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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
EDITORIAL  
Year : 2014  |  Volume : 17  |  Issue : 3  |  Page : 179-181
My journey as chief editor and future vision


Professor and Head, Department of Anaesthesiology, All India Institute of Medical Sciences ,Raipur, Chhattisgarh, India

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Date of Web Publication3-Jul-2014
 

How to cite this article:
Neema PK. My journey as chief editor and future vision. Ann Card Anaesth 2014;17:179-81

How to cite this URL:
Neema PK. My journey as chief editor and future vision. Ann Card Anaesth [serial online] 2014 [cited 2019 Jul 21];17:179-81. Available from: http://www.annals.in/text.asp?2014/17/3/179/135838


Just 2½ year back, I took over as chief editor. Indeed, it was a daunting task to keep the momentum on and excel further. I am grateful to the reviewers and board members for constant support, which helped me to move on and improve the quality of the accepted manuscripts and to take our journal further forward. Undoubtedly, the credit goes to the authors, the reviewers, the board members, the publisher and I am thankful to all of them for their time, support and commitment in improving Annals of Cardiac Anaesthesia. Our society, Indian Association of Cardiothoracic Anaesthesiologists (IACTA), firmly supported me and gave a free hand in running the journal. I sincerely thank the IACTA for reposing confidence in me and giving me a free hand to run the journal.

The journal frequency has increased to four issues yearly. During my tenure as chief editor, the Annals of Cardiac Anaesthesia received 445 manuscripts for consideration of publication. In the year 2012 and 2013, 34% and 45% of the manuscripts were accepted for publication, about 60% of the published manuscripts were from India, and the remaining was from the rest of the world among which United States of America and Europe were the major contributors. The journal successfully introduced "Invited Commentary" for all original articles. The visibility of the journal has increased, and the readership and the impact factor have increased to about 30,000 and 1.2. Evidently, the journal is moving in right direction.

On May 6, 1953, Dr. John Gibbon was the first to successfully repair an atrial septal defect on cardiopulmonary bypass (CPB) support. [1] Dr. Gibbon subsequently operated on two additional patients in July 1953, both of whom were young girls about 5 years of age with atrial septal defects. Both the patients died at surgery due to imprecise diagnosis of atrial septal defect and complications related to bleeding during long time periods on the heart-lung machine. [2]

In 61 years since first open-heart surgery, the cardiac surgery has advanced from uncertainty to certainty, from art to science. The burden of cardiac disease in India is enormous. In India, approximately 180,000 children are born with congenital heart disease. In the year 2000, there were an estimated 29.8 million people with coronary heart disease in India out of a total estimated population of 1.03 billion, or a nearly 3% overall prevalence. [3],[4] The health care industry is facing a gigantic task to tackle this growing burden of cardiovascular disease. Despite the fact that we, in India, harbor an epidemic population of cardiac patients and constantly growing medical and surgical treatment facilities, our contribution toward generating knowledge wealth to understand the genesis of cardiovascular diseases, development of preventive strategies, their perioperative management, postoperative strategies to prevent further progression of the disease and to ensure disease-free life remains dismal. During my tenure as chief editor of Annals of Cardiac Anaesthesia, only 13 original research articles were contributed by Indian authors. The findings are similar to the ones described by Landoni et al. while studying the pattern of publication in the Journal of Cardiothoracic and Vascular Anesthesia. [5] It is important to realize that money spent in research is not a waste of resources; however, a common misconception prevails among the medical personnel/faculty employed with governmental and private/corporate sector institutions that research is a job of statisticians. Institutions should realize that research is an important futuristic investment and money spent on research can yield rich dividends.

Neurologic outcomes, particularly, in pediatric cardiac surgical patients has been a cause of concern. It is noteworthy that developed countries are seeing a downward trend in pediatric cardiac surgery. Fetal echocardiography, particularly, to diagnose complex congenital heart disease is changing the course of such pregnancies and many such expectant mothers in the western world opt for medical termination of pregnancy. Such diagnosis is usually made during the mean gestational age of 20-24 weeks for the majority of associated cardiac defects. [6] However, in India, abortion is legal only up to 20 weeks of pregnancy under specific conditions and situations.

In the western world, the adult cardiac surgery is also on the decline because of changes in lifestyle and drastic reduction in smoking habits and rise of interventional cardiology procedures. All this knowledge has come from research. There is a need to restructure the training program of departmental fellows wherein a formal training in organizing and conducting research should be included in the curriculum. Similarly, departments should have positions for full time research faculty. The research starts with data collection; but, the state of data recording is appalling. The data recording is considered a thankless job and the junior most fellows are given the responsibility. Information technology is doing wonders, the automated data recording systems are available that can record, store and organize the data on click of a button. The scientific journals on their part should include simplified articles on research and analysis. The Annals of Cardiac Anaesthesia is scheduled to publish a review article on statistics "Clinical research: Important considerations". Only due recognition to research and reward to researchers at various levels can encourage members of faculties to excel. As mentioned earlier, we are harboring an epidemic population of cardiac patients; we should also realize that we can collect a wealth of information from these patients. What we need is a robust system of data collection; trained army of researchers, the day is not far when we will be generating knowledge for the well-being of our patients.

