Annals of Cardiac Anaesthesia最新文献

{"title":"Electrophysiological Mechanisms of ST Segment and T-Wave Changes: Insights into Ischemia, Conduction Delay, Hypertrophy, and Electrolyte Disturbance.","authors":"Praveen K Neema, Nagarjuna Panidapu","doi":"10.4103/aca.aca_304_25","DOIUrl":"10.4103/aca.aca_304_25","url":null,"abstract":"<p><strong>Abstract: </strong>ST-T abnormalities are commonly encountered in cardiology, cardiac surgical, critical care, and emergency settings. ST segment depression refers to displacement of the ST segment below the PR-segment (baseline), whereas ST segment elevation refers to displacement above this baseline. A downward displacement greater than 0.5 mm below the baseline or an upward displacement exceeding 0.1 mV in the limb leads or 0.2 mV in the precordial leads, measured 40 ms after the J point relative to the baseline, is considered significant. ST-T abnormalities can be primary or secondary. Primary ST-T changes are repolarization abnormalities seen in myocardial ischemia, electrolyte disturbances, tachycardia, increased sympathetic activity, and adverse drug effects. Secondary ST-T changes are activation (depolarization) abnormalities observed with bundle branch block, left ventricular hypertrophy, pre-excitation, ventricular ectopics, and pacemaker-stimulated complexes. Primary ST-T abnormalities due to acute myocardial ischemia, evolving myocardial infarction, and hyperkalemia represent life-threatening emergencies and require urgent medical intervention. Secondary ST-T abnormalities signal underlying structural or conduction disease and warrant evaluation and management. Cardiac anesthesiologists, cardiologists, and emergency physicians are frequently involved in the care of patients presenting with such cardiac emergencies. It is crucial to distinguish ST-T abnormalities caused by acute myocardial ischemia, evolving myocardial infarction, and hyperkalemia from those due to other conditions, as timely recognition and treatment can be lifesaving. This narrative review describes the electrophysiological basis of ST-T changes in various clinical contexts and outlines how to differentiate acute myocardial ischemia and hyperkalemia from other causes of ST-T abnormalities.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"169-179"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669628","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":"Sedation Strategies in Pediatric Cath: Methodological Gaps.","authors":"Devarakonda Venkata Bhargava, Sai Charan Kopparapu, Sri Sumanth Pelluru, Hannah Jane, Gurpinder Singh Ghotra, Brijindera Singh Sethi","doi":"10.4103/aca.aca_94_25","DOIUrl":"10.4103/aca.aca_94_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"297-298"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670024","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":"The Effect of Preoperative Oral Carbohydrate Loading on Insulin Resistance in Adult Patients Undergoing On-Pump Cardiac Surgery: A Randomized Controlled Trial.","authors":"Rifdhani F Nur, Meta R Synthana, Y Kurnia, Khairu M Rudiarto, Rivo J Alicia, J Kurniawaty, Bhirowo Y Pratomo, Fiandila E Deviatika","doi":"10.4103/aca.aca_313_25","DOIUrl":"10.4103/aca.aca_313_25","url":null,"abstract":"<p><strong>Background: </strong>Preoperative oral carbohydrate loading has been shown to reduce insulin resistance in various surgical fields, but its effect in cardiac surgery remains uncertain. This study aimed to evaluate whether preoperative carbohydrate loading can reduce insulin resistance in adults undergoing on-pump cardiac surgery.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Fifty adults scheduled for elective cardiac surgery (January-May 2024) were randomized to receive either 400 mL of a 12.5% maltodextrin-based carbohydrate drink (CL group) or 400 mL of water 2 h before surgery (PL group). Blood glucose and insulin were measured at postinduction, 0 h, and 24 h postoperatively to calculate HOMA-IR, analyzed at a significance level of 0.05.</p><p><strong>Results: </strong>Blood glucose and HOMA-IR did not differ significantly between groups at any time point (all P > 0.05). Insulin was higher in the CL group than in the PL group at postinduction ((95%CI = -6.07 to - 0.42; P = 0.022)). In the PL group, insulin rose progressively (P < 0.05), while changes in the CL group were nonsignificant (P > 0.05). HOMA-IR increased from postinduction to 0 h in both groups (P < 0.05) but remained stable thereafter (P > 0.05).