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   2004| July  | Volume 7 | Issue 2  
    Online since January 22, 2008

 
 
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ORIGINAL ARTICLES
Surgical interventions in patients undergoing percutaneous balloon mitral valvotomy : a retrospective analysis of anaesthetic considerations.
Deepak K Tempe, B Gupta, A Banerjee, S Virmani, V Datt, C Marwah, AS Tomar
July 2004, 7(2):129-36
PMID:17827545
Between 1990 and 2000, 5499 balloon mitral valvotomies were performed at GB Pant Hospital. Amongst these, 45 patients required surgical intervention, which form the basis of this report. There were 18 males and 27 females with the mean age of 26.5+/-8.3 years and weight of 42.9+/-7.39 kg. Thirty-five patients underwent open-heart surgery and 10 closed-heart surgery. Twenty-five patients developed acute severe mitral regurgitation during balloon mitral valvotomy and required emergency open-heart surgery. Morphine based anaesthetic technique with careful attention to haemodynamic monitoring was used in these patients. All patients required a high inotropic support to terminate the cardiopulmonary bypass. The closed-heart surgical procedures included emergency exploration for cardiac tamponade (4), exploration + closed mitral valvotomy (4), and elective closed mitral valvotomy (2). The overall mortality was 9%, which is much higher than the reported mortality for elective mitral valve replacement. Morphine based anaesthetic technique is useful in these patients. Adequate oxygenation, vasodilators, inotropes and diuretics are required for preoperative stabilisation of patients who develop acute mitral regurgitation, while those who develop cardiac tamponade need volume replacement along with inotropes and immediate surgical decompression of the tamponade.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,457 288 -
REVIEW ARTICLE
Inflammatory Response to Cardiac Surgery and Strategies to Overcome it.
Mukul Chandra Kapoor, TR Ramachandran
July 2004, 7(2):113-28
PMID:17827544
A general activation of the immune system is observed during any operative procedure as a physiological response to the surgical trauma. Cardiopulmonary bypass may directly activate the inflammatory response by three distinct mechanisms: direct 'contact activation' of the immune system following exposure of blood to the foreign surfaces, ischaemia-reperfusion injury to vital organs and systemic endotoxaemia resulting from gut translocation of endotoxin. The inflammatory response depends upon recruitment and activation of inflammatory cells. The cellular immune response, in particular polymorphonuclear cell-endothelial adhesion, leads to widespread endothelial damage and dysfunction. Increased oxygen derived free radical activity represents a risk for myocardial and pulmonary complications. The clinical consequences of the stress response vary from a mild generalised transient response, termed the 'systemic inflammatory response syndrome,' to life threatening organ dysfunction. The introduction of the 'off-pump' coronary artery bypass graft surgery has now made it possible to differentiate the influence of cardiopulmonary bypass and surgical access on different modalities of the immune response. 'Off-pump' cardiac surgery has been found to trigger inflammatory response, lesser than 'on-pump' cardiac surgery. Researches are directed towards understanding this complex interplay of humoral and cellular mediators and develop strategies to limit the resultant organ dysfunction. Current literature on the various mediators of this inflammatory response, the role of surgical stress, the pathogenesis of the organ damage and strategies to limit / overcome this response are reviewed.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,188 438 -
TUTORIAL
Weaning from cardiopulmonary bypass : problems and remedies.
M Vakamudi
July 2004, 7(2):178-85
PMID:17827556
Full text not available  [PDF]  [PubMed]
  1,085 531 -
ORIGINAL ARTICLES
A comparison of halothane and sevoflurane for bronchoscopic removal of foreign bodies in children.
Yatindra K Batra, R Mahajan, Sushil K Bangalia, P Chari, Katragadda Ln Rao
July 2004, 7(2):137-43
PMID:17827546
The present study was designed to compare induction and recovery characteristics of sevoflurane and halothane for rigid bronchoscopy for removal of foreign bodies in tracheobronchial tree in children. Forty four children (age 1-4 years) were allocated randomly to two groups to receive either halothane (group H; n=22) or sevoflurane (group S; n=22) in oxygen. A graded inhalation technique was used with maximum inspiratory concentration of 5% for halothane and 8% for sevoflurane. Time for loss of consciousness and induction time in group H and group S were 2.3+/-0.4 min vs 2.2+/-0.4 min (p>0.05) and 4.6+/-0.7 min vs 4.9+/-0.6 min (p>0.05) respectively. Intubation conditions with rigid bronchoscope were similar in both groups. Fewer children in group H had vocal cord movements as compared to group S on laryngoscopy (3 vs 8, p>0.05). Six children in group H and two children in group S had disturbances of cardiac rhythm (p>0.05). Emergence time was significantly shorter in group S as compared to group H (group H - 29.6+/-10.7 min vs group S- 12.3+/-7.6 min, p<0.05). Modified Aldrete's score of 8 was achieved significantly faster in group S as compared to group H (group H - 33.8+/-9.3 min vs group S- 17.3+/-6.8 min, p<0.05). Adverse events during induction and recovery were comparable between the two groups except for significantly high incidence of excitement in group S. In conclusion, halothane is as suitable as sevoflurane for children undergoing rigid bronchoscopy for airway foreign body retrieval, but sevoflurane has a quicker recovery.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,171 281 -
Influence of changes in the pulmonary artery pressure on ventilation requirements in patients undergoing mitral valve replacement.