Nearly 50 years back pulmonary artery catheter (PAC) was introduced in anesthesia practice and almost at the same time in Critical Care Unit (CCU). The PAC, for the first time brought out anesthesiologists from operating rooms (ORs) to CCU; however, the perceived benefits of PAC did not last long and now various studies claim either no benefit or increased morbidity and mortality in critically ill patients with PAC. [7],[8],[9] The introduction of transesophageal echocardiography (TEE), particularly in cardiac anesthesia practice, has again put the anesthesiologists in the driver's seat. The TEE has given the status of diagnosticians to perioperative physicians; however, one should understand that this role comes with a great responsibility and accountability. TEE has been instrumental in judging the adequacy of surgical repair in cardiac surgical patients and changing surgical plan in many cardiac surgical patients, while in many others TEE imaging enforced, return to CPB and further correction of the inadequate repair. In many cardiac centers, TEE assessment of adequacy of surgical repair is a must prior to chest closure. Ongoing advances in imaging technology resulted in the development of small and compact matrix transducers and availability of real-time three-dimensional TEE for adult patients. In the year 2009, a miniaturized micro-TEE has been launched with the world's smallest TEE transducer for cardiac imaging of neonatal patients. Now, all kinds of cardiac surgical repairs can be assessed on the operating table before the patients are transferred to the cardiac intensive care unit.

The responsibility of the perioperative physicians has grown manifold. The perioperative physicians should not lose this opportunity, and those who are not trained in TEE should train themselves. The TEE and its predecessor transthoracic echocardiography (TTE) has immense value in managing cardiac as well as other noncardiac critically ill patients. TTE in CCU has the same capabilities as TEE. A workshop on TEE has become an integral part of various anesthesiology meetings and conferences, and IACTA itself has an IACTA-TEE committee which conduct TEE workshop cum CME program every year. The IACTA-TEE committee has already run seven such workshops. Indeed, it is encouraging to note that the number of TEE-related articles helping management of patients or changing the course of intraoperative management is constantly increasing and now 4-7 papers on TEE find their place in every issue of Annals of Cardiac Anaesthesia. All these developments indicate the growing expertise in TEE. American and European societies run board certificate examination in perioperative transesophageal echocardiography and for last 5 years IACTA is also running a fellowship program in perioperative TEE.

Extra Corporeal Membrane Oxygenation (ECMO), an extension of CPB is another important area where anesthesiologists should take a lead. ECMO has already moved into CCU and the results of ECMO in critically ill patients are encouraging. The anesthesiologists are familiar with the art of supporting failing systems, physiological way of thinking is natural to them and therefore, learning these technologies shall not be difficult.

Percutaneous techniques are advancing rapidly and now many cardiac surgical diseases such as coronary artery disease, patent ductus arteriosus, patent foramen ovale, atrial septal defect, ventricular septal defect, aortic stenosis, mitral regurgitation, and perivalvular leak, are amenable to percutaneous treatment. In all these procedures TEE or TTE assessment of the interventional procedure is mandatory. These procedures provide enormous opportunity to anesthesiologists to consolidate their knowledge of TEE and TTE. Percutaneous treatment is available for many vascular diseases also. Occasionally, in the event of failure of percutaneous procedure or complications, full surgical intervention is required emergently. Thus, the newer generation catheterization laboratories are hybrid ORs, the laboratory can function like an OR as and when required without wasting time in transfer of patient and arranging for OR. Minimally invasive cardiac surgery (MICS) and Robotic cardiac surgery are two other important advances; MICS is already firmly placed and available for various cardiac surgical procedures, whereas Robotic surgery is growing slowly. The anesthetic requirement of percutaneous procedures, MICS, and Robotic cardiac surgery are often unique and offer differing challenges.

All these advances in cardiac sciences have happened in a short span of 61 years after the advent of open-heart surgery. With growing awareness, technological advances, preventive strategies and treatment of many so-called cardiac surgical patients in the catheterization laboratory, the cardiac surgical population is likely to undergo a sea change. Perhaps, cardiac surgeons and cardiac anesthesiologists will have more challenging cases, and cases that have already undergone an interventional procedure in the cardiac catheterization laboratory. The advances are exciting; however, each one of us should appreciate that we cannot have expertise in all areas and that the time has come when we will have to choose and decide our area of practice. Expertise in a particular area alone will advance the disciplines of cardiac anesthesia and ensure expert care of patients.

 
   References Top

1.Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954;37:171-85.  Back to cited text no. 1
[PUBMED]    
2.Romaine-Davis A. John Gibbon and His Heart-Lung Machine. Philadelphia, Pa: University of Pennsylvania Press; 1991.  Back to cited text no. 2
    
3.Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008;94:16-26.  Back to cited text no. 3
    
4.Census of India 2001. Population Projection for India and States 2001-2026. Report of the Technical Group on Population Projections Constituted by the National Commission on Population, Office of Registrar General and census Commissioner, India. 2006.  Back to cited text no. 4
    
5.Landoni G, Bignami E, Nicolotti D, Pieri M, Silvetti S, Buratti L, et al. Publication trends in the journal of cardiothoracic and vascular anesthesia: A 10-year analysis. J Cardiothorac Vasc Anesth 2010;24:969-73.  Back to cited text no. 5
    
6.Stoll C, Garne E, Clementi M, Euroscan Study Group. Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in Europe. Prenat Diagn 2001;21:243-52.  Back to cited text no. 6
    
7.Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: A randomized controlled trial. JAMA 2003;290:2713-20.  Back to cited text no. 7
    
8.Shah MR, Hasselblad V, Stevenson LW, Binanay C, O′Connor CM, Sopko G, et al. Impact of the pulmonary artery catheter in critically ill patients: Meta-analysis of randomized clinical trials. JAMA 2005;294:1664-70.  Back to cited text no. 8
    
9.Schwann NM, Hillel Z, Hoeft A, Barash P, Möhnle P, Miao Y, et al. Lack of effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg 2011;113:994-1002.  Back to cited text no. 9
    

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Correspondence Address:
Praveen Kumar Neema
Professor and Head, Department of Anaesthesiology, AIIMS Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.135838

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