Annals of Cardiac Anaesthesia最新文献

{"title":"Analysis of First 50 Robotic-Assisted Thoracic Surgeries in a University Teaching Hospital: Anesthetic Considerations and Postoperative Outcomes.","authors":"Manuel Granell, Ruth Martínez-Plumed, Eva García Del Olmo, Enrique Pastor Martínez, Marta Grynovska, Elena Biosca Pérez, Alvaro Cervera Puchades, José De Andrés, Ricardo Guijarro Jorge","doi":"10.4103/aca.aca_174_24","DOIUrl":"https://doi.org/10.4103/aca.aca_174_24","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted thoracic surgery (RATS), due to its multiple advantages, has revolutionized the medical field in recent years. Yet, its implementation has been slower compared to other surgical fields. More data on the benefits of RATS regarding patient outcomes are required to justify the high costs of equipment. This study aimed to expand our understanding of anesthetic management of RATS and to analyze the postoperative patient outcomes.</p><p><strong>Materials and methods: </strong>The r-retrospective descriptive study of the clinical history of 50 patients who underwent RATS using Da Vinci dVX® between 2018 and 2021 in the Thoracic Surgery Department of a single-center university teaching hospital. Statistical analyses of the clinical-demographic variables and those related to airway management, mechanical ventilation, intraoperative hemodynamics, and postoperative outcomes were carried out. Subgroup analysis of patient cases was performed based on the date of surgical intervention to compare the operating time, length of hospital stay, and postoperative complications as surrogates of the learning curve.</p><p><strong>Results: </strong>92% of patients were easily intubated with double-lumen tubes (76% were VivaSight-DL and 12% standard double-lumen tubes) following the usual protocol, while in 8% of patients, a difficult airway was detected and lung isolation using bronchial blockers was performed. During the one-lung ventilation (OLV) period, 24.4% of patients suffered arterial hypotension and 19.5% required intravenous vasoconstrictors probably due to the capnothorax. The mean duration of the interventions was 135.4 minutes. The average hospital stay was 5.4 days on average, and the mean number of complications was 0.48% per person. No statistically significant difference was found between early and late patient subgroups in terms of operating time, length of hospital stay, and postoperative complications.</p><p><strong>Conclusions: </strong>RATS is a safe intervention which is well managed anesthetically by the use of double-lumen tubes with embedded camera. The use of protective ventilation strategy, including optimal PEEP and lung recruitment maneuver, during one-lung ventilation is effective and hemodynamically well-tolerated in the majority of the patients (80%). The RATS approach is associated with short hospital stay and low postoperative complication incidence. Further studies are warranted to explore new anesthetic management techniques and compare the benefit of robot-assisted thoracic surgery with conventional surgical approaches.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"255-263"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590201","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":"WATCHMAN Gone Astray, Catastrophic Mitral Regurgitation Following Device Dislodgement.","authors":"Basil Jouryyeh, Michael Beshara","doi":"10.4103/aca.aca_263_24","DOIUrl":"https://doi.org/10.4103/aca.aca_263_24","url":null,"abstract":"<p><strong>Abstract: </strong>WATCHMAN (Boston Scientific, Plymouth, MN, USA) is the most commonly utilized left atrial appendage occlusion device. Although increased operator experience has led to a significant decline in reported complications, serious and potentially fatal events can still occur. We present a case of WATCHMAN device embolization that was identified using transesophageal echocardiography shortly after device deployment, along with the subsequent management and retrieval of the device.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"313-316"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590315","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":"From Scopes to Bots: The Clinical Journey from VATS to RATS.","authors":"Mukul Chandra Kapoor","doi":"10.4103/aca.aca_139_25","DOIUrl":"https://doi.org/10.4103/aca.aca_139_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"213-215"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590297","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":"An Approach to Intraoperative Accidental Pulmonary Artery Transection and Role of Mid-Point to Transverse Process Interfascial Plane Block.","authors":"Ankita Suri, Swati Jindal, Deepika Gupta, Varna Madhu, Naini Sood","doi":"10.4103/aca.aca_233_24","DOIUrl":"https://doi.org/10.4103/aca.aca_233_24","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"332-333"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590200","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":"Assessment of Right Ventricle Function in Patients with Mitral Repair: Case Series.","authors":"Yannis Amador, Jacobo Moreno Garijo, Azad Mashari, Giovanni Gadotti, Wilma M Hopman, Tirone E David, Massimiliano Meineri","doi":"10.4103/aca.aca_34_25","DOIUrl":"https://doi.org/10.4103/aca.aca_34_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"342-344"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590203","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":"Intravenous