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   2012| October-December  | Volume 15 | Issue 4  
    Online since October 1, 2012

 
 
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ORIGINAL ARTICLE
Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion
Michael Mazzeffi, Michael Marotta, Hung-Mo Lin, Gregory Fischer
October-December 2012, 15(4):266-273
DOI:10.4103/0971-9784.101855  PMID:23041683
Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001). There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06). The association between deep hypothermia duration and the amount of bleeding (RBC transfusion) was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes) there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes), there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes), prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes), there appears to be no relationship.
  9 3,710 300
Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study
Gamal Z El-Morsy, Alaa El-Deeb, Tariq El-Desouky, Ashraf A Elsharkawy, Mohamed Adel F Elgamal
October-December 2012, 15(4):259-263
DOI:10.4103/0971-9784.101848  PMID:23041682
To compare the outcomes of thoracic epidural block with thoracic paravertebral block for thoracotomy in pediatric patients. A prospective double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III scheduled for thoracotomy were randomly allocated into two groups. After induction of general anesthesia, thoracic epidural catheter was inserted in group E (epidural) patients and thoracic paravertebral catheter was inserted in group P (paravertebral) patients. Post operative pain score was recorded hourly for 24 hours. Plasma cortisol level was recorded at three time points. Tidal breathing analysis was done preoperatively and 6 hours postoperatively. Analgesia, serum cortisol level, and pulmonary function parameters were comparable in the two groups. However, failure rate (incorrect placement of catheter) was significantly higher in epidural group than in paravertebral group (7% versus 0%, respectively). The complications were also significantly higher in epidural group (vomiting 14.8%, urine retention 11.1% and hypotension 14.8%) than paravertebral group (0%, 0%, and 3.6%, respectively). We conclude that both thoracic paravertebral block and thoracic epidural block results in comparable pain score and pulmonary function after thoracotomy in pediatric patients; the paravertebral block is associated with significantly less failure rate and side effects.
  7 7,002 571
REVIEW ARTICLES
Acute kidney injury following cardiac surgery
Dilip Gude, Ratan Jha
October-December 2012, 15(4):279-286
DOI:10.4103/0971-9784.101874  PMID:23041685
Acute kidney injury (AKI), a recognized complication of cardiac surgery with cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality (15-30%) with approximately 1% of all the affected patients requiring dialysis. Early detection of AKI would enable intervention before occurrence of irreversible injury and might minimize the morbidity and mortality. Recently developed biomarkers of AKI facilitate its earlier discovery and help assessment of its severity and prognosis. In this article, we review the causes of well-known yet inexplicable association between CPB and AKI, the advances in pathophysiologic basis, the diagnostics and the management options.
  7 8,813 1,059
Understanding traumatic blunt cardiac injury
Ayman El-Menyar, Hassan Al Thani, Ahmad Zarour, Rifat Latifi
October-December 2012, 15(4):287-295
DOI:10.4103/0971-9784.101875  PMID:23041686
Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.
  5 12,876 875
CASE REPORTS
Safe management of cesarean section in a patient of Eisenmenger syndrome
Silvia Minicucci, Vincenzo Segala, Claudio Verdecchia, Piero Sismondi, Riccardo Casabona, Fabrizio Sansone
October-December 2012, 15(4):296-298
DOI:10.4103/0971-9784.101863  PMID:23041687
We report our experience of a 29-year-old female with a complete atrio-ventricular septal defect leading to a single ventricle physiology and Eisenmenger syndrome. The patient successfully underwent spinal anesthesia for cesarean section in the 31 st week of pregnancy. A multidisciplinary approach involving cardiologist, cardiac surgeon, obstetrician, and anesthesiologist was utilized to achieve a safe pregnancy and cesarean for the delivery of the baby. A close clinical assessment is required, especially during the third trimester when the risk of acute right ventricular dysfunction increases. The use of extracorporeal membrane oxygenation (ECMO) (as a bridge to recovery or bridge to salvage) was planned to support oxygenation and circulation in case of acute biventricular dysfunction. The delivery/cesarean section was performed in a cardiac surgery operating room, and to reduce the time-frame for ECMO institution the femoral vessels were exposed surgically before the cesarean section.
  4 3,694 478
ORIGINAL ARTICLE
A survey on the use of intra-aortic balloon pump in cardiac surgery
Elena Bignami, Luigi Tritapepe, Laura Pasin, Roberta Meroni, Laura Corno, Valentina Testa, Giovanni Landoni, Fabio Guarracino, Alberto Zangrillo
October-December 2012, 15(4):274-277
DOI:10.4103/0971-9784.101871  PMID:23041684
Intra-aortic balloon pump (IABP) is an established tool in the management of cardiac dysfunction in cardiac surgery. The best timing for IABP weaning is unknown and varies greatly among cardiac centers. The authors investigated the differences in IABP management among 66 cardiac surgery centers performing 40,675 cardiac surgery procedures in the 12-month study period. The centers were contacted through email, telephone, or in person interview. IABP management was very heterogeneous in this survey: In 43% centers it was routinely removed on the first postoperative day, and in 34% on the second postoperative day. In 50% centers, it was routinely removed after extubation of the patients whereas in 15% centers it was removed while the patients were sedated and mechanically ventilated. In 66% centers, patients were routinely receiving pharmacological inotropic support at the time of removal of IABP. The practice of decreasing IABP support was also heterogeneous: 57% centers weaned by reducing the ratio of beat assistance whereas 34% centers weaned by reducing balloon volume. We conclude that the management of IABP is heterogeneous and there is a need for large prospective studies on the management of IABP in cardiac surgery.
