Annals of Cardiac Anaesthesia最新文献

{"title":"Strengthening Patient Education on Anesthesia Risks by Overcoming Existing Challenges.","authors":"Saurabh RamBihariLal Shrivastava, Prateek Sudhakar Bobhate, Anjali Borkar, Roshani Manwani, Kirti Gujarkar","doi":"10.4103/aca.aca_235_24","DOIUrl":"https://doi.org/10.4103/aca.aca_235_24","url":null,"abstract":"<p><strong>Abstract: </strong>Patients are administered anaesthesia to avoid pain and discomfort while performing different medical procedures. It is the responsibility of anesthesiologists and surgeons to make patients aware of the potential risks during anaesthesia. This is predominantly because once patients are aware of potential anaesthesia risks, they can make informed choices about their care and be an active part of the shared decision-making process. Acknowledging the need to educate patients on anaesthesia risks, there is a definite need to plan and implement targeted interventions for the benefit of the patients and the healthcare facilities. In conclusion, it is the responsibility of healthcare providers to inform patients about anaesthesia risks to empower them to make informed decisions about the procedure and the recovery process. However, considering that there are multiple patient and healthcare provider-related barriers, we must take into account all these factors and implement targeted interventions to benefit patients.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"195-197"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956335","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 Versus General Anesthesia for Ablation of Ventricular Arrhythmias: A Systematic Review and Meta-Analysis.","authors":"Shubh Patel, Jiawen Deng, Areeba Zubair, Kiyan Heybati, Shayan Heybati, Oswin Chang, Umaima Abbas, Umair Tahir, Harikrishnaa B Ramaraju, Chi Y Wong, Thanansayan Dhivagaran, Daniel Rayner, Magnus Krever, Tiffany Woelber, Gurukripa N Kowlgi, Harish Ramakrishna","doi":"10.4103/aca.aca_229_24","DOIUrl":"https://doi.org/10.4103/aca.aca_229_24","url":null,"abstract":"<p><strong>Abstract: </strong>Ventricular arrhythmias (VA), including ventricular tachycardia and fibrillation, are critical cardiac conditions that are often managed by catheter ablation among those unresponsive to pharmacologic therapy. The choice of anesthesia and sedation regimens for VA ablations may impact arrhythmia inducibility and hemodynamic stability, which can affect procedural success and complication rates. This systematic review and meta-analysis aimed to compare the efficacy and safety of sedation versus general anesthesia (GA) among patients undergoing VA ablation. The review was prospectively registered on PROSPERO (CRD42023441553). Database searches were conducted across five major databases from inception to March 9, 2024 to identify randomized trials or observational studies including adult patients undergoing ablations for VA. Screening and data extraction were completed in duplicate. Risk-of-bias assessments were conducted using ROBINS-I as all included studies were observational, and the quality of evidence was evaluated using the GRADE framework. Six observational studies (N = 16,435) were included. No significant differences were found between sedation and GA for total procedure time (MD: -14.16 minutes; 95%CI: -38.61 to 10.29 minutes), arrhythmia non-inducibility (RR: 0.73; 95% CI: 0.33-1.58), acute ablation success (RR: 1.06; 95% CI: 0.65-1.71), or procedural complications (RR: 0.72; 95% CI: 0.28-1.85). However, sedation was associated with significantly lower intraprocedural hemodynamic instability (RR: 0.28; 95% CI: 0.12-0.70). These findings indicate that while sedation and GA have comparable outcomes, sedation may be associated with less hemodynamic instability during VA ablation. However, more high-quality studies are needed to confirm these results.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"119-127"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960154","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":"Intraoperative Transesophageal Echocardiography Quantification of Mitral Regurgitation by Regurgitation Volume and Fraction Using 2D and 3D Techniques.","authors":"Devika Poduval, Reshmi L Jose, Thushara Madathil, P Nagarjuna, Niveditha Kartha, Praveen Varma, Praveen Kumar Neema","doi":"10.4103/aca.aca_218_24","DOIUrl":"https://doi.org/10.4103/aca.aca_218_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Intraoperative quantification of mitral regurgitation (MR) is sometimes necessary to quantify the severity of incidentally detected MR during cardiac surgeries. We aimed to compare and correlate the regurgitant volume (Rvol) and regurgitant fraction (RF) using 2D proximal isovelocity surface area (PISA) and 3D vena contracta area (VCA) with the 3D volumetric method and the integrated multiparametric approach.