K Muralidhar, E Rupert, R Singh, N Gowda, V Kumar, S Kumar
July 2004, 7(2):144-8
PMID:17827547
The study was designed to evaluate the influence of changes in pulmonary artery pressure on the ventilation requirements in patients undergoing mitral valve surgery. Thirty patients with mitral valve disease with significant pulmonary arterial hypertension undergoing mitral valve replacement under cardiopulmonary bypass were included in this prospective study. All patients had a pulmonary artery catheter placed after the anaesthetic induction. The minute ventilation was adjusted to achieve an arterial carbon dioxide tension (PaCO2) of 35-40 mm Hg. After a stabilisation period of 15 minutes, the pulmonary artery pressure and the minute volume needed for maintaining a PaCO2 of 35-40 mm Hg in the precardiopulmonary bypass, post-cardiopulmonary bypass and six hours postoperatively were measured after ensuring stable haemodynamics and normothermia. There was a significant decrease in the mean pulmonary artery pressure from pre-cardiopulmonary bypass value of 41.3+/-15 mm Hg to 29.3+/-8 mm Hg in the postcardiopulmonary bypass period and subsequently to 25.5+/-7 mm Hg in the intensive care unit. There was a corresponding increase in the minute volume requirements from a pre-cardiopulmonary bypass value of 6.8+/-1 L/min to 8.0+/-1 L/min in the post cardiopulmonary bypass period and then to 9.4+/-1.2 L/min in the postoperative period. We conclude that there is a significant decrease in the pulmonary blood volume and a subsequent decrease in the pulmonary artery pressure after a successful mitral valve replacement in patients with pulmonary arterial hypertension. This is associated with a significant increase in the requirement of minute ventilation to maintain normocarbia.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,031 215 -
CASE REPORTS
Conscious sedation as an anaesthetic technique in patients undergoing nonthoracotomy placement of automatic implantable cardioverter defibrillator : an initial experience.
VP Singh, BN Shahi, A Dhall, ML Chawla, A Sinha
July 2004, 7(2):149-54
PMID:17827548
Six adult patients with life threatening recurrent ventricular arrhythmias who underwent non- thoracotomy placement of automatic implantable cardioverter defibrillator under conscious sedation are reported. Our clinical experience, patient satisfaction, recovery profile, complications and cardiologist perception about the technique of conscious sedation is presented and discussed.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,007 186 -
Percutaneous transvenous mitral commissurotomy - a life saving option in severe mitral stenosis with cardiogenic shock.
Mukul Chandra Kapoor, Jaskaran Singh Dugal, S Sharma, S Singh
July 2004, 7(2):158-61
PMID:17827550
Full text not available  [PDF]  [PubMed]
  767 235 -
EDITORIALS
Management of Complications of BMV - Further Insight.
P Chandra
July 2004, 7(2):107-8
PMID:17827542
Full text not available  [PDF]  [PubMed]
  738 211 -
CASE REPORTS
Post balloon valvotomy acute mitral regurgitation.
S Chauhan, P Gharde, A Bisoi, S Kale, U Kiran
July 2004, 7(2):155-7
PMID:17827549
Full text not available  [PDF]  [PubMed]
  655 199 -
EDITORIALS
Fast track paediatric cardiac surgery : feasible or foolhardy.
Andrew R Wolf
July 2004, 7(2):109-12
PMID:17827543
Full text not available  [PDF]  [PubMed]
  653 190 -
LETTERS TO EDITOR
An indigenous continuous positive airway pressure device for the nonventilated lung to improve oxygenation during one lung ventilation.
R Kumar, Rajendra Kumar Singh, S Kumar, R Sehgal
July 2004, 7(2):177-177
PMID:17827555
Full text not available  [PDF]  [PubMed]
  546 158 -
Temporomandibular Joint Dislocation After GA for CABG Surgery.
Manish Kumar Sharma, Y Mehta, M Bhise
July 2004, 7(2):176-176
PMID:17827554
Full text not available  [PDF]  [PubMed]
  529 160 -
INTERESTING IMAGES
Partial AV Canal Defect with Common Atrium and Mitral Regurgitation.
C Chatterjee, J Singh, PK Ghosh, AK Ganjoo
July 2004, 7(2):174-174
PMID:17827552
Full text not available     [PubMed]
  573 0 -
A rare case of calcified right ventricular mass.
R Garg, SK Mohanty, K Muralidhar, PV Suresh, J Punnen, D Shetty
July 2004, 7(2):173-173
PMID:17827551
Full text not available     [PubMed]
  501 0 -
Mitral valve surgery through the left atrial appendage.
K Satya Sridhar, Vithalkumar M Betigeri, V Sharma, V Datt, A Banerjee
July 2004, 7(2):175-175
PMID:17827553
Full text not available     [PubMed]
  377 0 -