Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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   2013| October-December  | Volume 16 | Issue 4  
    Online since October 1, 2013

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Practice guidelines for perioperative transesophageal echocardiography: Recommendations of the Indian association of cardiovascular thoracic anesthesiologists
Kanchi Muralidhar, Deepak Tempe, Murali Chakravarthy, Naman Shastry, Poonam Malhotra Kapoor, Prabhat Tewari, Shrinivas V Gadhinglajkar, Yatin Mehta
October-December 2013, 16(4):268-278
DOI:10.4103/0971-9784.119175  PMID:24107693
Transoesophageal Echocardiography (TEE) is now an integral part of practice of cardiac anaesthesiology. Advances in instrumentation and the information that can be obtained from the TEE examination has proceeded at a breath-taking pace since the introduction of this technology in the early 1980s. Recognizing the importance of TEE in the management of surgical patients, the American Societies of Anesthesiologists (ASA) and the Society of Cardiac Anesthesiologists, USA (SCA) published practice guidelines for the clinical application of perioperative TEE in 1996. On a similar pattern, Indian Association of Cardiac Anaesthesiologists (IACTA) has taken the task of putting forth guidelines for transesophageal echocardiography (TEE) to standardize practice across the country. This review assesses the risks and benefits of TEE for several indications or clinical scenarios. The indications for this review were drawn from common applications or anticipated uses as well as current clinical practice guidelines published by various society practicing Cardiac Anaesthesia and cardiology . Based on the input received, it was determined that the most important parts of the TEE examination could be displayed in a set of 20 cross sectional imaging planes. These 20 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination. Because variability exists in the precise anatomic orientation between the heart and the esophagus in individual patients, an attempt was made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections.
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Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography
Sanjay Orathi Patangi, Anthony George, Henning Pauli, Denis O'Leary, Chandrika Roysam, Tanveer Butt, Stephan Schueler, Mahesh Prabhu, Guy MacGowan
October-December 2013, 16(4):259-267
DOI:10.4103/0971-9784.119173  PMID:24107692
Left ventricular assist devices (LVAD) are increasingly used for mechanical circulatory support of patients with severe heart failure, primarily as a bridge to heart transplantation. Transesophageal echocardiography (TEE) plays a major role in the clinical decision making during insertion of the devices and in the post-operative management of these patients. The detection of structural and device-related mechanical abnormalities is critical for optimal functioning of assist device. In this review article, we describe the usefulness of TEE for optimal perioperative management of patients presenting for HeartWare LVAD insertion.
  9,364 376 7
Anesthesia for gastrointestinal endoscopy in patients with left ventricular assist devices: Initial experience with 68 procedures
Basavana G Goudra, Preet Mohinder Singh
October-December 2013, 16(4):250-256
DOI:10.4103/0971-9784.119167  PMID:24107691
Aims and Objectives: Continuous flow left ventricular assist devices (LVAD) have emerged as a reliable treatment option for heart failure. Because of bleeding secondary to anticoagulation, these patients present frequently for gastrointestinal (GI) endoscopy. The presently available literature on perioperative management of these patients is extremely limited and is primarily based upon theoretical principles. Materials and Methods: Perioperative records of patients with LVAD undergoing (GI) endoscopy between 2008 and 2012 were reviewed. Patient, device and procedure specific information was analyzed. Results: A total of 105 LVADs were implanted, and 68 procedures were performed in 39 patients. The most common indication was GI bleed (48/68), with yearly risk of 8.57% per patient. A total of 63 procedures were performed under deep sedation, with five procedures requiring general anesthesia. Intra-procedure hypotension was managed by fluids and (or) vasopressors/inotropes (phenylephrine, ephedrine or milrinone) guided by plethysmographic waveform, non-invasive blood pressure (NIBP) and LVADs pulsatility index (for HeartMate II)/flow pulsatility (for HeartWare). No patient required invasive monitoring and both NIBP and pulse oximeter could be reliably used for monitoring (and guided management) in all patients due to the presence of native heart's pulsatile output. Conclusion: In the presence of residual heart function, with optimal device settings, non-invasive hemodynamic monitoring can be reliably used in these patients while undergoing GI endoscopy under general anesthesia or monitored anesthesia care. Transient hypotensive episodes respond well to fluids/vasopressors without the need of increasing device speed that can be detrimental.
  8,105 229 6
Posterior mediastinal mass: Do we need to worry much?
Parin Lalwani, Rajiv Chawla, Mritunjay Kumar, Akhilesh S Tomar, Padmalatha Raman
October-December 2013, 16(4):289-292
DOI:10.4103/0971-9784.119183  PMID:24107699
Anesthetic management of mediastinal masses is challenging. There is abundant literature available on anesthesia management of anterior mediastinal mass. Anesthetic management of posterior mediastinal mass lesions normally have uneventful course. We describe airway collapse and difficult mechanical ventilation in the postoperative period in a patient with posterior mediastinal mass.
