The Egyptian Journal of Cardiothoracic Anesthesia最新文献

{"title":"Efficacy of erector spinae plane block versus serratus anterior plane block for perioperative analgesia in lateral thoracotomy surgeries: a randomized controlled trial","authors":"Ahmed Said, M. Salah, Mohamed Ibrahim, Khaled Hassan, Asser Hussein","doi":"10.4103/ejca.ejca_14_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_14_22","url":null,"abstract":"Background Lateral thoracotomy is considered one of the most painful types of surgical access. Post lateral thoracotomy pain is attributable to several mechanisms including muscle incisions, rib retraction or resection, intercostal nerves injury, and the presence of an indwelling chest tube. Inadequate pain management can lead to increased postoperative complications, especially in compromised patients. Acute pain may affect pulmonary function and clearance of secretions. Thus, postoperative pain control is crucial in decreasing morbidity and mortality after major thoracic surgery. Numerous analgesic techniques are available for the management of acute postthoracotomy pain, including patient controlled analgesia, regional nerve blockades, and neuraxial blocks. Thoracic epidural analgesia and thoracic paravertebral block are currently the recommended techniques for managing postthoracotomy pain. Objectives Our aim was to evaluate the analgesic efficacy of both techniques [erector spinae plane block (ESPB) and serratus anterior plane block (SAPB)] in patients undergoing lateral thoracotomy surgeries. Patients and methods Randomized controlled study in which 32 patients American Society of Anesthesiology I–II–III undergoing lateral thoracotomy were enrolled. With age more than or equal to 18 and less than or equal to 60 years. Patients were allocated into two groups: group 1 (SAPB) N=16 and group 2 (ESPB) N=16. After induction of anesthesia patients received either ultrasound-guided ESPB or SAPB with injection of 20 ml 0.25% bupivacaine. The total amount of morphine consumption in the first 24 h postoperatively. Total amount of intraoperative fentanyl and block related complications were recorded, visual analog scale score, both at rest and during movement, nausea and vomiting scores, and overall patient satisfaction were recorded. Results Statistically significant reduction in the mean postoperative morphine consumption was found in group 2 with 4.20±1.55 mg compared to 7.25±2.01 mg in group 1 (P<0.001). Statistically significant reduction in the mean intraoperative fentanyl consumption in group 2 with 129.38±40.08 μg compared to 165.63±39.66 μg in group 1 (P<0.001). Group 2 showed statistically significant lower scores at visual analog scale at rest and at movement. Among those who required postoperative morphine the mean time to 1st postoperative analgesia in group 1 (N=16) was 5.50±2.84 h compared to 9.09±3.62 h group 1 (N=16). Two (12.5%) patients of group 1 developed muscle hematoma and two (12.5%) patients complaint from pain at injection site in group 2.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123189019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of a paediatric cardiac surgical patient with Glucose-6 Phosphate Dehydrogenase deficiency","authors":"Jeril Kurien","doi":"10.4103/ejca.ejca_5_23","DOIUrl":"https://doi.org/10.4103/ejca.ejca_5_23","url":null,"abstract":"Glucose-6-Phosphate Dehydrogenase (G6PD)-deficiency is one of the most common enzymatic disorders of Red Blood Cells (RBCs). Cardiac surgery involving conventional Cardiopulmonary bypass (CPB) in such patients pose an increased risk of haemolysis as well as impaired oxygenation leading to prolonged ventilation. Many commonly used drugs also predispose such patients for haemolysis when they are subject to surgery. Here we describe a successful perioperative management of a 3 year old child, a known case of G6PD- deficiency who presented with a diagnosis of Atrial septal defect (ASD) with Partial Anomalous Pulmonary Venous Connection (PAPVC) and Mild-Moderate Mitral Regurgitation & underwent surgery with preplanned precautionary measures avoiding haemolysis.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132550624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal timing of parasternal intercostal nerve block application (pre-incisional versus post-incisional) for acute pain management in cardiac surgery; a randomized double-blinded clinical trial","authors":"Samar Amin, Mona Emara","doi":"10.4103/ejca.ejca_1_23","DOIUrl":"https://doi.org/10.4103/ejca.ejca_1_23","url":null,"abstract":"Background In patients undergoing cardiac operations, parasternal intercostal nerve block (PSIB) has been suggested to enhance pain management and lower opioids consumption. However, inadequate literature has discussed its effectiveness as a pre-emptive analgesic approach. This trial was designed to investigate the optimal timing to perform the block pre- or post-surgical incision. Methods This prospective study enrolled 51 patients, aged 18–70 years, with ASA status II/III, who underwent on-pump cardiac surgery. Participants were allocated to two groups randomly; Group-A received ultrasound-guided PSIB pre-incisional, while in Group-B, the surgeon performed the block under direct vision. Ten bilateral injections of four