  3 3,894 364
EDITORIAL
Eisenmenger syndrome: An unsolved malady
Praveen Kumar Neema
October-December 2012, 15(4):257-258
DOI:10.4103/0971-9784.101844  PMID:23041681
  2 4,393 376
CASE REPORTS
Incidental discovery of an unusual right atrial membrane in an adult patient
Nasrin N Aldawoodi, Harendra Arora, Priya A Kumar
October-December 2012, 15(4):309-311
DOI:10.4103/0971-9784.101870  PMID:23041691
We describe presence of an unusual right atrial membrane in a 30-year old female with end stage renal disease, hypertension and peripheral vascular disease. The patient was scheduled for midline sternotomy and pericardiotomy and removal of a migrated vascular stent in the right pulmonary artery. An intraoperative transesophageal echocardiogram (TEE) revealed an unusual membranous structure with fenestrations that stretched across the right atrium with attachments superiorly at the free wall and inferiorly at the inter-atrial septum. There was no evidence of flow obstruction across the tricuspid valve. Some of the considerations for the likely diagnosis of this structure were a prominent Eustachian valve, persistent Chiari network, aneurysmal inter-atrial septum, an inter-atrial septal cyst or Cor triatriatum dexter (CTD).
  1 5,677 141
LETTERS TO EDITOR
Coronary artery bypass grafting and dengue fever
Yatin Mehta, S. K. S. Rawat
October-December 2012, 15(4):318-318
DOI:10.4103/0971-9784.101847  PMID:23041694
  1 1,414 108
Iatrogenic superior vena cava syndrome during off pump CABG
Rajnish Kumar
October-December 2012, 15(4):320-321
DOI:10.4103/0971-9784.101856  PMID:23041697
  1 1,377 101
BRIEF COMMUNICATION
Transradial approach to interventional cardiology: Lessons for the anesthesiologist
Satyen Parida, Ramaiah Mahadeva Mohan Kumar, Pankaj Kundra
October-December 2012, 15(4):315-317
DOI:10.4103/0971-9784.101859  PMID:23041693
  - 2,153 154
CASE REPORTS
Transesophageal echocardiography for diagnosis of inadvertant closure of Inferior Vena Cava opening during minimally invasive atrial septal defect closure
Kanwar A Baloria, Marc St-Amand, Biju S Pillai, Nandini Selot
October-December 2012, 15(4):312-314
DOI:10.4103/0971-9784.101872  PMID:23041692
Transesophageal echocardiography (TEE) is widely used in cardiac surgery. TEE provides important diagnostic and functional information before and after cardiopulmonary bypass thereby having a very important impact on perioperative clinical outcomes. We describe a case in which intraoperative TEE was instrumental in the timely diagnosis of inadvertant closure of the inferior vena cava (IVC) opening during minimally invasive surgical closure of atrial septal defect.
  - 2,050 138
Anesthetic management of congenital broncho-esophageal fistula in an adult
RV Ranjan, TR Ramachandran, David George Veliath
October-December 2012, 15(4):299-301
DOI:10.4103/0971-9784.101865  PMID:23041688
Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.
  - 2,735 143
Management of a patient with hyperkalemic periodic paralysis requiring coronary artery bypass grafts
Sanjay Orathi Patangi, Mathew Garner, Hazel Powell
October-December 2012, 15(4):302-304
DOI:10.4103/0971-9784.101867  PMID:23041689
Hyperkalemic periodic paralysis (HPP) is an autosomal-dominant inherited muscle disease characterized by episodes of flaccid weakness and intermittent myotonia. There are no previous reports in the literature about anesthesia for cardiac surgery with cardiopulmonary bypass in this disorder. We describe perioperative anesthetic management for on-pump coronary artery bypass grafting in a 75-year-old man with a history of hyperkalemic periodic paralysis. This case report outlines our management strategy and the issues encountered during the perioperative period.
  - 2,987 140
Anesthetic management of a child with nephrotic syndrome undergoing open heart surgery: Report of a rare case
Vishnu Datt, Deepak K Tempe, Kapil Arora, Sanjula Virmani, Chander S Joshi, Saket Agarwal
October-December 2012, 15(4):305-308
DOI:10.4103/0971-9784.101868  PMID:23041690
The congenital nephrotic syndrome (NS) in infancy and childhood is an important entity but combination with acyanotic congenital heart disease is uncommon. Anesthesia in such cases is challenging because of associated problems like hypo-protienemia, anti-thrombin III deficiency, edema, hyperlipidemia, coagulopathy, cardiomyopathy, immunodeficiency, increased lung water etc. We describe anesthetic management of a patient with childhood NS and sinus venosus atrial septal defect (ASD) undergoing open heart surgery. We also suggest guidelines for safe conduct of anesthesia and CPB in such patients.
  - 8,407 341
INVITED COMMENTARY
Invited Commentary
Yatin Mehta
October-December 2012, 15(4):264-265
  - 1,410 103
Invited Commentary
Deepak K Tempe
October-December 2012, 15(4):273-273
  - 1,149 90
Invited Commentary
Murali Chakravarthy
October-December 2012, 15(4):277-278
  - 1,117 73
LETTERS TO EDITOR
RE: Disappearing ring in chest cavity
Sivasubramanian Srinivasan
October-December 2012, 15(4):318-319
PMID:23041695
  - 1,290 73
Pericardial effusion causing ventricular arrhythmias: Atypical presentation
Vivek Chowdhry, BB Mohanty
October-December 2012, 15(4):319-320
DOI:10.4103/0971-9784.101851  PMID:23041696
  - 4,783 131
RETRACTION NOTICE
Retraction Notice

October-December 2012, 15(4):322-322
PMID:23213671
  - 1,077 102