% CI -2.15 to -0.95); P < 0.001] and time to extubation [SMD -1.22 (95% CI -2.05 to -0.38); P < 0.001]. A subgroup analysis of multiple- versus single-shot injections yielded consistent results. Analyses including only US-guided PIFB revealed consistent reductions in total opioid consumption [SMD -1.18 (95% CI -1.79 to -0.56); P < 0.001] and time to extubation [SMD -0.82 (95% CI -1.01 to -0.63); P < 0.001]. PIFB effectively reduced opioid consumption and shortened postoperative time to extubation in cardiac surgery involving sternotomy.

Abstract: Acute kidney injury (AKI) is a common complication following cardiac surgery, often leading to increased morbidity and mortality. Despite its prevalence, the role of acetaminophen in preventing AKI after cardiac surgery remains uncertain. This meta-analysis sought to clarify whether perioperative administration of acetaminophen could reduce the risk of postoperative AKI in adult patients undergoing cardiac procedures. To address this question, a systematic review and meta-analysis were performed by searching the MEDLINE, Cochrane, and Embase databases. Studies comparing the effects of perioperative acetaminophen to those of no acetaminophen in adult cardiac surgery patients were evaluated, with risk of bias assessed for each study. Sensitivity analyses were also conducted to strengthen the reliability of the findings. In total, 13 studies, including nine randomized controlled trials and four observational studies, involving 11,583 patients, were analyzed. The results showed that acetaminophen administration was associated with a lower incidence of AKI [OR 0.62 (95% CI 0.40-0.97), P = 0.04]. Additionally, acetaminophen use was linked to reduced in-hospital mortality, delirium rates, and shorter ICU stays, though it had no significant effect on overall hospital length of stay. These findings suggest that perioperative acetaminophen administration may play a protective role in reducing both AKI incidence and in-hospital mortality in patients undergoing cardiac surgery. Until large multicenter randomized controlled trials confirm these results, acetaminophen may still be considered as a preventive measure for patients both before cardiopulmonary bypass initiation and in the postoperative period.

Abstract: Mitral regurgitation (MR) can occasionally mimic aortic stenosis (AS) on echocardiographic Doppler imaging, leading to diagnostic challenges. We present the case of a 55-year-old man undergoing minimally invasive mitral valve surgery for severe MR caused by posterior mitral valve leaflet prolapse. Preoperative transthoracic echocardiography revealed severe MR with no significant aortic valve abnormalities. Intraoperative transesophageal echocardiography (TEE) initially showed a high transvalvular aortic gradient (3 m/s) in the transgastric long-axis view, suggestive of mild-to-moderate AS. However, detailed Doppler analysis revealed a double envelope signal, representing both eccentric MR and true aortic valve flow. The closer evaluation showed the MR signal occurred earlier in the cardiac cycle, aligning with its hemodynamic timing, while the true aortic flow followed isovolumetric contraction. Subsequent three-dimensional TEE confirmed normal aortic valve morphology and function. This case highlights the importance of correlating preoperative findings, Doppler signal timing, and imaging data to avoid misdiagnosis. Systematic echocardiographic evaluation, including signal timing analysis, can differentiate between MR and AS, ensuring accurate intraoperative decision-making and preventing unnecessary interventions.

Background: Extravascular lung water (EVLW) in children undergoing cardiac surgery may affect the outcomes after surgery. The study aimed to evaluate if extravascular lung water assessed by ultrasound could serve as a predictor of short-term postoperative outcomes in pediatric cardiac surgery.

Material and methods: This is a prospective observational study conducted at a tertiary care facility involving children aged 6 months to 12 years who were scheduled for cardiac surgery. A lung ultrasound assessment was carried out before the operation (T0), immediately after the surgery (T1), 6 to 8 hours after surgery (T2), and 18 to 24 hours postoperatively (T3). A score was assigned based on the presence of extravascular lung water indicated by B lines. Pearson's correlation analysis was performed to examine the relationship between the lung ultrasound score of extravascular lung water and the duration of mechanical ventilation and the length of stay in the intensive care unit, with fluid balance, inotrope score, and oxygenation status being analyzed secondarily.

Results: The EVLW score demonstrated a positive relationship with the duration of mechanical ventilation across all time points, with correlation coefficients of r = 0.56 at T0, r = 0.70 at T1, r = 0.40 at T2, and r = 0.52 at T3. The most pronounced correlation occurred at T1, where r = 0.7 was observed. A moderate positive correlation with the duration of ICU stay was noted at the time points T0, T1, and T3. The EVLW score at T1 proved to be significant in linear regression analysis for prediction of both the duration of mechanical ventilation and the length of stay in the ICU.

Conclusions: The EVLW score measured at T1, which is immediately after surgery, can serve as an indicator of short-term postoperative outcomes in pediatric cardiac surgery related to the duration of mechanical ventilation.