RESUMEN

Prolonged ventilation remains the most common cause of tracheal stenosis. Tracheal reconstruction is the gold standard treatment in these cases. The success of surgery is based on results of the pulmonary function test (PFT) which relies on patients' performance and their cooperation. The objective of the study was to investigate the impact of tracheal reconstruction in cases of tracheal stenosis on blood gas indices as well as airflow indices and whether arterial blood gas (ABG) can be a better surrogate of adequacy of tracheal reconstruction. This was a retrospective observational study of 61 patients with tracheal stenosis between the ages of 21 and 65 years who underwent tracheal reconstruction. The preoperative and postoperative values of various blood gas indices like partial pressure of oxygen (pO2), partial pressure of carbon dioxide (pCO2), and potential of hydrogen (pH) and airflow indices like forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) were evaluated and found that all the parameters showed significant improvement after tracheal reconstruction with P < 0.0001. Tracheal reconstruction resulted in improvement of oxygenation and airflow parameters which led to relief of symptoms. Hence, ABG can be used as a surrogate marker for denoting the success of the surgery.

RESUMEN

Background: Maintaining a low left atrial pressure (LAP) in off-pump coronary artery bypass grafting (OPCAB) is desirable. This study was done to compare the effects of intravenous levosimendan or milrinone on LAP at different stages of OPCAB. Materials and Methods: After institutional ethics committee clearance, this two-arm double-blind randomized control trial was done in 44 adult patients with triple vessel coronary artery disease undergoing OPCAB at cardiac OT of IPGME&R, Kolkata. The patients were randomly allocated into two groups receiving intraoperative either levosimendan or milrinone. Pulmonary capillary wedge pressure (PCWP) was compared as the primary outcome parameter, whereas other echocardiographic and hemodynamic parameters were also assessed during six stages of OPCAB, that is, after sternotomy, proximal(s), left anterior descending artery (LAD), obtuse marginal (OM), posterior descending artery (PDA) grafting, and before sternal closure. Numerical parameters were compared using Student's unpaired two-tailed t-test. Results: PCWP was found to be significantly lower (P < 0.05) in the levosimendan group during proximal (P = 0.047), LAD (P = 0.018), OM (P < 0.0001), PDA grafting (P = 0.028), and before sternal closure (P = 0.015). Other parameters indicate LAP, that is, from mitral early diastolic inflow velocity to mitral annular early diastolic velocity ratio (E/e'), which indicated significantly lower LAP in levosimendan group during LAD, OM, and PDA grafting and before sternal closure. Conclusion: Levosimendan may be used as a primary inotrope in terms of better reduction in left atrial pressure during different stages of OPCAB, translating to a decrease in left ventricular end-diastolic pressure, therefore maintaining optimum coronary perfusion pressure, which is the primary goal of the surgery.

Asunto(s)

Puente de Arteria Coronaria Off-Pump , Milrinona , Adulto , Humanos , Simendán , Milrinona/farmacología , Milrinona/uso terapéutico , Presión Atrial , Estudios Prospectivos

RESUMEN

PURPOSE: Mitral valve disease is often complicated with atrial fibrillation (AF). Conventional treatment for AF has now been replaced by various energy sources. Our purpose was to evaluate a cost-effective and efficient energy source for performing the Maze procedure. We evaluated and compared diathermy and high-frequency ultrasound as energy source to create maze lines, in terms of outcome. METHODS: Forty patients with mitral valve disease requiring mitral valve replacement and in atrial fibrillation were included in the study. Twenty patients underwent the Maze procedure using diathermy and 20 using high-frequency ultrasound (Harmonic scalpel probe). All Maze lines were made endocardially from within the cavum of the left atrium isolating the pulmonary veins. All patients were assessed by standard 12 lead electrocardiogram (ECG) in the postoperative period as well as in each follow up visit. Left atrial appendage was ligated in those having left atrium (LA) clot. RESULTS: Sinus rhythm was restored in 95% of patients in the immediate postop period in diathermy group as compared to 90% in the high-frequency ultrasound group. At 3 months, 90% were in sinus rhythm in the diathermy group and 85% in the high frequency ultrasound (HFU) group. Statistically significant differences between groups were observed in the following variables: cardiopulmonary bypass (CPB) time (p = 0.011), cross clamp time (p = 0.019), maze time (p = 0.00), and in hospital stay (p = 0.05). CONCLUSION: Both energy sources were safe, time sparing, effective, and simple; however, the diathermy took less time to perform maze than the HUF and the total CPB time and cross clamp time was less in the diathermy group.

RESUMEN

CONTEXT: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). AIMS: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. DESIGN: Prospective, observational study. SETTINGS: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. MATERIALS AND METHODS: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. STATISTICAL ANALYSIS USED: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. RESULTS: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. CONCLUSIONS: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.

Asunto(s)

Biomarcadores/sangre , Glucemia/análisis , Puente de Arteria Coronaria Off-Pump/métodos , Complicaciones Posoperatorias/sangre , Anciano , Anestesia , Femenino , Humanos , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Perfusión , Complicaciones Posoperatorias/diagnóstico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Flujo Sanguíneo Regional , Resultado del Tratamiento

RESUMEN

Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Several adjuvants have been tried along with local anesthetic for prolonging the duration of analgesia. In this study, we have observed the effect of midazolam as an adjuvant in patients undergoing infraumbilical surgery. In this prospective, randomized, double blinded, and parallel group and open label study of 90 adult patients aged 18-60 years, of American Society of Anaesthesiologists (ASA) status I and II, scheduled for elective infraumbilical surgery, were randomly allocated in two groups. Each patient in group "B" received hyperbaric bupivacaine 12.5 mg along with 0.4 mL of normal saline in the subarachnoid block, and patients of group "BM" received 12.5 mg hyperbaric bupivacaine along with preservative free midazolam 0.4 mL (2 mg). We found that use of midazolam as adjuvant with the local anesthetic in spinal anaesthesia significantly increases the duration of analgesia (median 320 min versus 220 min) and motor block (median 255 min versus 195 min) but decreases the incidence of postoperative nausea-vomiting (PONV).

RESUMEN

The perioperative management of patients with mediastinal mass is challenging. Complete airway obstruction and cardiovascular collapse may occur during the induction of general anaesthesia, tracheal intubation, and positive pressure ventilation. The intubation of trachea may be difficult or even impossible due to the compressed, tortuous trachea. Positive pressure ventilation may increase pre-existing superior vena cava (SVC) obstruction, reducing venous return from the SVC causing cardiovascular collapse and acute cerebral oedema. We are describing here the successful management of a patient with a large anterior mediastinal mass by anaesthetizing the patient through a femoro-femoral cardiopulmonary bypass (fem-fem CPB).