Annals of Cardiac Anaesthesia最新文献

{"title":"GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review.","authors":"Danish Hassan, Rida Shakeel, Waleed Qaisi, Syed Rayyan Ahmed, Javeria Taj, Mohammad Adi, Ahmed Yousry Ahmed, Ammir Abuzahra, Emad Uddin Sajid, Hamza Arshad Khan, Tuba Basit, Javed Iqbal, Asraf Hussain","doi":"10.4103/aca.aca_307_25","DOIUrl":"10.4103/aca.aca_307_25","url":null,"abstract":"<p><strong>Abstract: </strong>Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing cardiac surgery and is linked to adverse outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer glucose-dependent insulinotropic effects and potential cardiac benefits, but their perioperative role remains uncertain. This review evaluated the efficacy and safety of GLP-1 RA therapy as an adjunct to insulin in this setting. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant articles up to October 2025. The primary endpoint was blood glucose levels during the perioperative period, while secondary endpoints included hypoglycemia incidence, total insulin requirement, time in target glucose range, and postoperative complications. Three randomized controlled trials (RCTs) including 168 patients with type 2 diabetes undergoing cardiac surgery were assessed. Perioperative use of liraglutide (subcutaneously in doses of 0.6-1.8 mg/day) was associated with preliminary evidence of improved glycemic control across preoperative, intraoperative, and early postoperative periods, including lower glucose levels, reduced glycemic variability, and fewer insulin adjustments, with a low incidence of hypoglycemia. However, heterogeneity in dosing, timing, and monitoring protocols across studies limits direct comparisons. Mild gastrointestinal adverse events, such as nausea and vomiting, were more frequent with liraglutide. One study reported exploratory immunometabolic effects in adipose tissue. Preliminary evidence from these heterogeneous studies suggests that adding liraglutide to insulin may improve perioperative glycemic control compared to insulin or placebo in patients with type 2 diabetes undergoing cardiac surgery. However, findings are limited by the small number of studies, methodological variability, and lack of long-term outcomes, necessitating larger, standardized trials.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"464-470"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164391","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 Cardiac Tumor with Concomitant Pericardial Effusion and Hemodynamic Compromise in a Septuagenarian: Case Report of Anesthetic and Surgical Considerations.","authors":"Amir Zabida, Ascher Schmelczer, Ehud Karni, Yuval Kahila, Leonid Sternik","doi":"10.4103/aca.aca_11_26","DOIUrl":"10.4103/aca.aca_11_26","url":null,"abstract":"<p><strong>Abstract: </strong>Primary cardiac tumors are rare, and cardiac lymphomas are particularly uncommon. Their presentation can mimic benign tumors, but perioperative management is highly challenging due to risks of tumor-related obstruction or invasion of surrounding cardiac structures. We present a 76-year-old woman with rapidly progressing dyspnea, found to have large biatrial masses, significant pericardial and pleural effusions, and evidence of tamponade. The patient underwent successful surgical resection of bilateral atrial tumors after careful anesthetic preparation and intraoperative monitoring. Histology revealed diffuse large B-cell lymphoma, and systemic chemotherapy was commenced. This case highlights the critical importance of multidisciplinary collaboration, preoperative hemodynamic stabilization, careful anesthetic planning, and prompt histological diagnosis in managing primary cardiac lymphoma presenting with tamponade physiology.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"642-645"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164958","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":"Myxomatous Mitral Valve Disease and CHARGE Syndrome: An Uncommon Association.","authors":"Ravina Mukati, Ajmer Singh, Yatin Mehta","doi":"10.4103/aca.aca_381_25","DOIUrl":"10.4103/aca.aca_381_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"669-671"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164082","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 Extracavitary Left Ventricular Apical Band Encountered During Intracardiac Repair: An Intraoperative Echocardiographic Blind Spot.","authors":"Sharek A Nazir, Subrata Kumar Singha, Gade Sandeep, Anil Gupta, T C Arun","doi":"10.4103/aca.aca_1_26","DOIUrl":"10.4103/aca.aca_1_26","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"668-669"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164865","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":"Mitral Inflow Doppler Variation Due to Retrograde Ventriculoatrial Conduction during Ventricular Pacing after Mitral Valve Replacement.","authors":"Shanthi Sharmiya, Saravana Babu, Vaithi K Vishwanath, Bineesh Radhakrishnan, Thomas Koshy","doi":"10.4103/aca.aca_354_25","DOIUrl":"10.4103/aca.aca_354_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"666-667"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172031","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":"Expanding Role of Regional Anesthesia in Cardiac Surgery.","authors":"Mukul Chandra Kapoor","doi":"10.4103/aca.aca_258_26","DOIUrl":"10.4103/aca.aca_258_26","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"461-463"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163803","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":"Posterior Mediastinal Biopsy Gone Awry: Managing Biopsy Needle-Induced Intubation Challenges in Emergency Surgery.","authors":"Mohanish Rajendra Badge, Lulu Fatema Vali, Aditya S Rao, Pallavi Wankhede","doi":"10.4103/aca.aca_355_25","DOIUrl":"10.4103/aca.aca_355_25","url":null,"abstract":"<p><strong>Abstract: </strong>Foreign bodies entering the thorax via a posterior trajectory present distinct challenges in positioning and intubation, particularly during emergency exploration. We present the case of a 37-year-old female who sustained a subclavian artery perforation during a computed tomography-guided biopsy for a posterior mediastinal mass. The biopsy needle advanced to the left common carotid artery. She was brought in the prone position for emergency surgical exploration, which posed significant challenges for airway management. This case highlights the importance of flexible airway strategies, multidisciplinary coordination, and decision-making in managing endotracheal intubation under non-standard conditions.