Levosimendan versus Milrinone: Coronary Sinus Lactate and PA Catheter Derived Parameters in Patients with Pulmonary Hypertension Undergoing Elective Mitral Valve Replacement.","authors":"Sanjula Virmani, Sukhdev Garg, Indira Malik, Abhas Chandra Dash, Sayyed Ehtesham Hussain Naqvi, Rachna Wadhwa, Harpreet Singh","doi":"10.4103/aca.aca_4_25","DOIUrl":"https://doi.org/10.4103/aca.aca_4_25","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronary sinus (CS) lactate level has been shown to corroborate with changes in myocardial metabolism induced by ischaemia and reperfusion, and hence can be used to indicate the effect on myocardial metabolism. In patients with mitral stenosis (MS) undergoing valvuloplasty or valve replacement, presence of severe pulmonary hypertension (PH), indicates advanced disease state and development of right ventricular (RV) failure, an important hallmark of bad prognosis. Levosimendan and milrinone are increasingly being used as inodilators to treat PH and improve RV function to varying degrees, but their effect on myocardial metabolism awaits precise validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty patients were randomized into two groups of 15 patients each. Group L (received levosimendan) and Group M (received milrinone). All the patients received fentanyl (8-10 μg/kg), rocuronium bromide 0.8 mg/Kg for induction and maintenance of anaesthesia. In addition to the routine intravenous and invasive arterial access, a Cavafix® (Certo® 257, 45 cm, B Braun Melsungen AG, Germany) was inserted via right IJV and positioned in the right atrium (RA) to be later re-positioned in the CS before coming off cardiopulmonary bypass (CPB), to obtain blood samples for measuring the CS lactate levels postoperatively. At the commencement of rewarming, group L received levosimendan 10 μ/kg bolus over 10 min, followed by an infusion (0.1 μ/kg/min) and group M received 50 μg/kg bolus over 10 min, followed by infusion (0.5 μg/kg/min), till 24 hours post-operatively. CS lactate, heart rate (HR), mean arterial pressure (MAP) and PA catheter derived data [Cardiac index (CI), cardiac output (CO), PA pressure, systemic and pulmonary vascular resistance indices (SVRI/PVRI)] and mixed venous oxygen saturations (SvO2) were recorded at predetermined time points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In both the groups the CS lactate levels increased gradually till 6 hours after surgery followed by a decrease at 24 hours. Comparison of CS lactate between the two groups revealed that the CS lactate levels were significantly lower in group L at various time points till 24 hours after surgery with a P value of &lt; 0.05. HR and MAP were comparable in both the groups at all time points. MAP was significantly lower in the two groups, both after induction of anaesthesia and after CPB. 7 patients in group M (46.7%) developed hypotension (MAP decreased by &gt; 20% of baseline) that was treated with norepinephrine. CO increased significantly in both group M and group L, post CPB 10 min after surgery. Patients in group L had a significantly higher CO and CI, compared to group M, P &lt; 0.05. PAP was significantly reduced compared to baseline values after valve replacement in both the groups being lower in group L compared to group M, but the difference was statistically not significant. After valve replacement, SVRI decreased significantly in both the group the decrease being sig","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"298-304"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590302","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 Role of Acetaminophen Use in Acute Kidney Injury Prevention in Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Luis E Ciconini, Victor Perim, Theodoro Beck, Mauren F Carbonar, Mazpa M Ejikem, Ahmed Zaky, Javier Neyra, Andre F Gosling","doi":"10.4103/aca.aca_223_24","DOIUrl":"https://doi.org/10.4103/aca.aca_223_24","url":null,"abstract":"<p><strong>Abstract: </strong>Acute kidney injury (AKI) is a common complication following cardiac surgery, often leading to increased morbidity and mortality. Despite its prevalence, the role of acetaminophen in preventing AKI after cardiac surgery remains uncertain. This meta-analysis sought to clarify whether perioperative administration of acetaminophen could reduce the risk of postoperative AKI in adult patients undergoing cardiac procedures. To address this question, a systematic review and meta-analysis were performed by searching the MEDLINE, Cochrane, and Embase databases. Studies comparing the effects of perioperative acetaminophen to those of no acetaminophen in adult cardiac surgery patients were evaluated, with risk of bias assessed for each study. Sensitivity analyses were also conducted to strengthen the reliability of the findings. In total, 13 studies, including nine randomized controlled trials and four observational studies, involving 11,583 patients, were analyzed. The results showed that acetaminophen administration was associated with a lower incidence of AKI [OR 0.62 (95% CI 0.40-0.97), P = 0.04]. Additionally, acetaminophen use was linked to reduced in-hospital mortality, delirium rates, and shorter ICU stays, though it had no significant effect on overall hospital length of stay. These findings suggest that perioperative acetaminophen administration may play a protective role in reducing both AKI incidence and in-hospital mortality in patients undergoing cardiac surgery. Until large multicenter randomized controlled trials confirm these results, acetaminophen may still be considered as a preventive measure for patients both before cardiopulmonary bypass initiation and in the postoperative period.