milliliters each containing bupivacaine (0.25%) were given (40 ml total volume). The study primary outcome was the amount of morphine consumed within postoperative 24 h. The secondary measures included fentanyl utilization and hemodynamic swings during surgery, as well as postoperative pain scores, rescue analgesic doses, adverse events, extubation time, ICU and hospital stay durations, and patients’ satisfaction. Results The pre-incisional PSIB demonstrated significant decrease in intraoperative fentanyl utilization (893.85±113.39 ug vs. 982±129.81 ug, P =0.01) and more stabilization of hemodynamics at skin incision and sternal retraction time-points, compared to postincisional group. Otherwise, no significant differences were noted regarding the total postoperative morphine consumption (28.54±17.17 mg vs. 27.92±15.52 mg), pain scores, rescue analgesic demand, extubation time, length of ICU stay, hospitalization duration in both groups. Conclusion Pre-incisional and post-incisional PSIB presented comparable pain profile in the early postoperative period after open heart surgeries. But pre-emptive application of PSIB showed better control of intraoperative hemodynamics and less fentanyl utilization.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127260650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous origin of the left main coronary artery from the right pulmonary artery: a case report","authors":"Guriqbal Singh, R. Shah, V. Arora, Amit Mishra","doi":"10.4103/ejca.ejca_12_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_12_22","url":null,"abstract":"","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116313296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The novel derived preoperative-POSSUM score as a predictor of surgical patients’ allocation to an elective postoperative ICU ordered by anesthesiologists at Cairo University Hospital","authors":"H. Ahmed, D. Soliman, A. Raouf, M. Elshazly, Verina Youhana, Ahmed Nabih","doi":"10.4103/ejca.ejca_10_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_10_22","url":null,"abstract":"Backgroun d Anesthesiologists depend on multiple factors to request a postoperative ICU bed after elective surgeries. This decision may be based on the risk of surgery and comorbidities. Some surgeries may be postponed, or some patients may be exposed to unnecessary ICU admission. So, this aroused the need for certain scores upon which anesthesiologist could build their request for ICU admission. Aim To evaluate the accuracy of the pre-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) score as a predictor for the need for postoperative ICU. Patients and methods This study calculated the POSSUM score preoperatively (pre-POSSUM) for 308 patients who underwent elective general surgeries at Kasr Alainy Hospital, a leading tertiary care hospital in Cairo, Egypt. Results Our study showed the possibility of having a cutoff value of pre-POSSUM score that could predict patients who would benefit most from a postoperative ICU stay. The best cutoff value for the estimated morbidity percent was 19.545, with 100% sensitivity and 64.3% specificity. Moreover, the estimated mortality percent at a cutoff value of 3.375 showed 100% sensitivity and 62% specificity. Conclusion The pre-POSSUM could be used as a reliable tool for the allocation of patients after elective general surgeries, identify those who require intensive postoperative care, and use the cutoff values shown in a study to help to triage patients after elective surgeries.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126443253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of supplemental parasternal block for sternal keloid excision under general anesthesia in a child status post multiple cardiac surgeries","authors":"S. Rajan, B. Spandana, Reshma Rajkumar, J. Paul","doi":"10.4103/ejca.ejca_2_23","DOIUrl":"https://doi.org/10.4103/ejca.ejca_2_23","url":null,"abstract":"","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130231928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External shunt versus internal shunt for off-pump Glenn","authors":"A. Elhaddad, A. Mohammed","doi":"10.4103/ejca.ejca_6_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_6_22","url":null,"abstract":"Background Off-pump bidirectional Glenn (BDG) operation can be associated with elevation of superior vena cava (SVC) pressure that may lead to neurological damage. Aim Off-pump BDG operation was done using either a veno-atrial shunt or external shunt to decompress SVC during clamping. Patients and methods A prospective, randomized comparative study in a single tertiary care cardiac center where 30 patients with functional single ventricle underwent off-pump BDG. Group I with a veno-atrial shunt (internal) and group E with an external shunt. Measurements and main results There was no early hospital mortality. The mean SVC pressure during clamping was 40.4±3.4 mmHg before and 28.5±3.8 mmHg after shunt opening in group I and 37.6±4.5 mmHg before and 26.4±2.1 mmHg after shunt opening in group E. The mean clamp time was 19.8±3.5 min in group I and 16.9±4.4 min in group E. The transcranial pressure gradient was 58.1±6.89 mmHg in group I, while 54.86±9.1 mmHg in group E. There were no major neurological complications apart from treatable convulsions in one (3%) case in group I and delayed recovery in one (3%) case in group E. Conclusions Off-pump BDG can be safely performed with either external or internal shunt avoiding cardiopulmonary bypass complications.