Ajeet D. Sharma

“Other” Neurologic Complications After Cardiac Surgery

Compared to the neurologic morbidity of stroke and cognitive dysfunction, “other” neurologic complications involving injuries to the brachial plexus, phrenic nerve, cranial nerves, other peripheral nerves, as well as the visual pathways, have been disproportionately underrepresented in the cardiac surgery and anesthesiology literature. These injuries are often missed in the early postoperative period when attention is focused principally on recovery from the acute trespass of cardiac surgery and cardiopulmonary bypass. However, when these problems do become apparent, they can cause considerable discomfort and morbidity. An overview of the current concepts of injury mechanisms/etiology, diagnosis, prognosis, and when possible, prevention of these injuries is presented.

Anaesthetic considerations for a child with combined Prader-Willi syndrome and mitochondrial myopathy.

We report the anaesthetic management of a child with Prader–Willi syndrome and mitochondrial myopathy for open heart surgery. We used ketamine, fentanyl, rocuronium and caudal morphine together with a propofol infusion with no untoward effects. The implications of both conditions for anaesthesia are discussed.

Leukocyte-reduced blood transfusions: perioperative indications, adverse effects, and cost analysis.

I n recent years, interest in leukocyte-reduced blood products has increased as accumulating evidence suggests that cancer recurrence, graft-versus-host disease (GVHD), and postoperative infections are mediated by leukocyte contamination of blood components (Table 1). Herzig et al. (1) in the mid-1970s stimulated interest in leukocyte depletion by showing that leukocyte reduction of platelet components improved posttransfusion platelet counts in patients with human-leukocyte-associated (HLA) antigen incompatibilities. Further studies by Eernisse and Brand (2) demonstrated that leukocyte contamination of platelet concentrates was responsible for HLA antibody formation. These findings led to growing use of leukocyte-reduced platelet transfusions. However, debate continues as to how low the leukocyte count must be to prevent leukocyte-mediated alloimmunization. In the last decade, great strides have been made in developing more efficient leukocyte filters, and the administration of leukocyte-reduced blood products has become routine. This review focuses on evidence that leukocyte-reduced blood products may decrease adverse effects associated with blood transfusion.

Association of leukocyte-depleted blood transfusions with infectious complications after cardiac surgery.

BACKGROUND To test the hypothesis that leukocyte-mediated immunosuppression may contribute to postoperative infections after blood transfusions, we compared the incidence of postoperative infections in patients undergoing elective coronary artery bypass graft (CABG) surgery who received either leukocyte-depleted (LD-RBCC) or non-LD transfusions of red blood cell concentrates (RBCC) within 48 h of surgery. MATERIALS AND METHODS Data for all primary elective CABG patients between 1995 and 1998 who received allogeneic RBCC transfusions in the first 48 h after surgery were collected. Patients were divided into two groups (group LD: LD-RBCC transfusions only; group non-LD: non-LD-RBCC transfusions only were excluded). Patients who received a combination of LD and non-LD-RBCC transfusions, or any blood products other than RBCC were excluded. Infectious complications recorded included pneumonia, acute respiratory distress syndrome, mediastinitis, leg wound/sternal wound infection, nosocomial infection, catheter-related infection, urinary tract infection, decubitus ulcers, and bacteremia/fungemia. RESULTS One hundred forty-two patients received only LD-RBCC transfusions, and 1,765 patients received only non-LD-RBCC transfusions. Power analysis demonstrated that the sample size attained 80% power to detect an odds ratio of 2.1 at a significance level of p < 0.05. Infection rates were not significantly different between the non-LD and LD groups (7.57% vs. 9.52%, p = 0.40). Leukocyte depletion status of RBCC transfusions was not a predictor of infectious complications (p = 0.73). However, total units of RBCC received was highly associated with increased infection (p = 0.0001). CONCLUSIONS No association between postoperative infections and the use of leukocyte-depleted blood was identified. However, an increased incidence of postoperative infections was observed to be associated with blood transfusions in general.

Surgical resection of an intracardiac rhabdomyoma

There are only a few previous reports of intracardiac rhabdomyomas causing ventricular arrhythmias and near syncope. In this report we describe the successful surgical resection of an intracardiac rhabdomyoma using cardiopulmonary bypass, blood cardioplegia, and hypothermia. Preoperative evaluation consisting of echocardiography, computed tomography (CT), magnet resonance imaging (MRI), and positron emission tomography (PET) strongly suggested the presence of a symptomatic primary cardiac tumor projecting from the interventricular septum into the right ventricle.