</p><p><strong>Conclusions: </strong>Preoperative oral carbohydrate loading did not significantly affect perioperative glucose or HOMA-IR in cardiac surgery. While insufficient to counteract the magnitude of CPB-induced insulin resistance, carbohydrate loading may modestly stabilize metabolic responses, as reflected by a flatter insulin trajectory.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"228-236"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669986","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":"Comment on \"The Effect of Continuous Magnesium Infusion to Prevent Postoperative Atrial Fibrillation in Patients Undergoing OffPump Coronary Artery Bypass Grafting\".","authors":"Mohammad Burhan Khan, Daniyal Rashid","doi":"10.4103/aca.aca_270_25","DOIUrl":"10.4103/aca.aca_270_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"304-305"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670160","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":"Hypoplastic Left Heart Syndrome in a Neonate with Tracheoesophageal Fistula: An Anesthesiologist's Nightmare!","authors":"M Aravind, Anju Gupta","doi":"10.4103/aca.aca_237_25","DOIUrl":"10.4103/aca.aca_237_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"299-301"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669637","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":"Malposition of the Selective Antegrade Cerebral Perfusion Catheter Identified by Carotid Ultrasonography: A Case Report.","authors":"Taisuke Kumamoto, Takahiro Fukuda, Yuji Kunitoku","doi":"10.4103/aca.aca_51_25","DOIUrl":"10.4103/aca.aca_51_25","url":null,"abstract":"<p><strong>Abstract: </strong>Cerebral hypoperfusion can occur during aortic surgery. We present a case in which malposition of the selective antegrade cerebral perfusion (SACP) catheter was identified using carotid ultrasonography. A 66-year-old man underwent total arch replacement. SACP was initiated via the brachiocephalic artery following deep hypothermic circulatory arrest. However, right forehead regional oxygen saturation (rSO2) remained unchanged. Carotid ultrasonography revealed no blood flow in the right common carotid artery, suggesting catheter malposition into the right subclavian artery. After a slight catheter withdrawal, blood flow was restored, and rSO2 increased. Carotid ultrasonography, along with rSO2 monitoring, is recommended for evaluating cerebral perfusion during SACP.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"253-256"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669740","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":"Ultrasound-Guided Superficial Versus Deep Continuous Serratus Anterior Plane Block in Patients Undergoing Thoracotomy for Lung Surgery: A Randomized Controlled Trial.","authors":"R Raghupathy, Sunder Lal Negi, Indranil Biswas, Harkant Singh, Banashree Mandal, Krishna Prasad Gourav, Arun Sharma","doi":"10.4103/aca.aca_115_25","DOIUrl":"10.4103/aca.aca_115_25","url":null,"abstract":"<p><strong>Background: </strong>Thoracic surgery is considered to be one of the most painful surgical procedures; therefore, providing adequate analgesia in the perioperative period is crucial. Inadequate pain control impedes deep breathing, which further leads to atelectasis and pneumonia. The optimal analgesic protocol that allows adequate postoperative pain control and facilitates fast recovery of this population has yet to be determined. The serratus anterior plane (SAP) block is a new procedure that is relatively easier to perform and safer, compared with other modalities.</p><p><strong>Materials and methods: </strong>Patients undergoing lung resection surgery via thoracotomy at a single center were randomized to undergo either superficial or deep SAP block with 0.4 mL/kg of bupivacaine 0.25%, following which 20-gauge peripheral nerve block catheter was placed above or below the serratus anterior muscle plane and continuous bupivacaine 0.125% infusion at the rate of 5-7 mL/h was initiated up to 24 hours in intensive care unit (ICU). The primary outcome was the total opioid consumption during the first 24 h in the ICU. Secondary outcomes were the severity of pain in the visual analog scale (VAS) score, patient satisfaction score, ICU stay duration, and the incidence of postoperative nausea and vomiting (PONV).</p><p><strong>Results: </strong>A total of 36 participants were randomized to each group, and the baseline characteristics were comparable between the groups. The total postoperative opioid consumption during the first 24 h in ICU was lower in deep SAP block (60.00 ± 68.22) compared to superficial SAP block (85.31 ± 68.40), but it was not statistically significant (P > 0.303). The VAS score, time to first rescue analgesia, patient satisfaction score, incidence of PONV, and the length of ICU stay were comparable between the two groups (P > 0.05).