  5,687 349 1
Comparison of left internal mammary artery diameter before and after left stellate ganglion block
Divya Gopal, Naveen G Singh, AM Jagadeesh, Ajay Ture, Ashwini Thimmarayappa
October-December 2013, 16(4):238-242
DOI:10.4103/0971-9784.119161  PMID:24107689
Aims and Objectives: Left internal mammary artery (LIMA) is the preferred arterial conduit for coronary artery bypass grafting. Various pharmacological agents are known to increase LIMA blood flow. Sympathetic blockade mediated by stellate ganglion block (SGB) has been used to provide vasodilatation in the upper extremities and in the treatment of refractory angina. We investigated effect of left stellate ganglion block (LSGB) on LIMA diameter. Materials and Methods: In 30 diagnosed patients of triple vessel coronary artery disease, LSGB was given under fluoroscopic guidance by C6 transverse process approach using 10 ml of 1% lignocaine. LIMA diameter was measured before and 20 min after the block at 2 nd , 3 rd , 4 th and at 5 th rib level. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded before and 20 min after the block. Results: The LIMA diameter increased significantly at 2 nd (2.56 ± 0.39 vs. 2.99 ± 0.40; P < 0.0001), 3 rd (2.46 ± 0.38 vs. 2.90 ± 0.40; P < 0.0001), 4 th (2.39 ± 0.38 vs. 2.84 ± 0.41; P < 0.0001) and 5 th rib level (2.35 ± 0.38 vs. 2.78 ± 0.40; P < 0.0001). No statistically significant change occurred in HR, SBP, DBP and MAP before and 20 min after LSGB. Conclusions: LSGB significantly increased the LIMA diameter. The LSGB can be considered as an alternative to topical and systemic vasodilators for reducing vasospasm of LIMA.
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Stellate ganglion block in cardiac surgery
Mukul Chandra Kapoor, Gautam Khanna
October-December 2013, 16(4):242-244
  3,680 170 -
A dangerous communication
Sivasubramanian Srinivasan, Hui Seong Teh, Daniel Eh Zhen Wei
October-December 2013, 16(4):281-282
DOI:10.4103/0971-9784.119179  PMID:24107695
  2,780 85 -
Use of optimized ultrasound axis along with marked introducer needle to prevent mechanical complications of internal jugular vein catheterization
Tanmoy Ghatak, Ratender Kumar Singh, Arvind Kumar Baronia
October-December 2013, 16(4):296-298
DOI:10.4103/0971-9784.119185  PMID:24107701
Internal jugular vein (IJV) catheterization is a routine technique in the intensive care unit. Ultrasound (US) guided central venous catheter (CVC) insertion is now the recommended standard. However, mechanical complications still occur due to non-visualization of the introducer needle tip during US guidance. This may result in arterial or posterior venous wall puncture or pneumothorax. We describe a new technique of (IJV) catheterization using US, initially the depth of the IJV from the skin is measured in short-axis and then using real time US long-axis view guidance a marked introducer needle is advanced towards the IJV to the defined depth measured earlier in the short axis and the IJV is identified, assessed and cannulated for the CVC insertion. Our technique is simple and may reduce mechanical complications of US guided CVC insertion.
  2,584 206 1
Heart failure: Advances and Issues
Praveen Kumar Neema
October-December 2013, 16(4):235-237
DOI:10.4103/0971-9784.119157  PMID:24107688
  2,422 304 -
Interesting facts about chest radiograph
Narendra Bodhey
October-December 2013, 16(4):301-301
DOI:10.4103/0971-9784.119188  PMID:24107703
  2,535 169 -
Anesthetic and hemodynamic management of a rare case of Brucella multivalvular endocarditis in cardiogenic shock undergoing emergency aortic valve replacement and mitral valve repair
Ashok Kandasamy, Senthil Kumar Ramalingam, Bhaktavatsala Deva Reddy, Harshavardhan Krupananda
October-December 2013, 16(4):286-288
DOI:10.4103/0971-9784.119182  PMID:24107698
We describe a very rare case of human brucella multivalvular endocarditis. Patient presented in a state of cardiogenic shock with low urine output and a history of breathlessness. Patient was diagnosed to have brucellosis 2 months back by blood cultures and agglutination tests and was receiving doxycycline and rifampicin therapy. Echocardiography showed severe aortic regurgitation, moderate mitral regurgitation, severe left ventricular dysfunction and a mobile vegetation attached to the aortic valve. Patient was scheduled for emergency surgery; while preparing for surgery hemodynamic monitoring, non-invasive ventilation and inotropic supports were started. During surgery, the aortic valve was found perforated and the aortomitral continuity was disrupted. Aortic valve replacement and mitral valve repair were performed. Hemofiltration was used during cardiopulmonary bypass. Weaning from bypass was achieved with the help of inodilators, dual chamber pacing and intra-aortic balloon pump.