</p><p><strong>Methods and materials: </strong>A prospective observational study was conducted on 37 patients undergoing mitral valve surgery for MR. Intraoperative quantification of the severity of MR was done using 2D PISA and 3D VCA methods and was compared with the 3D volumetric method. All three methods were compared with the integrated multiparametric method to obtain cutoff values for identifying severe MR.</p><p><strong>Results: </strong>The correlation coefficients for Rvol with VCA and PISA with the 3D volumetric method were 0.688 and 0.58, respectively. VCA and PISA overestimated the Rvol (VCA = 77.93 ± 27.82 ml, PISA = 76.13 ± 19.25 ml) compared to the 3D volumetric method (66.12 ± 20.30 ml); the RF by the three methods was comparable. Using the receiver operating characteristic-area under curve (AUC) comparing Rvol by these methods with the integrated multiparametric method, the 3D volumetric method performed the best.</p><p><strong>Conclusion: </strong>The Rvol VCA and PISA overestimated MR severity compared to the 3D volumetric method with moderate to good correlation. Rvol 3D was superior with a higher AUC when compared with the integrated multiparametric approach. The RF by the three methods was comparable, albeit with a higher threshold in quantifying severity compared to the conventional criteria.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"161-169"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966516","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":"Intraoperative Management of Hypoxemia with Anticoagulant-Free Venovenous Extracorporeal Membrane Oxygenation Amid Diagnostic Uncertainty.","authors":"Eric M Tretter","doi":"10.4103/aca.aca_237_24","DOIUrl":"https://doi.org/10.4103/aca.aca_237_24","url":null,"abstract":"<p><strong>Abstract: </strong>Clinically relevant fat embolism syndrome (FES) is a potentially fatal intraoperative event, particularly in trauma patients. Rapid diagnosis is challenging in the perioperative setting, but treatment requires swift intervention and multidisciplinary coordination. This case report presents a polytrauma patient undergoing pelvic ring fixation who developed refractory hypoxia secondary to suspected FES. Successful initiation of anticoagulant-free venovenous extracorporeal membrane oxygenation (ECMO) intraoperatively, without definitive diagnosis, resulted in patient survival. Given the paucity of large-scale studies detailing the efficacious use of ECMO for FES in the perioperative setting, this report serves to expand the growing understanding of treatment for this potentially catastrophic event.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"187-189"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962049","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":"Clinical Benefits of Parasternal Block with Multihole Catheters when Inserted before Sternotomy.","authors":"Vedat Eljezi, Crispin Jallas, Bruno Pereira, Melanie Chasteloux, Christian Dualé, Lionel Camilleri","doi":"10.4103/aca.aca_110_24","DOIUrl":"10.4103/aca.aca_110_24","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to assess whether parasternal block with multihole catheters inserted before surgical incision enables to alleviate postoperative analgesia and opioid reduction in cardiac surgery patients with sternotomy.</p><p><strong>Methods: </strong>Twenty-six adult patients scheduled for cardiac surgery with sternotomy aged between 18 and 84 olds were included in this prospective, monocentric, open, single-group trial. Two parasternal multihole catheters were inserted on each side of the sternum before the surgical skin incision for cardiac surgery and 10 mL of ropivacaine 7.5 mg mL -1 was initially administered in each catheter. Local anesthetic administration followed by continued infusion at 3 mL hr -1 of ropivacaine 2 mg mL -1 per catheter for 48 h postoperatively upon patient arrival in the intensive care unit. The efficacy of the parasternal block was assessed according to a composite endpoint including pain score at rest, pain score during movements (dynamic pain), and morphine consumption over 48 hours.