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115112724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of bilateral erector spinae plane block on intraoperative requirement of fentanyl in patients undergoing cardiac surgery: a randomized controlled interventional study","authors":"Parbeen Bano, Anjum Saiyed, A. Joshi, Gouda Sunil, Nikhilesh Ladha, R. Meena, Arish Husain, M. Hashim","doi":"10.4103/ejca.ejca_4_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_4_22","url":null,"abstract":"Background and objectives Erector spinae plane block (ESPB) is a newly defined and effective interfacial plane block. Cardiac surgeries are performed mainly via a median sternotomy leads to significant postoperative pain. Multiple studies have confirmed that ESPB is effective in cardiothoracic and abdominal surgeries. This study aimed to compare the efficacy of ESPB in two groups (group A and group B) for the intraoperative requirement of fentanyl (entropy index guided), hemodynamic variables, need of first rescue analgesia in the postoperative period, and side effects. Settings and design The study was designed as a prospective, randomized, control, hospital-based interventional study. Patients and methods A total of 60 patients, 18–65 years old of either sex who underwent cardiothoracic surgery by midline sternotomy under general anesthesia, were divided into either group A (n=30), which received ultrasound-guided bilateral ESPB by 25 ml 0.5% ropivacaine with dexmedetomidine 0.5 μg/kg with general anesthesia), or group B (n=30), which received general anesthesia without block. Statistical analysis used To observe the difference in quantitative variables between both groups Student’s t test/analysis of variance test was performed. The Fisher’s exact or χ2 test was used to establish the association between qualitative variables. Results The median requirement of fentanyl (μg/kg/h) in group A and group B was 1.97 (1.43–2.83) and 2.55 (1.55–3.19). This difference was statistically nonsignificant (P=0.348). The mean time of first rescue analgesia in group A and group B was 10.9±8.6 and 7.1±4.4 h, respectively (P<0.05). Demographically both groups were comparable. Conclusions ESPB produced safe and effective analgesia in the postoperative period following cardiac surgery.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"183 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125160039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon pulmonary valvotomy and anesthesia implications","authors":"Renu Upadhyay, J. Ramteke, Sanjeeta R Umbarkar, R. Chavan, Apurva Jumley","doi":"10.4103/ejca.ejca_7_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_7_22","url":null,"abstract":"Isolated pulmonary valve stenosis (PS) constitutes 7.5–9% of all congenital heart diseases. Percutaneous balloon pulmonary valvotomy (BPV) is the treatment of choice for the isolated PS. BPV is preferred in moderate-to-severe pulmonary stenosis and typical dome-shaped valvular PS. BPV is also the preferred treatment in neonates with critical pulmonary stenosis. BPV success rate is lesser with dysplastic valves. As a part of the team, an anesthesiologist not only helps in anesthesia management of the procedure but prompt management of the complications, especially during manipulation across RVOT, balloon inflation, and postoperative course.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122564423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of stroke volume variation assessed by electrical cardiometry to predict fluid responsiveness in patients undergoing coronary artery bypass surgery after closure of the sternum: an observational study","authors":"Ahmed Said, M. Salah, Sherif Mamdouh, E. Heggy, M. Wagih","doi":"10.4103/ejca.ejca_8_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_8_22","url":null,"abstract":"Background Cardiac output is an important determinant of tissue perfusion, with several methods described to assess it. Electrical cardiometry is a new noninvasive method for determination of stroke volume variation (SVV), which is used to calculate the cardiac output. Aim of work This study aimed to validate the electrical cardiometry measurements of SVV compared with measurements of SVV taken by transesophageal echocardiography (TEE). Methods A total of 38 patients were included in this study. Hemodynamic parameters were obtained by TEE and cardiometry soon after closure of the sternum and after volume expansion. Results SVV after 10 min of sternum closure by TEE was 15.5% (SD=7.1), and SVV after 10 min of sternum closure by cardiometry was 14.3% (SD=6.1). Bland–Altman analysis revealed a mean bias of −1.2. The 1.96 SD limits of agreement were −8 to 5.7%. Conclusion There is a good correlation between SVV measured by TEE and that measured by cardiometry. Cardiometry can be used as a noninvasive hemodynamic monitoring in patients undergoing coronary artery bypass surgery surgery.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123417155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}