Thomas Kavanagh, Thomas Kilpatrick, Ben Hardy, Sang Lee, Miles Seavill, Chun-Wun M Lau, Sam Bullard, Samira Green, Matthew Cadd
{"title":"Intravenous Versus Inhaled Milrinone in Patients with Known Pulmonary Hypertension Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.","authors":"Thomas Kavanagh, Thomas Kilpatrick, Ben Hardy, Sang Lee, Miles Seavill, Chun-Wun M Lau, Sam Bullard, Samira Green, Matthew Cadd","doi":"10.4103/aca.aca_271_24","DOIUrl":"https://doi.org/10.4103/aca.aca_271_24","url":null,"abstract":"<p><strong>Abstract: </strong>To summarize the evidence on the hemodynamic effects and vasopressor requirements of adult patients with known pulmonary hypertension (PH) undergoing cardiac surgery treated with intravenous and inhaled milrinone. A total of 400 patients in 5 prospective (4 RCT) studies were included for pooled analysis. There was no significant difference in the primary outcome; mean pulmonary artery pressure (MPAP) between groups (MD: -4.80, 95% CI -10.57 to 0.98). Inhaled milrinone was associated with a greater systemic vascular resistance index (SVRI) (MD: 259.21, 95% CI 168.70 to 349.72) and reduction in pulmonary capillary wedge pressure (MD: -4.64, 95% CI -5.47 to -3.81). There were no observable differences in mean arterial pressure, pulmonary vascular resistance, cardiac index, or central venous pressure. All studies included were assessed to be moderate/some concern risk of bias. Inhaled milrinone has not been shown to have a significant beneficial effect on MPAP and SVR when compared to intravenous milrinone in patients with known PH undergoing cardiac surgery. However, it has shown some benefits in maintaining MAP and improving oxygenation in this patient cohort. The study is limited by the bias of the included studies and the variability of inhaled drug dosage and administration timing, further well-powered randomized controlled trials are required.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783309","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}
Aidan Sharkey, Adnan A Khan, Shirin Saeed, Rayaan Ahmed Yunus, Usman Ahmed, Adil Al-Karim Manji, Ruma Bose, Kamal Khabbaz, Feroze Mahmood, Robina Matyal
{"title":"Peripheral Nerve Blocks for Enhanced Recovery in Cardiac Surgery: A Retrospective Observational Study.","authors":"Aidan Sharkey, Adnan A Khan, Shirin Saeed, Rayaan Ahmed Yunus, Usman Ahmed, Adil Al-Karim Manji, Ruma Bose, Kamal Khabbaz, Feroze Mahmood, Robina Matyal","doi":"10.4103/aca.aca_244_24","DOIUrl":"https://doi.org/10.4103/aca.aca_244_24","url":null,"abstract":"<p><strong>Background: </strong>This retrospective observational study evaluates the effect of incorporating peripheral nerve blocks (PNBs) into an established enhanced recovery after surgery (ERAS) protocol. The PNBs used included pecto-intercostal fascial block (PIFB) and rectus sheath block, performed under ultrasound guidance with the administration of a long-acting local anesthetic, Ropivacaine. Both patient and process outcomes were assessed to determine the effect PNBs have as part of an ERAS protocol.</p><p><strong>Materials and methods: </strong>Adult patients undergoing cardiac surgery with midline sternotomy who were expected to be extubated within 6 hours of arrival to the intensive care unit (ICU) between October 2022 and June 2023 were included. Patients were dichotomized by whether they received a PNB or not. Outcomes included opioid consumption as measured by morphine milligram equivalents (MME), ICU length of stay (LOS), postoperative mobility, and the incidence of postoperative atrial fibrillation (POAF).</p><p><strong>Results: </strong>431 patients were included: 170 (39.4%) received a PNB, and 243 (60.6%) did not (non-PNB group). Patients who received a PNB required a significantly shorter time to achieve first ambulation as measured from bed to chair (15.2 hours PNB vs. 18.5 hours non-PNB, P = 0.037), significantly lower rates of atrial fibrillation (26.5% PNB vs. 32.9% non-PNB, P = 0.045), shorter LOS in the ICU (44.4 hours PNB vs. 49.7 hours non-PNB, P = 0.024).</p><p><strong>Conclusion: </strong>Incorporating PNBs as part of a multimodal analgesic strategy for patients undergoing cardiac surgical procedures is associated with improved patient and process outcomes. Our finding of a reduction in POAF warrants further investigation in an adequately powered randomized controlled trial.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783310","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":"Complex Aortic Aneurysms: The Role of Custom and Off-the-Shelf Fenestrated Endografts.","authors":"Omar Elsaka","doi":"10.4103/aca.aca_30_25","DOIUrl":"https://doi.org/10.4103/aca.aca_30_25","url":null,"abstract":"<p><strong>Abstract: </strong>Complex aortic aneurysms, including thoracoabdominal, juxtarenal, and pararenal aneurysms, pose significant challenges due to their involvement with vital branch vessels. Fenestrated endografts have emerged as a promising alternative to traditional open surgery. These devices are available in two types: custom-made and off-the-shelf. Custom fenestrated endografts are tailored to individual anatomy, offering precision but requiring longer preparation times and higher costs. Off-the-shelf fenestrated endografts provide a standardized approach with shorter deployment times and lower costs but may not suit highly complex cases. The aim of this review is to assess the role of custom and off-the-shelf fenestrated endografts in treating complex aortic aneurysms, focusing on clinical outcomes, complications, cost-effectiveness, and advancements in technology. We conducted a systematic search of PubMed, Scopus, and Google Scholar for studies published between 2000 and 2024 using keywords such as \"complex aortic aneurysms,\" \"fenestrated endograft,\" \"custom endograft,\" and \"off-the-shelf endograft.\" Data on outcomes, complications, and technological advancements were extracted and analyzed. This review seeks to provide insights into the advantages and challenges of both approaches, guiding clinicians in optimizing treatment strategies for complex aortic aneurysm patients.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783308","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}
Pramod Kumar, Bineesh K Radhakrishnan, Arun Gopalakrishnan
{"title":"Rivero-Carvallo Sign in Right Ventricular Dysfunction.","authors":"Pramod Kumar, Bineesh K Radhakrishnan, Arun Gopalakrishnan","doi":"10.4103/aca.aca_7_25","DOIUrl":"10.4103/aca.aca_7_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783312","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}
Aswathy P Purayil, Suresh G Nair, Jobin Abraham, Joel Devasia, Nisha Rajmohan, Anupama Shaji
{"title":"Response to Comments on Continuous Positive Airway Pressure versus Differential Lung Ventilation during One Lung Ventilation for Thoracic Surgery.","authors":"Aswathy P Purayil, Suresh G Nair, Jobin Abraham, Joel Devasia, Nisha Rajmohan, Anupama Shaji","doi":"10.4103/aca.aca_23_25","DOIUrl":"https://doi.org/10.4103/aca.aca_23_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783311","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}
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
{"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":"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":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"10.4103/aca.aca_139_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"213-215"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"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":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chandrika Jagadish, Vijaya Kumara, Mahammad A Aspari, D Guruprasad Rai, R Sumanth
{"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":"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":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"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":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}