</p><p><strong>Results: </strong>The treatment failed in 11 patients and was considered effective in 15 patients. Sixteen patients out of 26 had a sternal pain score ≤≤3/10 on more than 75% of observations, and the treatment was considered successful. In 23/26 patients (88%), the mean pain score at cough was ≤≤3.5/10 and the treatment was considered successful. Morphine consumption over 48 h was significantly lower in the intervention group compared to the control group 7 mg [6; 21] versus 142 mg [116; 176] ( P < 0.001).</p><p><strong>Conclusions: </strong>Parasternal block with multihole catheters inserted before the surgical incision is an effective technique for postoperative analgesia and opioid reduction.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"39-45"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942914","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":"Accuracy of Intraoperative Transesophageal Echocardiographic Doppler Parameters in Assessing the Right Ventricular Diastolic Function After Repair of Tetralogy of Fallot in Pediatric Patients.","authors":"Nagarjuna Panidapu, Saravana Babu, Baiju S Dharan, Barsha Sen, Thomas Koshy","doi":"10.4103/aca.aca_85_24","DOIUrl":"10.4103/aca.aca_85_24","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the accuracy of tricuspid spectral Doppler (E/A) and tissue Doppler parameters (E/E') to diagnose right ventricular diastolic dysfunction (RVDD) in comparison to American Society of Echocardiography (ASE criteria) in pediatric tetralogy of Fallot (TOF) patients after surgical repair.</p><p><strong>Methods: </strong>This prospective, observational study was done at a tertiary care hospital involving 40 pediatric TOF patients aged less than 2 years who underwent complete intracardiac repair with cardiopulmonary bypass (CPB). Echocardiographic observations were made using a pediatric transesophageal echocardiography probe after surgical repair in the post-CPB period. The ASE-described parameters (late diastolic forward flow in the main pulmonary artery, right atrial dilatation, inferior vena cava dilatation, and hepatic venous flow reversal) were acquired to diagnose the RVDD. The tricuspid Doppler parameters (E/A and E/E') were measured, and its predictive ability to diagnose RVDD was analyzed and compared with the ASE criteria.</p><p><strong>Results: </strong>Based on the ASE criteria, 13 patients (32.5%) were diagnosed to have RVDD. We found that an E/E' ratio of ≥ 6.26 and an E/A ratio of >1.34 can be taken as the cutoff for diagnosing the RVDD. Based on the tricuspid Doppler parameters (E/A > 1.34 and E/E' >6.26), 17 patients (42.5%) were diagnosed to have RVDD, which was comparable to that of the diagnosis by ASE criteria (P > 0.05).</p><p><strong>Conclusion: </strong>The results suggested that the use of tricuspid Doppler parameters can be equally accurate and reproducible to the current ASE-described echocardiographic parameters for diagnosing RVDD after surgical repair of TOF.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 1","pages":"53-60"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031876","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":"A Case of Life-Threatening Contralateral Tension Pneumothorax during Video-Assisted Thoracic Surgery in a Patient with Retrosternal Goiter.","authors":"Nimitha Prasad, Sucheta S Gaiwal","doi":"10.4103/aca.aca_51_24","DOIUrl":"10.4103/aca.aca_51_24","url":null,"abstract":"<p><strong>Abstract: </strong>We report a case of a 74-year-old female with a retrosternal goiter undergoing video-assisted thoracic surgery (VATS) for a left lung lower lobectomy, necessitating one-lung ventilation (OLV). We encountered a highly unusual complication: contralateral tension pneumothorax. Forty-five minutes into the surgical procedure, a sudden cardiovascular collapse occurred. After confirming the correct positioning of the double-lumen tube and excluding mediastinal mass syndrome (MMS), tension pneumothorax was suspected. Immediate needle decompression followed by right chest tube thoracostomy resulted in a successful patient outcome. This case highlights the importance of maintaining a high index of suspicion for contralateral tension pneumothorax in patients with sudden cardiovascular collapse during OLV.