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"630-633"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163606","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":"Ventilation Strategies in a Pediatric Patient Undergoing Resection and Anastomosis for a Juxta Carinal Tumor.","authors":"Anju E Brillin, Achinthya R Arul, Antrofelix M Dhasan, Sundeep Kisku, Anita S Joselyn","doi":"10.4103/aca.aca_332_25","DOIUrl":"10.4103/aca.aca_332_25","url":null,"abstract":"<p><strong>Abstract: </strong>Tumors close to the carina pose a unique challenge to the Anesthesiologist in terms of lung isolation and ventilation strategies. We present the case of a 15-year-old patient who was diagnosed with a myofibroblastic tumor in the left main bronchus and carina, posted for a robotic assisted sleeve resection and anastomosis. The surgical approach was from the right side. Hence, the traditional strategies for right lung ventilation could not be employed. A combination of endobronchial intubation, jet ventilation via airway exchange catheter (AEC) and cross field ventilation enabled us to complete the procedure successfully.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"610-613"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164952","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":"Evaluation of Changes in Myocardial Deformation Parameters Assessed by Speckle -Tracking Echocardiography following Coronary Artery Bypass Grafting: A Prospective Observational Study.","authors":"S Nanditha, Guru P Patel, Anupama V Hegde, Shivraj N Somanna","doi":"10.4103/aca.aca_9_26","DOIUrl":"10.4103/aca.aca_9_26","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) uses native conduits to bypass blocked coronaries. It relieves anginal symptoms, reduces incidences of further myocardial infarction, improves myocardial function, and prevents sudden death.Left ventricular ejection fraction (LVEF) that is most commonly to use to quantify myocardial contractility is not a good marker post CABG. Long term follow-up studies have found conflicting results.Speckle tracking echocardiography (STE) is a promising way to objectively quantify left ventricular function. Global longitudinal strain (GLS) has been found to be a better predictor after CABG. We attempted to see improvement in myocardial function by assessing changes in GLS, post systolic index (PSI) and peak strain dispersion (PSD) 4 weeks and 3 months after CABG.</p><p><strong>Methods: </strong>In our prospective observational study, we examined 70 patients undergoing CABG. Baseline LVEF, GLS, PSI, and PSD were compared with postoperative values at 4 weeks and 3 months.</p><p><strong>Results: </strong>We found that GLS, PSI, and PSD improved significantly at 3 months post-surgery after showing deterioration at 4 weeks in patients with LVEF 45%. However, in patients with LVEF <45%, Only GLS showed statistically significant improvement at 3 weeks even though all 3 had deterioration at 4 weeks. LV EF did not change much in our study in either of the groups.</p><p><strong>Conclusion: </strong>STE provides useful, efficient tools to monitor improvement in left ventricular function post CABG. This improvement follows an initial deterioration in function at 4 weeks.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"516-521"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163717","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":"Postoperative Emergence After Remimazolam- Versus Propofol-Based Total Intravenous Anesthesia for Cardiac Valve Surgery: A Retrospective Observational Study.","authors":"Emi Fujii, Yasuhiko Imashuku, Motoi Inoue, Hirotoshi Kitagawa","doi":"10.4103/aca.aca_90_26","DOIUrl":"10.4103/aca.aca_90_26","url":null,"abstract":"<p><strong>Context: </strong>Remimazolam is an ultra-short-acting benzodiazepine used for general anesthesia, including cardiac surgery; however, its effect on postoperative emergence following cardiopulmonary bypass remains unclear.</p><p><strong>Aims: </strong>We aimed to compare postoperative emergence following remimazolam- and propofol-based total intravenous anesthesia in adult patients undergoing cardiac valve surgery.</p><p><strong>Settings and design: </strong>A retrospective observational study.</p><p><strong>Methods and materials: </strong>We included adult patients who underwent elective cardiac valve replacement surgery at a single center between April 2023 and September 2024. Patients received either remimazolam- or propofol-based total intravenous anesthesia according to institutional practice. The primary endpoint was postoperative emergence time. Secondary endpoints included time to extubation and early postoperative hemodynamic stability assessed using the vasoactive-inotropic score.</p><p><strong>Statistical analysis used: </strong>Baseline characteristics and perioperative variables were compared between the groups. Univariate and multivariable linear regression analyses were performed.</p><p><strong>Results: </strong>Sixty-three patients were included in the analysis (remimazolam group, n = 21; propofol group, n = 42). Postoperative emergence time did not differ significantly between the two groups (164 [120-253] min vs. 137 [95-188] min, P = 0.193). Time to extubation was also comparable between the groups (1,009 [914-1,070] min vs. 1,033 [906-1,057] min, P = 0.844). Early postoperative hemodynamic parameters, including vasoactive-inotropic scores, were comparable between the two groups.</p><p><strong>Conclusions: </strong>In adult patients undergoing cardiac valve surgery, postoperative emergence time was comparable between remimazolam- and propofol-based total intravenous anesthesia. More prospective studies are warranted to clarify the role of remimazolam in cardiac anesthesia.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"570-576"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164199","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}