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"238-247"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590314","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":"Identification of Right-sided Aortic Arch Using TEE and its Impact on Cardiac Surgical Planning.","authors":"Matea Malinovic, Basil Jouryyeh, Michael Beshara","doi":"10.4103/aca.aca_270_24","DOIUrl":"https://doi.org/10.4103/aca.aca_270_24","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"310-312"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590299","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":"A Comparative Study of the Efficacy and Safety Profile of Topical Application of Tranexamic Acid in the Form of Mist to Reduce Postoperative Bleeding in on-Pump CABG Procedures.","authors":"Chandrika Jagadish, Vijaya Kumara, Mahammad A Aspari, D Guruprasad Rai, R Sumanth","doi":"10.4103/aca.aca_176_24","DOIUrl":"https://doi.org/10.4103/aca.aca_176_24","url":null,"abstract":"<p><strong>Background: </strong>Postoperative bleeding is a major concern in cardiovascular surgery, leading to an increased need for blood transfusions and a longer hospital stay. Between 30% and 70% of open-heart surgery patients will require blood product transfusion. The use of the cardiopulmonary bypass machine (CPB) often leads to bleeding due to complement activation, platelet activation, and hyperfibrinolysis. Antifibrinolytic drugs, like ε-aminocaproic acid, aprotinin, and tranexamic acid (TXA) are used to decrease postoperative bleeding in cardiac surgery. According to the Society of Thoracic Surgeons guidelines, TXA is class I recommendation to reduce the risk of bleeding.</p><p><strong>Aims: </strong>Compare the efficacy and safety of TXA in the mist form to reduce postoperative bleeding.</p><p><strong>Settings and design: </strong>Prospective, Randomized, Single-Centre, Interventional Study.</p><p><strong>Material and methods: </strong>The study included sixty participants undergoing on-pump CABG randomized into two groups. Group T and Group C received topical TXA and 20 mL NS in mist form, respectively. The mist was blown over the pericardium, LIMA bed, and sternotomy sites before chest closure. The primary objectives were to compare the 48th hour drain collection and need for blood transfusion.</p><p><strong>Statistical analysis used: </strong>Simple t-test, Chi-square test and Mann-Whitney U test.</p><p><strong>Results: </strong>The experimental group had significantly less 48-hour drain (P value 0.001), reduced need of blood and blood products (P value 0.001) and less duration of postoperative ventilation (P value 0.001).</p><p><strong>Conclusion: </strong>The topical application of TXA in mist form significantly reduced postoperative bleeding, the necessity for blood transfusion, and the duration of mechanical ventilation in on-pump CABG procedures.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"287-291"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590198","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 Pecto-Intercostal Fascia Plane Block in Reducing Total Postoperative Opioid Consumption in Cardiac Surgery Involving Sternotomy: A Meta-Analysis.","authors":"Ardyan Wardhana, Halim Sudono, Juni Kurniawaty","doi":"10.4103/aca.aca_248_24","DOIUrl":"https://doi.org/10.4103/aca.aca_248_24","url":null,"abstract":"<p><strong>Abstract: </strong>The pecto-intercostal fascia plane block (PIFB) is gaining recognition for its potential to reduce postoperative opioid use after cardiac surgery. This study aimed to evaluate the effectiveness of PIFB compared with conventional intravenous regimens in reducing total postoperative opioid consumption in patients undergoing cardiac surgery involving sternotomy. A meta-analysis of relevant studies, published up to August 13, 2024, retrieved from the PubMed and CENTRAL databases was performed. The inclusion criteria were studies involving a superficial parasternal block or PIFB for patients undergoing cardiac surgery involving sternotomy. Studies comparing PIFB with other blocks or local anesthetic regimens were excluded. Data analysis was performed using an inverse variance random-effects model using RevMan 5.4.1 software, with the effect measure expressed as standardized mean difference (SMD) to account for the different opioids used. Of 88 studies retrieved in the literature search, 16 fulfilled the inclusion criteria [ten ultrasound (US)-guided and six non-US-guided]. PIFB significantly reduced total opioid consumption [SMD -1.55 (95% CI -2.15 to -0.95); P < 0.001] and time to extubation [SMD -1.22 (95% CI -2.05 to -0.38); P < 0.001]. A subgroup analysis of multiple- versus single-shot injections yielded consistent results. Analyses including only US-guided PIFB revealed consistent reductions in total opioid consumption [SMD -1.18 (95% CI -1.79 to -0.56); P < 0.001] and time to extubation [SMD -0.82 (95% CI -1.01 to -0.63); P < 0.001]. PIFB effectively reduced opioid consumption and shortened postoperative time to extubation in cardiac surgery involving sternotomy.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"219-227"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590205","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}