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 1","pages":"72-75"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031863","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":"A Comprehensive Clinical Acumen Enhanced by Point-of-Care Ultrasonography in Managing Acute Life-Threatening Massive Pulmonary Thromboembolism in a Peripheral Setting: A Case Report.","authors":"Prabhav Chhaperwal, Sudhir Kumar, Gurbinder Suri, Uma Garg, Suraj Kapoor, Bhargava Devarakonda","doi":"10.4103/aca.aca_77_24","DOIUrl":"10.4103/aca.aca_77_24","url":null,"abstract":"<p><strong>Abstract: </strong>Acute massive pulmonary thromboembolism (PTE) is a potentially life-threatening condition requiring urgent management to decrease mortality. However, in the peripheral setting, managing the emergency can be challenging. We report a case of massive PTE presenting with cardiopulmonary arrest, successfully managed with advanced cardiac life support, early initiation of anticoagulants (heparin), and thrombolytics. This case report explores the successful management of a critically ill patient presenting with massive pulmonary embolism in a peripheral healthcare facility, emphasizing the importance of a well-coordinated approach in such challenging environments. The approach in the case included recognizing the challenge with timely provisional diagnosis, initial stabilization, hemodynamic support, early consideration for anticoagulants, and thrombolysis after supporting provisional diagnosis with point-of-care ultrasonography (POCUS), team effort, and administrative support in Cas Evac to the tertiary care center. Timely administration of heparin and thrombolytics may serve as potential life-saving measures in peripheral settings, along with the availability of an ultrasound machine. Managing acute life-threatening massive PTE in peripheral settings requires a strategic and resourceful approach. Timely administration of heparin and thrombolytics may serve as potential life-saving measures. However, the administration of thrombolytics in PTE needs the support of POCUS to make quick decisions in peripheral settings. Collaboration between peripheral and advanced tertiary care healthcare facilities is crucial to ensure optimal outcomes for patients experiencing this critical condition.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 1","pages":"61-64"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031873","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":"Fast-Track Extubation in a Patient Undergoing Whole Lung Lavage: A Case Report.","authors":"Gade Sandeep, Subrata K Singha, Anil Gupta, Keerthi Chinnadurai, Harishchandra Gupta","doi":"10.4103/aca.aca_163_24","DOIUrl":"10.4103/aca.aca_163_24","url":null,"abstract":"<p><strong>Abstract: </strong>Pulmonary alveolar proteinosis (PAP) is a rare pulmonary pathology characterized by the accumulation of surfactant within type II alveolar epithelial cells. Whole lung lavage is the standard treatment for pulmonary alveolar proteinosis involving a large volume of fluid is infused into one lung and subsequently retrieved while the other lung is remains ventilated. Fast-tracking a patient undergoing whole lung lavage requires vigilant monitoring of arterial blood gases, fluid status, and respiratory mechanics. We report a case of a patient who underwent whole lung lavage for PAP, where early extubation was performed, avoiding the complications associated with prolonged mechanical ventilation.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 1","pages":"80-83"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031891","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":"Pregnancy with a Left Ventricular Assist Device: A Narrative Review.","authors":"Matthew S Abraham, Lijo M Andrews, Harsha Deo, John Paul, Santhalakshmi Angappan, Abraham Samuel, Abey S Abraham","doi":"10.4103/aca.aca_136_24","DOIUrl":"10.4103/aca.aca_136_24","url":null,"abstract":"<p><strong>Abstract: </strong>This narrative review discusses the various challenges associated with the presence of a left ventricular assist device (LVAD) during pregnancy. Given the hemodynamic and coagulation changes associated with pregnancy, the presence of an LVAD adds a layer of complexity with respect to optimal management. This review will discuss the anesthetic considerations when dealing with this subset of patients who may have other comorbidities alongside their advanced heart failure. Additionally, this paper aims to review successful pregnancies with an LVAD placement focusing on the mode of delivery and hemodynamic management risk.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 1","pages":"10-16"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031590","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}