  2,359 192 -
Cardiomegaly due to left atrial enlargement mimicking dextrocardia in chest radiograph
Mukul C Kapoor, Anju Sarupria, Kushant Gupta, Arkalgud Sampath Kumar
October-December 2013, 16(4):279-280
DOI:10.4103/0971-9784.119178  PMID:24107694
  2,330 123 -
Coronary artery bypass surgery in the presence of cerebrospinal fluid rhinorrhea
Rajinder Singh Rawat, Yatin Mehta, Naresh Trehan, Aditya Gupta
October-December 2013, 16(4):283-285
DOI:10.4103/0971-9784.119181  PMID:24107697
A seventy eight year old male patient was admitted in our hospital with headache, vomiting, irritability and confusion. Initially he was diagnosed as a case of pyogenic encephalitis. Further investigations revealed that patient had cerebrospinal fluid rhinorrhea and coronary artery disease. He successfully underwent coronary artery bypass grafting and cerebrospinal fluid leak repair.
  2,232 81 -
Global left and right ventricular dysfunction after tranexamic acid administration in a polytrauma patient
Sukhen Samanta, Sujay Samanta, Kajal Jain, YK Batra, Sukhen Samanta, Sujay Samanta, Kajal Jain, YK Batra
October-December 2013, 16(4):305-307
DOI:10.4103/0971-9784.119193  PMID:24107706
  2,115 143 2
Influence of ethanol-induced pulmonary embolism on hemodynamics in pigs
Shinsaku Yata, Masayuki Hashimoto, Toshio Kaminou, Yasufumi Ohuchi, Kimihiko Sugiura, Akira Adachi, Tsuyoshi Kawai, Masayuki Endo, Shohei Takasugi, Shuichi Yamamoto, Kensuke Matsumoto, Mika Kodani, Takashi Ihaya, Makoto Takahashi, Hisao Ito, Toshihide Ogawa
October-December 2013, 16(4):245-249
DOI:10.4103/0971-9784.119164  PMID:24107690
Aims and Objectives: Ethanol is widely used for the embolization treatment of vascular malformations, but it can also cause serious complications such us pulmonary hypertension, cardiopulmonary collapse and death. The complications are considered secondary to pulmonary vasospasm and ethanol-induced sludge embolism, etc., We studied the hemodynamic effects of intravenous absolute ethanol injection and ethanol sludge injection in pigs. Materials and Methods: A total of 5 pigs underwent intravenous injection of ex vivo generated ethanol-induced sludge in which residual ethanol was removed (Group S) and 4 pigs underwent intravenous injection of absolute ethanol (Group E). Hemodynamic parameters related to the pulmonary and systemic circulation were compared between the groups. Results: Transient pulmonary hypertension was observed in both groups and the hemodynamic changes were similar in both groups. Conclusions: Sludge can induce transient pulmonary hypertension or cardiopulmonary collapse, without ethanol and may be the mechanism by which ethanol induces its adverse hemodynamic effects.
  2,115 104 -
Primary malignant fibrous histiocytoma involving the left pulmonary vein presenting as a left atrial tumor
Saikat Bandyopadhyay, Sunip Banerjee, Abhijit Paul, Ratan Kumar Das
October-December 2013, 16(4):293-295
DOI:10.4103/0971-9784.119184  PMID:24107700
A 35-year-old woman presented with 4 months history of progressively increasing intermittent dyspnea and hemoptysis. Transthoracic echocardiography revealed a loculated mass in the left atrium (LA). A provisional diagnosis of LA myxoma was made. Intraoperatively the tumor was found extending into and closely adherent to the left pulmonary vein and could not be completely cleared off from the pulmonary venous wall. The histopathological examination of the tumor revealed it to be a myxoid malignant fibrous histiocytoma.
  1,844 134 1
Ventricular assist devices
Sandeep Chauhan
October-December 2013, 16(4):257-258
  1,515 200 -
Anterior mitral leaflet myxoma: A rare occurrence
Mohd Lateef Wani, Ab Gani Ahangar, Shyam Singh, Mohd Lateef Wani, Ab Gani Ahangar, Shyam Singh
October-December 2013, 16(4):304-305
DOI:10.4103/0971-9784.119192  PMID:24107705
  1,402 108 -
Authors' reply
Deepak Borde, Uday Gandhe, Neha Hargave, Kaushal Pandey, Vishal Khullar
October-December 2013, 16(4):300-301
  1,286 79 -
Transesophageal echocardiography images of right ventricular sarcoma
Ramesh Varadharajan, Satyen Parida, S Adinarayanan, Ashok S Badhe
October-December 2013, 16(4):302-303
DOI:10.4103/0971-9784.119190  PMID:24107704
  1,253 90 -
In response to, "The application of European system for cardiac operative risk evaluation II and society of thoracic surgeons risk score for risk stratification in Indian patients undergoing cardiac surgery"
Madhur Malik, Sandeep Chauhan
October-December 2013, 16(4):299-300
DOI:10.4103/0971-9784.119186  PMID:24107702
  1,160 103 1
Authors' reply
Rajinder Singh Rawat, Yatin Mehta, Naresh Trehan
October-December 2013, 16(4):302-302
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October-December 2013, 16(4):282-282
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