</p><p><strong>Conclusion: </strong>There was lower opioid consumption in the continuous deep SAP block compared to the superficial SAP block at 24 hours; however, the difference was not statistically significant. Continuous analgesia through an indwelling catheter is safe and an effective method for the management of postoperative pain in lung resection surgery.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"180-185"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670154","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":"Airway Obstruction due to Abutting of the Distal Tip of the Microcuff Endotracheal Tube with the Tracheal Wall in an Infant Undergoing Cardiac Surgery.","authors":"S Suvetha, Ms Saravana Babu, Thomas Koshy, Baiju S Dharan","doi":"10.4103/aca.aca_210_25","DOIUrl":"10.4103/aca.aca_210_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"303-304"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670168","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":"Anesthetic Management in Patients with Impella Devices: A Retrospective Review and Clinical Guide.","authors":"Harrison Yang, Divakara Gouda, Kent B Berg, Katherine Green, Suvan Sundaresh, Basavana Goudra","doi":"10.4103/aca.aca_308_25","DOIUrl":"10.4103/aca.aca_308_25","url":null,"abstract":"<p><strong>Background: </strong>The Impella family of percutaneous a left ventricular assist devices are increasingly used for hemodynamic support in patients with cardiogenic shock or advanced heart failure. However, guidance on anesthetic management for patients with Impella support undergoing noncardiac procedures remains sparse. This study reviews perioperative practices and outcomes to inform clinical management.</p><p><strong>Methods: </strong>Following institutional review board approval, a retrospective analysis was performed of adult patients receiving an Impella device (2.5, CP, 5.0, or 5.5) at Thomas Jefferson University Hospital, Philadelphia, USA, between December 2017 and October 2024. Patients, who subsequently underwent procedures involving anesthesia care were included. Demographics, procedure type, anesthetic technique, pharmacologic management, hemodynamic support, and intraoperative outcomes were analyzed descriptively.</p><p><strong>Results: </strong>Among 165 Impella recipients, 41 underwent anesthesia requiring procedures: Eight gastrointestinal (GI) and 33 non-GI interventions. All GI cases involved Impella 5.5 devices, commonly for urgent endoscopy in gastrointestinal bleeding. General anesthesia was used in 50% of GI and 94% of non-GI cases. Propofol and etomidate were predominant induction agents; fentanyl and rocuronium were widely utilized. Phenylephrine and norepinephrine were the most frequent vasopressors, with adjunctive use of dobutamine or epinephrine. No intraoperative device malfunctions, dislodgements, or arrests occurred.</p><p><strong>Conclusions: </strong>With individualized anesthetic planning and vigilant hemodynamic control, Impella-supported patients can safely undergo diverse procedures. Deep sedation may suffice for select endoscopic interventions, whereas complex non-GI operations generally require general anesthesia. These findings provide a foundation for developing standardized perioperative management protocols for this growing patient population.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"237-246"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670212","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":"An Ascending Aortic Pseudoaneurysm: Anesthetic Challenges.","authors":"Pravinkumar H Patel, Abhishek Verma, K S Ramkiran, Ramesh Patel, Kartik Patel","doi":"10.4103/aca.aca_164_25","DOIUrl":"10.4103/aca.aca_164_25","url":null,"abstract":"<p><strong>Abstract: </strong>Ascending aortic pseudoaneurysm repair is one of the challenging tasks for the anaesthesiologists as well as the surgeon due to its proximity to the posterior sternal table. Here, we are presenting a huge ascending aortic pseudoaneurysm repair in a 28-year-old man, the challenge of weaning off bypass, and the role of transesophageal echocardiography (TEE) in managing the case.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"257-260"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670189","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}